In their latest In The Loop podcast Niall and Roy lock horns with Dr Charlotte Refsum Director of Health Policy at the Tony Blair Institute. In a frank discussion Chalotte a former GP reveals how the former Prime Minister is still closely involved in policy development and she lays out the stark choices facing the NHS if it is to survive in the face of the enormous challenges it currently faces.

Charlotte is a former GP who has specialised in health policy. She worked for the consultancy firm KMPG and has been involved in supporting change in 25 countries. She contributed to the government’s NHS plan and has worked with Sir Patrick Vallance and Sir John Bell on technology and how the arrival of the AI era will transform health and care.

In the podcast Charlotte defends the Institute’s links with big tech companies and non- democratic governments and insists she and her colleagues have editorial independence and have never felt under any pressure to write anything or hold a view because of those relationships or funding.

What follows is a frank assessment of the current government’s strategy but hard questions about what will be needed to implement the changes needed and whether the absolute priority, which concentrates so much of its resources on older people with long term conditions, is justified.

Charlotte suggests the current budget may be all we can afford, and in her view the NHS needs to find ways of living within its means. That will involve thinking like an insurer, assessing future risks and taking prevention much more seriously. And there is also talk of copayments for some new treatments for those who can afford it and the need for the NHS to start decommissioning some services if it is to embrace the technological revolution that is underway. And she suggests we need a revolution in primary care.

As for the professions, she suggests the impact on doctors and others is uncertain but will be profound. One of the changes she identifies is how new technology will continue to undermine the asymmetry of information that underpins the professions and how it will become easier and cheaper for people to seek advice from elsewhere. But she adds, that does not mean a dystopian future where we send out someone with an NVQ and an iPad to get and manage complex cases!