Abstract
The Judge Dredd film and comic book character combines the powers of police, judge, jury, and executioner within the same individual. The new NHS white paper thrusts a similarly poisoned chalice of conflicting interests upon GPs, with little detail as to how they can be resolved.1 Scenario 1: In the morning, Dr A sees an obese patient requesting referral to a structured weight-loss service. The patient has borderline eligibility for an oversubscribed and financially constrained local diet and exercise programme. The GP's duty of care clearly dictates that he should refer her to the service. In the afternoon, he sits on a practice-based commissioning (PBC) consortium committee making decisions on commissioning weight-loss programmes in the area. A local authority public health doctor explains that while all weight-loss services are under-resourced, the greatest gap in local provision is actually for bariatric surgery. There is no extra money …
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