Tom Coffey On compulsory insurance schemes

Published: 01/07/2004, Volume II3, No. 5912 Page 17

A few months ago an advertisement appeared in The Times signed by 500 doctors from a previously unheard of organisation called Doctors for Reform. It called for a compulsory insurance scheme to be introduced in the UK. The ad and this embryonic organisation appeared from nowhere and caused a flurry of press activity.

The article caused a deep collective sigh among most working doctors.Most could not believe that this was going to be the next major debate in the NHS. The cause seemed pointless for a number of reasons.

First, the NHS has undergone a sequence of organisational change which has frustrated doctors because of the time taken to introduce new systems. Over two years of valuable management and clinical time can be wasted in the pursuit of introducing organisational change, applying for your own job and shuffling various targets and objectives like deckchairs on the Titanic.

Second, the social insurance scheme in France and Germany has recently come under much criticism.

It is seen as a poor way of getting efficient use of scarce health resources and has got a dismal track record on cost control. The Wanless report on NHS funding found it inefficient and a burden on employers. The generic prescribing rate in France is 3 per cent, which compares very poorly to that in the UK of 60 per cent. Third, the large insurance houses which might oversee and benefit from a new insurance-based health service have got limited organisational credibility. Their handling of pensions and endowment policies has not raised their standing in the public eye.

The next general election is likely to be held within the next 12 months. Inevitably, the NHS will become a major focus and assertions of who will run the NHS most efficiently will be flying about.Most medics realise that it take many years for health policies to mature and they despise short-term tinkering and change for change's sake. Three of my primary care group colleagues resigned solely through exasperation with the move to primary care trusts and the disruption it caused to a clinical change programme they supported. The clinical engagement in primary care trusts is finely balanced and any move to wholesale changes in NHS funding systems is likely to undermine this even further.

We may not have seen the last of a campaign to introduce compulsory social insurance for healthcare. Fortunately, almost every doctor I have spoken to has very little time for this and just wants to get on and treat their patients.

PS: I would like to thank everybody who agreed to sign a petition calling for the ending of smoking in enclosed public places and at places of work.

Tom Coffey is a South London GP and Wandsworth PCT professional executive committee chair.