The debate over the provision of medicines under the National Health Service took another turn this week, as doctors at the British Medical Association’s annual conference were told that drug rationing as a “necessary evil.”

Addressing delegates at the conference, Dr Alex Smallwood said that it is not possible to continue providing all the latest therapies to all patients without consequence. “Rationing is reduction in choice. Rationing has become a necessary evil,” he said, but he also stressed that, while inevitable, it must be “evidence-based, explicit and publicised,” according to media reports.

Speaking at the conference, Dr Smallwood reportedly proposed the creation of a document detailing a list of conditions – drawn up after debate and public consultation - that patients can expect to get treatment for under the NHS, which would ease the pressure on already struggling resources as well as allow people enough time to plan for private care should they need it.

Rationing already exists to some extent through the work of the cost-effectiveness bodies the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, whose decisions about what to offer on the respective NHS systems don’t always match and are, therefore, often the cause of frustration and anger.

But what Dr Smallwood is proposing is a giant leap further and, although it would undoubtedly ease some of the pressure currently on the Service, will likely not sit well with the champions of the NHS ideal – free healthcare for all.

SAS contract deadline

Meanwhile, the BMA says it has set the government a deadline – July 27 - to sign off the proposed contract detailing a new pay and career structure for the approximate 12,500 staff and associate specialist (SAS) doctors working in the NHS.

The Association says it has now been waiting seven months to get government clearance for the new contract, which needs to be obtained before SAS doctors – who work at a senior level in a range of specialities in both hospitals and in the community - can vote on the proposals it contains.

Mr Mohib Khan, Chairman of the Staff Grade and Associate Specialist Committee, said there is “anger and outrage” over the delay, and added: “Our service record is exceptional but we have never been properly acknowledged or adequately rewarded.”

And commenting on the situation, Dr Sam Everington, Acting Chairman of the BMA, said: “If Gordon Brown wants a modern NHS fit for purpose in the 21st century, and the improvements to patient care that entails, then he must provide the funding to finish the job. To single out one group of healthcare workers and delay their new contract is grossly unfair.”