Clive Peedell , co-chair 1 , consultant clinical oncologist 2 , and cosignatories 1NHS Consultants’ Association, Oxfordshire, UK 2James Cook University Hospital, Middlesbrough, UK Correspondence to: C Peedell clive.peedell{at}stees.nhs.uk

Clive Peedell and more than 100 co-signatories ask why the BMA is not representing its membership and has acted as though the proposed health reforms are a done deal

Dear Hamish Meldrum, Laurence Buckman, and all members of the BMA General Practitioners Committee,

After the publication of the health white paper earlier this year, Hamish Meldrum wrote to the profession to explain that the BMA was going to “critically engage with the consultation process” to defend the founding principles of the National Health Service and the principles underpinning the BMA’s Look after our NHS campaign.1 2

The consultation period is now over, and it is clear from the Department of Health’s response to the consultation3 that the BMA’s policy of “critical engagement” has failed to persuade the government to alter its approach. The BMA responded with a damning press statement: “There is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS. Most of the major concerns that doctors and many others have raised about the white paper seem, for the most part, to have been disregarded.”

In fact, Andrew Lansley’s plans are now even more market based. Within the new operational framework for the NHS in England,4 “price competition” will be introduced, which fundamentally changes the NHS from a “quasi-market” system of fixed prices (tariffs) to a more open market system. Hospitals will be allowed to charge rates lower than the national tariff, which sets prices for thousands of NHS procedures and covers roughly half of hospital income. According to Zack Cooper from the London School of Economics, “Every shred of evidence suggests that price competition in healthcare makes things worse, not better.”5

The NHS Confederation shares this view6: “Economic theory …