Care costs must be seen in the round

But while professionals should be free to charge what they believe is appropriate – senior partner GP incomes of £300,000 are a third of their equivalents in Court Row – there might be an argument for suggesting that health is different if doctors' pay here is significantly out of step with, say, the UK.

The competition regulator Cicra has already stopped the cartel-like system of all surgeries charging the same but the key to this is whether there is truly a free market helping to drive down prices.

Guernsey's care system is rooted in an uneasy mix of state-funded, private and insurance-based provision but with one important rider – the number of GPs here is capped by the Health and Social Services Department.

It explains why, if being a doctor here is so lucrative, others aren't banging on the door to provide the same quality service but cheaper.

They are, but HSSD will not let them in.

It does so to prevent extra cost to itself where GPs use hospital and other services free of charge. But the downside is that patients, in effect, bear the cost and even Jersey is £15 a visit cheaper.

It is a nonsense but HSSD appears to have lost its way and may even extend the contract with the medical specialists – the one found by an independent review not to provide value for money – beyond its renewal date in 2017.

The point here is not what individuals earn but whether that can be justified. More importantly, if everything that islanders currently pay in healthcare via taxes, insurance premiums and fees to practitioners was viewed in the round, would that fund a decent system?

Strip out excess profit-taking, add bulk buying and the multi-million pound procurement advantage of a more centralised approach and suddenly HSSD's cash problems are less pressing.

However, the department is embarking on health rationing to balance its books rather than going after the bigger picture.

And that is to the detriment of islanders.