GPs are at the centre of profound organisational change to the NHS. However, there are some things that will not change, namely the ethics and law of NHS rationing. The resources that any society has are limited and must be allocated between the different calls on them. This allocation could happen secretly, but an explicit method is ethically superior and legally necessary. We discuss the duties imposed by ethics and law.
MANAGING THE PROBLEM OF DEMAND AND SUPPLY
Demand for care is increasing as the supply of resources declines. Clinical commissioning groups (CCGs) must deal with all the pressures this brings. CCGs must introduce reasonable priority setting systems. They are not popular: they generate appeals, are poorly understood, and leave many patients unhappy. There is an urgent need for CCGs to understand the processes and procedures involved.
GPs must distinguish their ‘Hippocratic’ commitment to individual patients, from their duty to the community as a whole to manage finite resources competently. Conflicts are avoided principally by establishing a system which separates the commissioning decision-making process from the doctor–patient relationship.
FOUNDING ETHICAL PRINCIPLES
Patients should be treated equally, fairly, and consistently. On the one hand, the NHS is required to use its resources in the best way: treatments with the same outcome should be equally available to patients who need it (equality of outcome). On the other hand, the NHS should ensure that people are given an equal opportunity to be as healthy as they can.
Equality of outcome and equality of opportunity are important in the fair allocation of healthcare resources but often pull in different directions and people generally may differ about what is just in a particular case.1 However, there are a finite range of factors that should be taken into account when making decisions of this kind:
Cost. If the cost of an individual treatment is ignored …