Say no to the market

Editor—Godlee does not define market but exhorts us all to say no to it.¹

The market—a recognition that services, providers, consumers will all interact, and usually at a price—is as unavoidable as the weather. The NHS buys drugs largely from private companies, at considerable cost. NHS hospitals are built with public money by private building firms. Nurses, doctors, cleaners, and patient managers all look at alternative employment options outside the NHS. The BMA attempts to exert a trade union pressure to exact a price for doctors' labour. Medical schools train generations of doctors, who may or may not find work in the United Kingdom. Even the BMJ comes at a price.

Having recognised the pointlessness of saying no to the market, let us agree these principles of the NHS:

• Free at the point of use (in Wales, no prescription charge)

• Funded entirely from general taxation (with extra taxes on smokers and drinkers)

• Universal in its cover (everybody can have anything but may have a long wait).

Nowhere is there a law that says NHS contracts for cataracts cannot be given to private ophthalmologists. Bring on the tariff, I say—and let's get competitive in our service quality and delivery. Indeed, we general practitioners have had mixed fortunes over 50 or more years, varying this form of private provider and public payment contract, while dentists have largely given up on it. But did patients have their needs met as best the country could afford?