Herr Doktor can't cure our NHS

Fancy a spot of ozone therapy, guv? I know a doc in Cologne who can help. Want a baby, darling, but afraid you are past your sell-by date? No worries, sweetheart, I can fix you up with a nice Italian prof. Hyperactive child? Now there's this French specialist who has a revolutionary...

I foresee a few problems with the over-hyped scheme to cut the NHS's waiting lists by sending patients abroad – and the prospect of sharp-suited salesmen offering packaged hospital tours to the continent is only the first of them. The Daily Mail reported that Germany was offering to take all one million patients on the NHS list, clearing it at a stroke for the grand sum of £5 billion.

My reaction to that is a) I don't believe it, b) wild horses wouldn't get more than the most ardent Germanophiles to budge from their sickbeds and c) if they did it would create as many problems as it would solve. The biggest problem with the scheme is that just about the last thing anyone wants to do when they are sick is travel. When, a decade ago, the Tories introduced the internal market to the NHS under which the money was supposed to follow the patient, they briefly promoted the idea that patients in need of an operation should shop around the NHS for the hospital with the shortest waiting list.

League tables of waiting lists appeared enabling patients to see at a glance where the shortest waits were. And did the patients take up their beds and jump on the train? No, they did not.

Surveys suggested that even a journey of 30 miles was too much for most. They preferred to put up with a longer delay for the sake of undergoing the op in their home town, close to family and friends and to the family doctor who referred them and who would provide the after care.

So I don't buy the theory that the health department's change of heart last week, prompted by a ruling of the European Court of Justice, will lead to an exodus of thousands of patients in search of a quick hip replacement in the medical bazaars of Paris, Brussels and Bonn. But if I am wrong, if Germany really did come up with the goods and deliver hundreds of thousands of heart, cancer and other operations to grateful Brits, what then?

Waiting lists are the NHS's chief rationing tool. Remove them and you remove one of the main brakes on health spending. GPs would start to refer more patients at a higher rate to replace those removed from the lists. The consequence could be skyrocketing spending and no cut in the lists.

There is some evidence that there is a "natural" length for waiting lists of around 13 weeks. Over the past three or four decades this has remained roughly the average time people have waited, despite the huge increase in the number of patients treated as medicine has advanced.

This suggests that family doctors unconsciously adjust their referral rates to maintain the list. If hospitals work faster GPs refer more patients. If the hospitals slow, GPs curb their referrals so as not to overwhelm them. This has a benefit for patients, too. When waiting times fall below 13 weeks, the danger of over-treatment, or unnecessary treatment, rises. In the UK the risks of over-treatment are low – except in private specialties such as cosmetic surgery – and much less than the risks of under treatment caused by the long waiting lists.

On the continent, however, over capacity increases the risk of over treatment. Do you really need that heart operation or would drug therapy be just as effective? Can you trust a surgeon whose clinic is empty to give you unbiased advice?