Competition for doctors is healthy

The conclusion instead for many would be that the island gets a fine service, but it pays dearly for the privilege.

It is hard to see the regulator, for example, agreeing with the doctors that its report fails to identify any competition concerns.

Nor would Cicra agree that the absence of external targets and objectives is acceptable.

And they certainly do not see the practices as 'completely transparent' in their disclosure of financial information.

Instead, the picture that emerges from Cicra's preliminary investigation of primary healthcare is of an uncomfortable stand-off where insufficient data has prevented the regulator from making a meaningful analysis of the value for money from the out of hours and A&E service.

What they have been able to identify is a system in need of radical reform where a potentially illegal cap on the number of GPs – imposed by the Board of Health 25 years ago – has enabled a small number of doctors to earn significantly more than their UK counterparts, even allowing for NHS pensions and buy-in costs to the lucrative partnerships.

At a time when islanders are struggling to carry the burden of States taxes and charges, Cicra's concerns that competition is only just starting to make an impact on the GP practices has to ring alarm bells in HSSD offices where the rising cost of healthcare for an ageing population is already putting the States budget under great pressure.

The public reaction to the proposed loss of the £12 grant for doctors' appointments, for example, should focus minds on whether the opening of one or two more large practices would drive down GP fees.

But that can happen only if HSSD is genuinely determined to open up the market. As Cicra warns, it is not enough to remove the GP cap, room must be made at the table for out of hours and accident and emergency cover so that the new practices can compete.

GPs say they would welcome new doctors helping out. HSSD must test that resolve.