From the patient’s perspective what Dr Helen McKeown (Joint Chief Executive at Wessex Primary Health Care Alliance) describes as a “restriction” is rationing. And of course it remains covert, random and post-coded. NHSreality wonders what the other doctors, not on the Health Alliance board, and willing to speak out, would call it? NHSreality suggests this is a clear example of George Orwell’s “doublethink” – by politicians to placate the masses. It won’t do for much longer… Dr McKeown will not be unaware of the contradiction, but she will be afraid to use the right word. Politicians are unaware…. and guilty of doublethink.
A cash strapped clinical commissioning group in southwest England has been forced to implement new policies to ration the availability of medical care, because of its “dire” financial situation.
Wiltshire CCG has implemented a cap on planned care activity at local hospitals and increased the number of procedures that it can no longer fund as a result of “the very serious financial position” it was in.
In a letter to local GPs obtained and published online by the doctor and comedian Phil Hammond the CCG said that it was also considering tightening the criteria for referring patients to hospital and asked GPs to help it review the use of branded generic drugs and the number of repeat prescriptions issued, as part of its urgent cost cutting drive.1
The letter, dated 16 October 2015 and co-signed by the CCG’s accountable officer, Deborah Fielding, and clinical chairman, Peter Jenkins, said that the nationwide NHS squeeze on funding, coupled with an “ever increasing” demand for acute and non-acute care services, was putting huge pressure on the local health economy.
The CCG warned that as a result of this pressure it was on course to miss its financial targets by £4.8m (€6.5m; $7.4m) this year and was headed for a £23m deficit in 2016-17 unless urgent action were taken to bring costs under control.
An investigation by The BMJ in July 2013 shortly after CCGs were established found that some organisations were already implementing new restrictions on referrals to hospital and tightening thresholds for access to “low priority” surgery such as hernia and joint problems in light of financial pressures.2
With NHS finances across England deteriorating considerably since then, Wiltshire is the latest area being forced to ration care to control spiralling costs. The CCG’s letter called on local GPs to help it reduce demand in a bid to protect the sustainability of existing services. “Our financial situation is dire,” it warned.
“We are writing to you [GPs] now to emphasise this, to let you know what help we need from you.”
In the letter the CCG sets out a package of measures it was considering to tackle the funding crisis, including the possibility of introducing “pre-referral clinics . . . to ascertain whether a patient really needs acute care intervention” and investigating the options for rebates from the pharmaceutical industry against drugs already being used.
It also proposes additional controls to ensure that hospital doctors engaged with GPs before deciding on a course of clinical intervention, reviewing the use of branded generic drugs “to maximise value against NHS spend,” and tighter monitoring of repeat prescriptions. On this last point it said that it would also communicate directly with the public “to raise awareness of only ordering prescriptions when necessary.”
The CCG said that it had two months to provide evidence to NHS England that it could improve its financial position this year and implement policies to ensure future financial sustainability. If it failed to provide this evidence, it warned that NHS England would place the CCG into “turnaround” and assume external control over its finances.
“The seriousness of this situation cannot be overstated,” wrote Fielding and Jenkins. “Very simply, NHS Wiltshire CCG cannot continue to fund the excess demand that is being experienced. Our system is over-trading and it will have to shrink in order to fit within the financial envelope we receive.”
Helena McKeown, a GP in Salisbury and vice chair of Wiltshire Local Medical Committee, said that local doctors were very concerned about the possible effects on patients. She said, “We have patients with conditions like osteoarthritic joints and gynaecological prolapses. The natural reaction is to refer before anyone starts another layer of scrutiny or stops us referring. These are very necessary treatments.
“It looks like rationing. This is very worrying, because patient care is essentially being restricted to make the books balance.”