Opinion  

When prices, availability and standards are all fixed centrally, they
give no indication of whether the system is working properly, so those
in charge have to set up intrusive and expensive investigations to find
out.

This is why centrally directed projects can't work sensitively without
targets and surveys - and even then everyone wonders whether these
surveys are statistically accurate, whether they have asked the right
questions or are truly representative.

All this is redundant in a free market. Not only does it react
automatically to surpluses and shortages but the market itself provides
subtle and detailed information about the quality, convenience and
cost-effectiveness of its goods and services - and all for zero outlay,
because it requires no surveys, no statistical interpretation and no
management or user input.

If only the NHS were run as a truly free market, think what we would
gain. Gone would be the government's need to assess healthcare via
simplistic targets like access times, length of consultation, opening
hours, and the possession of written protocols.

A truly free market in primary care would have no rules over where new
practices can site themselves, or how they should be configured; it
would remove all professional restrictions on advertising and promote
nationally the idea that patients can change doctors without moving
house.

Patients would vote with their feet, trading off speed of access against
the need to wait to see the excellent Dr X; the availability (or
irrelevance) of extended opening; or the extent, quality and convenience
of practice facilities and infrastructure. The patients themselves will
perform the equivalent of the government's assessment calculations - and
more subtly.

List sizes will soon indicate which practices are fulfilling patients'
true requirements. Practices will be able to spend more time caring for
the sick rather than having to prove themselves by ticking boxes.

And all at no expense. No wonder NHS managers don't want true
free-market primary care - they would be out of a job.

Dr Lancelot is a GP from Lancashire. Email him at
GPcolumnists@haymarket.com.