Jeremy Laurance: A manifesto for NHS civil war

It may turn out to be the most politically explosive of all the changes to the NHS being driven through by Andrew Lansley.

Allowing hospitals – and other providers – to compete on price dramatically shifts the balance towards a commercial market in which the weakest players go to the wall. Patients referred for a cut-price procedure may question their GP's motives for doing so – is it the best service or the cheapest? It could set patients against GPs, GPs against hospitals and hospitals against hospitals. Communities who find their hospital threatened by price cutting will be enraged.

The risks, political and clinical, are huge. Research by Carol Propper, professor of economics at Imperial College, conducted during the era of GP fundholding in the 1990s showed convincingly that price competition led to lower quality and more deaths.

This change ramps up the dangers facing the NHS by an order of magnitude. The scale of Mr Lansley's gamble should concern every user of the health service.