A coded way of cutting health care

What it dismisses as of little importance will be of significance to the patient receiving it. Otherwise it would not have been prescribed in the first place.

Or would it?

Almost in the same breath, the spokesman for the BMA, which defends GPs' rights and champions the profession, says islanders must decide how much they want to pay for their health care.

What he really means is that island doctors see nothing wrong with £300,000 salaries and that every attempt will be made to retain the private model that underpins them.

In turn, as gatekeepers for the island's health system, the more often they can see patients to prescribe 'low priority' treatments, the more frequently £55.50 charges can be levied.

If a GP refers an individual to one of the local specialists, that's another £55.50 and code for saying, 'I have no idea what's wrong with you but I know a man who does. Please leave the cash on the way out...'

The specialist, on the other hand, doesn't much care whether he sees patients or not because he gets paid anyway.

In fact, the fewer referrals, the greater the time to see private patients. They are far more lucrative because they can be charged on top of the multi-million pound contract with HSSD.

Health knows all this and more, of course. But it has decided to review the health system piecemeal. That, too, is code for saying we are too craven to implement the 20:20 Vision we released earlier because it means taking on the medical lobby and breaking the cartels and self-interest.

HSSD should start from scratch and plan a new system based on access and affordability, but that requires courage.

It is much easier to prevent islanders from having the treatments they have come to rely on.