Methods of rationing in the news… Telephone triage, scrutiny of referrals, larger practices, reducing standards, reducing access, excluding treatments. So many different and covert methods of rationing. No political party offers the honest option. No wonder we are disengaged.

So many different and covert methods of rationing. Why not be honest and overt? You know it’s true but as yet no political party offers the honest option.

Melissa Jacobs in Pulse 29th August 2017 reports: CCGs are formulating plans to scrutinise practices’ referral systems after a leaked NHS England memo showed they have promised to incentivise peer review schemes in order to reduce referrals by 30%, Pulse has learnt and the BMJ reports: NHS (England) orders peer review of all referrals by GPs.

BMJ Correspondence shows that there is no “evidence” behind this decision and doctors resent it. Now that a large proportion of first primary care appointments are with nurses, untrained in differential diagnosis, we expect the referral rate to rise. It is rising anyway because of demographics, fear of litigation, referral guidelines and less ability to “live with uncertainty”.

this was followed by the Guardian, and in the Local Government Journal the next day:

that “Health England issues sexual health services warning”, and this is confirmed in Pulse 30th August by Alex Matthews-King: PHE report raises concerns over sexual health services provision

How can we cut the main expense of referral? This question is always being asked by the minister and his team. By bureaucratic rationing..

Secret NHS cost-cutting drive to reduce hospital referrals revealed

and the BMJ’s Margaret McCartney: “Are we reviewing GP referrals for the right reasons?” (BMJ 2017;358:j4240 is) the most erudite critique. It begs the Question “are we training GPs for?” Is the definition to be reviewed?

James Rodger reports 31st August in The Birmingham Mail reports that; Social care system ‘not fit for purpose’ – nine out of 10 MPs feel it is failing – A survey of 101 English MPs found that only 10% believe the current social care system is suitable for the UK’s ageing population. Rationing by ignoring?

In the Times 28th September Chris Smyth reports: Phone screening is no help to overstretched GPs 

in my experience there are some GPs who are willing to triage with more risk than others. This risk acceptance changes dramatically at the first time-consuming complaint. – whatever the outcome. Now that some practices are experimenting with higher risk and reduced confidentiality it will be interesting to see if their Defence and Insurance premiums rise. Chris Smyth reports in the Times 26th September: GP receptionists screen patients to cut surgeries’ workload – access is being rationed…

Patients prefer a good relationship with their doctor, but practices are getting larger and more and more doctors are part time. So continuity of care and the trust that went with it have disappeared. The CQC (Care Quality Commission) as reported by Laura Donelly in the Telegraph 21st September that “Small GP practices pose the worst risk to patients’ health” but it is small practices that are most appreciated and popular with patients when they are run well by committed doctors. The irony of this seems to be lost on Politicians… Now that GPs are not committed to 24 hr service, there is no reason that they could not work in smaller groups, even if administratively they are in large practices.

We have rationed training places, and reduced the value of nurse training so much, that we now import them. (We may be exporting our elderly eventually). The Times reports that 90% of recruits fail their language test, and the government response is to suggest the language test is too stiff. The is rationing by standard reduction and has been done in other areas …

Important treatment options are being excluded if you don’t have the means or the right insurance policy. Oliver Moody reports 25th September in the Times: Parkinson’s disease sufferers denied key US drugRationing by exclusion.

looking at some other areas that continue to be rationed:

Orthopaedics and pain from Arthritis: NHS ‘rationing leaves patients in pain’ – BBC News 7th July

Palliative Care: NHS rationing ‘leaving dying patients to suffer in pain’ report warns (Telegraph 14th March)

This entry was posted in A Personal View, General Practitioners, Nurses, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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