Jeremy Laurance: Doctors must remember their responsibilities

Analysis

Most people are likely to support the idea of advising smokers and the obese to change their lifestyle before going under the knife. It reduces the risks of surgery, increases the chances of a successful outcome and cuts costs.

By and large patients know their smoking or excess weight is bad for them but have never had a big enough incentive to do something about it. Suddenly they do. Why not exploit it? The problem is over trust. What is the doctor's motive here – to improve care for the patient or save money for the NHS? Up to now there has been a distinction between the managers who hold the budget and the doctors who spend it. Now, under the NHS reforms, GPs are to become responsible for balancing the books. That is bound to raise a doubt among patients over where the doctor's priorities lie. Rationing is inevitable. But it must be conducted fairly, or it risks destroying the NHS's greatest asset: patients' trust .