Has The BMJ fallen for neoliberalism? A rapid response to the latest opinion piece by our regular columnist Nigel Hawkes suggests that “the discredited Neoliberal Economic theories that are found throughout the mainstream media in the UK have now made it into The BMJ, which up to now has been a haven from such reactionary and damaging ideas.”

Certainly Hawkes, in a discussion of the current funding crisis, calls for the NHS to do what many other countries do and levy charges, perhaps for visiting a general practitioner or for some hospital treatment. But in his rapid response, Bristol GP David Porteous takes issue with this, saying, “The notion that Britain can no longer afford healthcare free at the point of need and the NHS has to be partially funded by patients being taxed to use primary care is wrong. It is another attempt by the wealthy to make the poor contribute disproportionately to the state service that benefits all.”

Admittedly, if the government were to adopt the kind of measures in England and Wales that Hawkes suggests (Scotland having its own NHS without prescription charges and free social care), the NHS would cease to be free at the point of use, which many people see as its defining principle, although it might still be mainly state funded.

This is a debate that is echoed elsewhere recently in The BMJ. In a Head to Head debate published last week, former BMJ editor Richard Smith argues that private sector investment in new products and services is essential to maintain the NHS, while consultant clinical oncologist Clive Peedell (who is also co-leader of the National Health Action Party, which opposes privatisation and marketisation of the NHS) says that the use of private providers in healthcare will increase costs and reduce the quality of care. This isn’t quite the same as the kind of copayments Hawkes is in favour of. But it also gives a flavour of the kind of debates taking place beyond The BMJ, but which The BMJ feels it has a duty to reflect.

How to cover the idea of copayments is something that has long been a concern among The BMJ’s UK editorial team, most of whom, as far as I know (although I haven’t asked all my colleagues individually), are fully committed to an NHS free at the point of use. Several years ago, when a right of centre think tank called for the NHS to charge £10 for GP visits, I argued that we shouldn’t cover it because that would be to elevate what I saw as an “outlier,” a maverick call by an unrepresentative body, to something that should matter to the mainstream. But the debate has not gone away, and at a time when the media are regularly full of dire warnings about the shortfall of billions besetting the NHS, ideas such as copayments are gaining ground. Perhaps it is time to report what the more thoughtful of their proponents and supporters have to say, so that those of us who do not support copayments can develop and strengthen our counter-arguments.

That is where Nigel Hawkes’s column and David Porteous’s rapid response come in. If neoliberal ideas are making their way into the pages of The BMJ, it is because we are prepared to air the debate that is happening in the wider world. But remember, this is the same BMJ that argued strongly to “kill the [Health and Social Care] bill,” arguing that “it would be better for the NHS, the government, and the people of England to sweep the bill’s mangled remains into an unmarked grave and move on.”

Trevor Jackson is deputy editor and head of news and views, The BMJ.