In a room full of juniors doctors all at a course to learn surgical skills and suturing techniques yesterday there were murmurings of disquiet all through every break. Young people who were doing the same job in different parts of the country were all discussing the different options they had, and those they might consider, come the years to come when the Government’s various proposals for the NHS come into force.

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I did not always grow up having the NHS in the background to fall back on. I was born and brought up in Malaysia, and only migrated here for the latter part of my secondary education, medical school and eventually junior doctor training. Malaysia, whilst having a socialised healthcare system, has severely limited government funding in comparison, and waiting lists are significantly longer than what the British public are used to on the NHS.

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Within the remit of the Health and Social Care Act the provision of healthcare services by private providers is set to endure and grow. I am not interested in the ideological arguments that surround this. What I have been considering is the battleground and potential inequalities that seem counter intuitive to the benefit of introducing market forces. Looking at existing market strategies, the closest model I can find that represents the current commissioning structure is franchising.

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There are a myriad of examples of inconsistent thinking when it comes to the NHS and working patterns. I would like to focus on the pre-assessment service for anaesthesia, before you have your surgery as an example relevant to me.

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