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I worry that in the future, when doctors get together, they will stop talking about patients and difficult cases and start talking about the business of medicine. This will be a huge and unquantified loss to the NHS and patient care.

I think it's important to distinguish between health planning for a community as a whole and "rationing" care for an individual patients.

Doctors should absolutely be involved in health planning. Where are the unmet needs, and what services, facilities, or providers do we need to fill them? That's a good thing to ask physicians to think about from time to time. Ditto for quality.

But that doesn't mean we should turn doctors into billers and negotiators and purchasers of every paper clip and appendectomy, which of course they can't do and have to hire an insurance corporation to run for them.

I think that we all need to be mindful as to what the reforms will be doing for the dr-pt relationship, both in primary and specialist care. Patients have to trust that we are doing what we are doing in thier best interests.

Clare