Good afternoon. Apologies for a day or two of radio silence, but to paraphrase John Lennon, life has been happening to us while we were busy making other plans.

The latest instalment of The Maynard Doctrine has arrived for your edification (www.healthpolicyinsight.com/?q=node/123). This touches on the vital issue of incentives, which will be addressed in our latest 'Colloquia', which should be up by this evening.

Tom Smith writes from the BMA conference in Edinburgh.

At its Annual Representatives Meeting today, the BMA debated copayments in a fiery, passionate and characteristically chaotic thirty minute session.

Representatives debated a six-part motion. After a vote, they supported the principle that patients who buy their own treatments should not be denied NHS care; called for a Royal Commission to explore the implications; and came within a hair’s breadth of voting to ‘demand’ the introduction of copayments in the NHS.

8 July 2008 - Tom Smith on the today's health policy debate.

I’m on my way to the BMA’s Annual Representative meeting in Edinburgh, really interested to hear what doctors are saying (off camera) about the latest stage of the reform programme.

Do BMA representatives see opportunities for greater clinical control? Do they believe that quality will be prioritised? What do they think is going on now in the NHS, and how do they see their role in reform?

Tom Smith analyses reactions to the Darzi report.

Tom Smith on the impact of Lord Darzi’s Next Steps review.

What are the chances of the Darzi review changing the terms of debate on NHS reform? Despite the political gloom that has engulfed the government over recent weeks - and the Prime Minister in particular - this edition of Health Policy Today looks at the potential for the Next Steps review, due to be published on Monday afternoon, to help the government shift debate away from its political failings and onto its reform agenda.

Can Gordon Brown shift the terms of the debate onto reform?

Tom Smith on today’s health policy debate.

Today’s press (and reports from the weekend) carry three key themes: speculation about the implications of top-ups, questions about the long-term viability of collective finance, and the attitudeof GPs to NHS reform. My personal favourite, however, and not completely divorced from the third topic, wasy esterday’s Desert Island Discs when Lord Ara Darzi told Kirsty Young his top eight tunes.

by Alan Maynard, professor of health economics, University of York

Ninety-nine NHS organisations now have Foundation Trust (FT) status. Most of them are acute trusts, but an increasing number are in mental health and related services. The objective of the FT initiative was to achieve greater efficiency by giving greater autonomy to hospitals within a rigorous framework of financial regulation in particular.

Has this objective been achieved?

Tom Smith on where the top up debate could go next go next.

At the end of a recent HSJ piece, on the political history of the NHS, Julian Le Grand said the remarkable thing is that consensus has held, surviving even three Thatcher reviews. Reading some commentary over the last week would suggest we are seeing the beginning of its end, following the announcement that ‘top ups’ will be reviewed.

by Andy Cowper

Some concluding thoughts from Confed

1. Every big conference has an atmosphere: a reflection of the mood across the service. This year the atmosphere has been elusive. Conference chair David Walker, editor of Guardian Public characterised it as “calm”. Calm was a symptom, but the cause was waiting. We are all waiting for Darzi.

Tom Smith on today’s health policy debate.
During David Nicholson’s speech to the NHS Confederation, he talked about a recent visit to his GP surgery where he was asked to sign the BMA petition, ‘save our surgery’. He declined but asked the receptionist how she was kept informed about what was happening to the NHS. “Oh, Dr Soandso tells us about it, and he never lies”. The continuing row over the future of general practice is increasingly becoming a question of trust.