Category Archives: Perverse Incentives

A GP in Milford Haven exposes the Inverse Care Law as applied by successive Governments, perversely and neglectfully..

The irony of the lack of doctors, and insufficient access to Primary Care is that it is government who is responsible, and it is successive governments who have ignored the advice of the profession. The Inverse Care Law as defined by Julian Tudor Hart, used to apply to citizens in poorer and deprived areas who got less resources when they needed most. Now it is government who are responsible for the inverse care law as applied to health. As private practice becomes more evident, it will be most available in those areas where people can afford it, and the people living in deprived areas will have to put up with a second class service. Doctors, knowing they are rare commodities, can choose where to live, and will mostly choose where infrastructure and education and housing are best. Most of them come from suburban and inner city schools and these doctors when qualified would rather work part time in their home city than full time in a challenging area.

Daniel Weaver, a GP in Milford Haven, has sent this out on facebook, and has been interviewed for the Milford Mercury. Dr Weaver is an experienced and altruistic GP. His cry for help comes too late in many ways. NHSreality has been highlighting the demise of the “Goose that laid the Golden Eggs” of efficiency and avoidance of overtreatment for 6 years. NHS reality has also pointed out the problems with GP recruitment on many occasions, and asked for more graduate entrants to medicine. NHSreality has also reported on the rejection of 9 out of every 11 applicants when they were all recommended to apply because they were good enough. Rationing of places to medical schools, uninformed manpower planning, and an over dependence on females as doctors (because they are better at undergraduate entry) have all conspired to get us to arrive at this point. The short termism of the First past the post electoral system means there is no incentive to plan capacity over 20 years. Obviously we need to address recruitment, but the  shape of the job also has to change. Golden Hellos are not enough…  The heartfelt letter below is a cry for help on one level, and a daming indictment of government at another. NHSreality only disagrees in that there is no “N”HS any longer. Here is Dr Weavers Post: “If anyone is in the Milford Haven area feel free to share this post”:

I wouldn’t normally do this but I feel compelled to put a message out in response to the increasing levels of aggression and abuse towards staff over recent months. Hopefully this will work as something of a FAQ about recent issues relating to the surgery. This may be a long post, stick with it though and hopefully it will give some clarity.

Currently Robert Street is effectively short of 2 doctors (which is 40% of our manpower) & this is less then ideal. This is in part because of maternity leave, and in part because despite spending thousands of pounds on advertising we haven’t had any success in recruiting since a doctor left a couple of years ago. Why haven’t you had success? Multiple factors including a national shortage of GPs in UK and especially in Wales. Wales is seen as less appealing to work in compared with rest of UK and Canada, Australia as earnings tend to be lower and due to harsher social service cuts problems with social care, social problems end up reaching general practice, and longer out patient waiting lists mean that people are seeing GPs more frequently so there is a harder workload. We are further west than most people want to work, and our practice area is one of relative deprivation, so any GP applying knows they will be busier then those working in more affluent areas.

I came to back to work in Milford because I enjoyed working in the town during my time training in Barlow house surgery and I have a family connection to the town, but unless someone has a connection to the area it’s not easy to get people to relocate from other areas. Many international Doctors in the NHS have families overseas and want to settle in a location with good access to airports etc. or to live in larger cities with people of similar faith or culture. We have up to 3 weeks less annual leave then several other local practices which has been cited as a factor when I’ve chatted to doctors who’ve moved elsewhere, especially doctors with children. We have specifically resisted increasing amount of annual leave we allow ourselves because it would pressurise appointments further.

There are higher paid practices in the region. (practice income is complex depends on multiple factors, like if practice is a dispensing practice or has branch surgeries etc) I have medical friends with whom I have discussed about working in Pembrokeshire. Feedback from them often revolves around issues like the above but more locally uncertainty about local hospital services making doctors nervous about possible knock in increased general practice workload in the region.

The loss of maternity services in the county and loss of 24 hour paediatrics is deterring younger doctors who either have children or are planning to have children. Also the state of the secondary schools in Pembrokeshire at the moment puts some off. Locum rates being paid within our health board and elsewhere mean that potentially a GP could earn more money in a week of locum work then if they were in a stable salaried or partnership role for a month. Locum doctors don’t have to follow up patients or results and usually will cap themselves to a limited number of consultations eg 12 in morning or afternoon and 1 home visit. Existing locums have low incentive to get permanent jobs with a practice. There is ironically also a shortage of locum doctors. We are continuously looking for locums, and getting them when we have a chance. We cannot compete with health board for locums as their rates far exceed what a normal general practice can pay.

Another factor is we are not a training practice, I will come back to this later. Would it be financially beneficial and better for work life balance for doctors to leave and do locum work? Yes in short, but if another doctor left it would cause the practice to collapse entirely and we feel a duty to each other, staff and the local area. This is the danger about locum work being so lucrative in the current climate, it actually risks destabilising things further. Why aren’t we a training practice? We’ve been desperate to get training status since I joined the practice, it’s something I’ve always wanted to do, I’m passionate about training and this is something I’ve always been involved in in different forms from my time in medical school. Aside from wanting to train there is also evidence that the surgeries that cannot recruit and have to close are much more likely to be non training practice. Why is that? GP training practices have a registrar or registrars who effectively work as a doctors while completing their GP training, this increases number of doctors available to see patients in training practices. It also allows doctors to test working in a practice. Many trainees will end up in taking a job in a practice they trained at if they had a good experience. The good news is that we have had the first indication that can start the process of becoming a training practice which gives possibility of progress in the next year towards this goal.

Why is it so hard to get routine appointments? Unfortunately at the moment we are often down to 2 doctors a day, as we are frequently seeing 40-60 emergency appointments daily there is limited capacity for routine appointments. This is entirely manpower related. We are working harder then ever. We have effectively close to 3000 patients per full time equivalent GP currently. To put this into perspective a Nuffield Health study in 2011 showed national averages for Scotland was 1400 per GP, England was 1500 and Wales a little over 1600. We are short staffed at the busiest time of the year without locums. If there are 3 doctors in, the routine slots are put on in addition to emergency but these obviously go quickly especially if people are trying to see a particular doctor.

Why don’t you see more patients? During the average day which is usually 10+hours, often the only break is to go out and get food to eat at desk while going through results or letters or for toilet. Although I was not on call today I didn’t get a chance to have lunch so when I got home at 6:45 I ate for the first time since breakfast. This isn’t unusual. I am on call on average 3 or 4x per week either in the AM & PM during an on call there is a continuous stream of messages, script requests queries etc. In addition to usual duties emergency surgeries and home visits and things are often very frenetic and pressurised. Apart from seeing patients in the surgery GPs have do go through letters from hospital, amending medication and arranging tests and referrals. We will often have many letters daily, for example I went through a little over 70 letters this morning. GPs have to write letters for referral or to other agencies, appeals, DWP forms, forms relating to end of life, death certificates, cremation forms. GPs have to also go through Emails from NHS/health board/and check safety updates on medications which get posted through. Review results, bloods results get reviewed and often require further action, same with scans, we will often get results for around 30 patients each daily to go through more if someone is away and we are covering them.

Home visits: these are the least time efficient part of the day. Often if spread out a GP can spend over an hour driving between houses and nursing homes which takes time away from doing other jobs. Phone calls: I can have up to an hour of phone call requests or more in a day. Prescriptions and sick notes. In a typical week each GP is signing several hundred repeat medication prescriptions, along with sick notes. OK, I get that you are busy, what else have you tried? We have tried employing a physiotherapist to see patients presenting with muscular/joint problems to take pressure of the on call, allowing GPs to see other patients. Did it work? No most patients refused to see a physiotherapist and they insisted on seeing a GP.

GP Triage: this is a service which exists due to pressurised situations. A lot of issues can be managed over the phone and potentially saves an unnecessary appointment being used on the on call which can be used for someone else. The GP can access the notes and takes a history/arranges investigations or a face to face appointment if required. We pay for this out of practice budgets. It’s not ideal but it is better then nothing and there is no alternative option at this moment in time.

What about health board? in June we applied with Barlow House and Neyland surgeries for some existing Welsh assembly sustainability money to go towards employing a paramedic practitioner who could take some pressure off the home visits situation. Nothing has been forthcoming. We, on a temporary basis, have attempted to close our practice list although the health board have resisted this. This is given current intense pressure a logical step to try to preserve our resources and time for existing patients as we are aware of the access issues. They are not offering help. What else are you doing? We have been training a practice nurse to become a nurse practitioner, meaning she will be able to see some of the simpler emergency appointments.

Why can’t I get through on the phones? It’s not ideal but we have a finite number of reception staff. At peak times we have up 100 people trying to get through and without a call centre there are likely to be delays. Being on hold is common for doctors too and I often have to wait 20 minutes+ when contacting the hospital to refer a patient in for other reasons.

Image result for overwork cartoonThe NHS in general is struggling to deal with the amount of people who use the service, it’s far from ideal but there is no obvious solution, and no additional funding to help with this. Why do routines only come out on a Thursday? If everyone who wanted a routine appointment phoned up every day it is going to increase phone traffic and difficulties getting through, in other words it would make the problem worse. It’s the same reason why people are encouraged to put in repeat medication requests through via their pharmacy or by dropping a slip in. There is the option of signing up to request repeats online which is super useful, but not many people do this. Thursday is traditionally the quietest day of the week so that time in the PM is least worst time of the week. Why don’t you just abandon all routine appointments and just do book on the day system? This gets discussed periodically but when it has been trialled before people complain about it. Why do reception staff ask me about my symptoms if I want an emergency appointment? They are not being nosy, sometimes people phone to get an appointment with a GP when actually it would be unwise & they should call 999 or go to A&E, for example if having a stroke or suspected fracture. Sometimes the issue is something that can be better dealt with by a pharmacist, a dentist or is completely non medical. Additionally if I am doing an on call, I need to be aware who the likely most ill people are, eg if someone is doubled over in agony with a possible appendicitis or acutely suicidal, I will need to see them before I see someone with mild earache or trapped wind. Will shouting at staff or being abusive help? No, please try and be patient and don’t take frustration out on staff. Everyone is working hard and it’s not an easy time for anyone. Taking it out on staff increases the likelihood of people walking away which makes the problem worse. I still want to complain! Feel free although hopefully this will help put your concerns into perspective. We are very stretched and this entirely relates to staffing issues beyond our control along with a difficult local healthcare environment. I am a doctor, I am not a politician and I have no influence on the larger, complex problems facing our county or country. There are multiple practices in difficulty in the county and elsewhere in Wales, and increasing numbers of doctors handing practices back to health boards due to being unsustainable and impossibly challenging working environments. In summary we are working hard and have been trying things. Why aren’t Barlow House having the same issues? It is harder to get an appointment with us then Barlow House Surgery but this is resource linked. They are fully staffed with permanent GPs and usually have between 2-3 GP trainees giving them roughly double our capacity, despite this they are still busy and working hard as well, as demand continues to rise in part because of problems in social care and secondary care being moved onto general practice. We get continuous complaints about difficulty getting appointments and problems with the phones but hopefully this gives extra insight into reality on the ground. Positive aspects for future are: more trainees coming from local scheme in next few years increases chances of us recruiting in a year or two. Dr Skitt won’t be on maternity leave for ever. We may be able to have trainees in the next 12 months which will help. We and another practice in Pembrokeshire will hopefully soon have a CPN attached to the surgery who may be able to help out with mental health related issues. This is a Welsh assembly funded pilot and hopefully will be positive. Age wise there are no doctors coming up to retirement soon unlike some other practices around the region. My colleagues are grafters and work as hard as any clinicians I’ve ever worked with in my entire career. If we do recruit and become a training practice Milford Haven is will be in an advantageous position compared with most of the rest of Wales with full compliment of relatively young doctors. I appreciate in the short term this isn’t much consolidation but at moment priority is survival. I apologise in advance but I’m not planning to respond to comments on this post as I made a decision some months ago to try and avoid social media and to try to prioritise spending any free time I have with family and friends rather then online. This was a decision ironically I took because of how late I tend to get home from work and the impact my job has on the people around me. Feel free to share this though.

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Deprivation differences…. especially across the UK – revisited

Early deaths: Regional variations ‘shocking’ – Hunt

Poverty in Wales

How to kill the goose and create a shortage of 10,000 GPs – Patients kept waiting as new doctors shun GP jobs

Hands up – who want’s to be a GP today?

Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

The Horse has bolted but “play it again Sam”…

“GPs to receive ‘golden hellos’ in hiring drive”….


The long term trsaining implications of farming out arthroplasties (Joint replacements) may not have been considered…

There are issues arising from the under capacity for the 4 health services. In the long term this includes training standards: will all the juniors get the same levels of exposure and experience as when these operations were conducted in state hospital units? In the short term NHSreality expects a lower level of infections (Staph and Strep), and cross infections (Campylobacter, Norovirus, MRSA). This may affect through-put. as the least risky patients will be operated on in the private system, whereas those with multiple pathologies will be retained. In the long run, if we believe in only state provision, we need cold orthopaedic hospitals matching the private ones.  And it does not apply to all 4 jurisdictions….. Is there another perverse outcome: that training will suffer so that only those already doing these operations will get enough practice, thus self perpetuating private demand? We don’t know yet, but rest assured the managers making the decision will have moved on, and few Trusts have an “Educational Lead” who could report on the longer term implications.

This article is about England. It’s high time the Times and others stopped referring to the NHS when there is nothing “National” about the service we get (especially in Wales).

There will be no private option for the miners of Tredegar, but there will be for the bankers of London. Exactly what Aneurin Bevan wanted to AVOID IN 1948..

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Rosemary Bennet reports 21st Jan 2019: Offer long-suffering patients private care, hospitals ordered

Patients who have waited six months for hospital treatment must be contacted by GPs and offered faster treatment elsewhere under NHS plans.

More than 4.15 million patients are on a waiting list, including more than half a million who have waited more than 18 weeks for treatment. Some 200,000 people have been waiting for six months or more, up by more than 45 per cent since last year.

Successive governments have pledged that patients referred to hospital should be offered a choice of provider, including private hospitals. Ministers have said that such policies give more rights to patients, while providing hospitals with an incentive to keep their waiting lists down, as they receive income for each case treated.

However, research has repeatedly suggested that many GPs do not offer such options routinely. The latest polls showed that only four in ten patients reported having been given a choice of hospital for their appointment.

The new promise, contained in NHS planning guidance for 2019-20, says that hospitals or local planning bodies will be obliged to contact patients who have been on lists for six months to advise them about quicker alternatives.

Professor Derek Alderson, president of the Royal College of Surgeons, said: “We are greatly concerned about the growing number of patients waiting more than six months for treatment. Any initiative to help reduce the number of people waiting a long time is therefore welcome. However, this option will primarily benefit patients in cities where it is easier to travel to another hospital, or those living in areas where a local private hospital may have capacity.” He added that different surgical teams would then need to become familiar with the patient, which could cause delay.

Professor Alderson said it was a welcome start but more needed to be done to reduce waiting times. “We continue to be engaged in NHS England’s review of performance standards,” he said. “While we accept that some changes to targets for planned treatment may be sensible . . . we could not support any revisions that leave patients in doubt as to how quickly they will be seen.”

If I pay for private treatment, how will my NHS care be affected? – NHS – 

In Wales if you start by seeing someone privately, but then elect to go to the Health Service, you should be put to the bottom of the waiting list. But we all know that if you have cancer or a problem that needs urgent attention the “rule” will be broken. The answer to the question is “You’re still entitled to free NHS care if you choose to pay for additional private care.”

Do I need a GP referral for private treatment? – NHS -Yes, but expect poorer communication.

What is an NHS Private Patient Unit? – NetDoctor

[PDF] Interface between NHS and private treatment: a practical guide … – BMA

[PDF] Defining the boundaries between NHS and Private Healthcare • The Warrington CCG…

Treating private patients in NHS hospitals – benefit or cost? — Centre for Health and Public Interest

[PDF] NHS treatment of private patients: the impact on NHS finances … – Centre for Health and Public Interest

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

2014 !! South Wales NHS: Plan to centralise services on five sites


More money is no use. An honour is debased. Poor systems lead to poor decisions… just like the 4 UK Health Services

The one good thing about a businessman philanthropist getting a “gong” is that he has exposed a loophole in the system for funding and provision of drugs. The idea that he should be rewarded for exposing this perverse incentive is anathema to all health service staff, and their lack of respect for our government and politicians will only be reinforced.  NHSreality has already commented on awards: The New Year’s Honours (RHS) List 2014 and there are suggestions for the “gong” system to be rearranged so that honest exit interviews are rewarded..

The next announcement should be the funding of health and social care. There is no chance that this review will change anything. There is so much money overspent already; even with the new funding they are £1bn short! At least the voters seem to have a longer term perspective... Expectations are reducing. Watch out for all the private options in the next decade. We have a poor system: money alone is not the answer. 

BBC News 6th Jan: NHS 10-year plan: Labour attacks Theresa May over proposals

Spend extra money on more nurses and doctors, urge voters – Chris SMyth reports in the Times

and NHS faces £1bn budget hole despite cash boost

The Times Leader sums it up well: The Times view on NHS funding shortages: Poor Service – Money alone is not the answer to the the health service’s long-term challenges

rexit will not be the only topic on the agenda of MPs returning to parliament this week. The country faces multiple other challenges, many of which have been neglected for too long while the government has been arguing with itself over the terms of our EU departure. Among the most pressing is the future of National Health Service. It is more than six months since Theresa May announced an extra £20 billion above inflation for the NHS by 2023 and asked its chief executive, Simon Stevens, to devise a plan to spend it. That plan was delivered to ministers last month, but its announcement was delayed amid Brexit chaos. It will be revealed this week instead.

The prime minister gave a preview over the weekend of what it will contain. It includes better mental health and maternity care, better protection from and detection of diseases such as cancer, increases in the NHS workforce and a drive to introduce better use of technology throughout the NHS in areas such as GP booking, prescriptions and health records. These are all important goals, though as we report today, health bosses rightly fear that Mrs May risks raising unrealistic expectations as to what can be achieved. The Nuffield Trust estimates that even with an extra £6 billion investment planned for next year, the NHS will still face a £1 billion shortfall.

Besides, money alone is not the answer to the NHS’s challenges. One of the biggest of those challenges is to free up hospital beds from people who have no clinical need to be in hospital. That requires far greater levels of integration between hospitals and other parts of the health system, including GPs and social care providers. Yet with the passage of time it has become clear that the reforms pushed through by the Cameron government at the start of the decade were misguided: new rules designed to bring greater commercial discipline between hospitals and GPs have not increased efficiency but proved a barrier to effective integration. The government’s first priority should, therefore, be to keep its promise to deliver any legislative changes requested by Mr Stevens that stand in the way of integrated health services.

The second priority must be to deliver an overhaul of social care provision. In an ageing society, finding a solution to the long-term care needs of elderly people is crucial to freeing up resources in the NHS. A tenth of hospital beds are occupied at present by people who cannot return home, solely because they have nowhere else to go, and that number is certain to rise, given that the numbers of those aged above 75 is likely to double over the next 30 years. It is now more than seven years since a government-ordered review recommended capping what individuals should pay for their care and nearly 18 months since the government promised a green paper on social care, yet ministers are still unable to give a date for its publication.

The broader question is whether, even with the extra cash and the right legal frameworks, the NHS has the requisite leadership skills to manage a vast, complex bureaucratic system that employs about 1.5 million people and consumes about 11 per cent of the national budget. Ministers insist that Britain’s model of a free health service at the point of use is sustainable, providing that resources are used more efficiently. But sustainability also depends on the stability of the public finances. In that respect, the fate of the NHS may hinge less on Mrs May’s long-term plan than her Brexit deal.

The Times view on V J Patel’s OBE: an unworthy honour.

We are going to spemnd more and more on private health care…. if we can afford it.

Remember that governments priority is not the same as doctors. They treat populations. Doctors treat patients. So prevention is better than cure: does this mean we should allocate our resources differently? David Buck reports for the Kings Fund. 

The book Factfulness by Hans Rosling teaches us to be sceptical of single facts, and to ask more questions. But the headline from the Times (Below) could have read “Patients pay £1bn to choose their specialist, or to avoid complications, or to have surgery when they want it”. There are many reasons people choose to go private, and nobody (I hope) is suggesting choice is removed in the UK. This would simply drive the services offshore… there is always a perverse outcome in health. Of the 3 health services which used to fund everything free 30 years ago, Scandinavia and New Zealand have accepted that this is an impossible aspiration. £1bn means £500 each (average). This is less than 1% of the total health budget across all 4 health systems. But we are going to spend more, and an unofficial two tier system is evolving. 

Only this week I have seen friends with problems that need surgery, and one of these is in my view an emergency with neuro-compression signs. Yet the Welsh Health service (post codes) can only offer an operation in a month, having delayed for 3 already. Nobody, surgeon or administrator has suggested that there might be another region with a shorter wait, or more capacity to fit him in. Choice is severely restricted in Wales… as the money moves with the patient. The operation is not available privately, so this is exactly the sort of thing the health services need to cover. The patient is still working, and should have ten more years of work possible….

Chris Smyth in the Times 13th December reports: 

Private Patients spend £1bn to jump NHS queues (whole article)

The NHS budget, and how it has changed. The Kings Fund.

When the NHS was launched in 1948, it had a budget of £437 million (roughly £15 billion at today’s value). For 2015/16, the overall NHS budget was around £116.4 billion. NHS England is managing £101.3 billion of this. For more detail on the NHS budget, visit the GOV.UK website.


In a celestial world as outlined by the old NHS, there was universal, cradle to grave cover, with no barriers to access, free at the point of delivery, and without reference to means. Funny that we have so many medical charities then. And the greatest number of these charities is in the Hospice (Palliative and Terminal care) sector. These charities are mostly run from physical buildings, and hospices, but in the poorer areas of the country they are “Hospices at Home”. The idea to help elderly at home is a good one, BUT it overlaps so much with charitable providers. The perverse incentive for Trusts and Commissioners to offload as much as possible to these charities will inevitable mean there are large post code voids in cover. NHS reality does not object to this IF it is honestly discussed. The solution is a means based insurance based system, and since most of the assets in the UK are held by the elderly this would be more progressive.

Chris Smyth reports November 22nd in the Times: Rapid response teams will help elderly at home

NHS “rapid response teams” will be on call 24 hours a day, seven days a week to help frail and elderly patients who fall or suffer infections, Theresa May will say today as she promises to use extra health service cash to keep people out of hospital.

GPs will also get to know care home residents personally in an effort to keep them well at home. Such services will get an extra £3.5 billion a year by 2024 as part of a £20 billion boost promised to the NHS in the summer

Experts welcomed the ambition but questioned whether the NHS would have the staff to provide the services, and warned that such top-down initiatives often backfired…..

…Simon Stevens, chief executive of NHS England, said that guaranteeing the money for local services would help to make the plans a reality.

“Everyone can see that to future-proof the NHS we need to radically redesign how primary and community health services work together,” he said. “For community health services this means quick response to help people who don’t need to be in hospital.”

Sally Gainsbury, of the Nuffield Trust think tank, said: “This money will simply allow GPs and community services to keep up with demand over the next five years. That’s important but it means the new money announced today is not going to lead to a significant change.”

She added that there were “serious questions about whether the NHS has the right staff in the right places to carry this out”. She warned: “We would agree the NHS needs to focus on helping people more outside hospital and getting them home more quickly. But the idea of telling every local area to do the exact same thing has often backfired in the NHS, as it is bound to be less well-suited to certain places.”

Advances in Diabetic care are rolled out at different speeds in different post codes.

There is a history of rationing new advances in medical care differently in different post codes and regions. Some things are too important for this type of random care. If it was open and honest, and announced in advance, for some cheap services rationing is appropriate: but of course it is not allowed to be talked about. The perverse incentive for commissioners to get away with what they can is too great..

Judy Hobson in the Mail in 2010: The alarm that can save diabetics’ lives (so why is the NHS rationing them?)

Faith Eckersall reports in the Daily (Dorchester) Echo 12th October: Diabetics to confront councillors over postcode lottery DORSET diabetics – including some children- will be part of a delegation at the county council on Wednesday to campaign for new testing technology free on the NHS.

Currently people with Type 1 diabetes must use the painful and inconvenient pin-prick method to check their blood sugar levels but Flash, which must be paid for in Dorset, works on a pain-free patch and scanning device.

The protestors are angry that despite the government’s NICE drugs and medicine rationing committee approving the use of Flash Glucose Monitoring on the NHS, Dorset Clinical Commissioning Group has not made it freely available, as has happened in adjoining health areas.

The CCG is running a six-month pilot of the Freestyle Libre blood glucose monitoring device for 200 people in three specific groups of diabetic patients in the county. But protestors point out there are 5,000 diabetics in Dorset who could potentially benefit and say no further testing or pilot is needed.

Diabetes UK south west regional head, Phaedra Perry, said: “The Dorset Clinical Commissioning group should make Flash available immediately to all people with diabetes in the area who can benefit, and not to just a very limited group of 200 patients for six months.

“Commissioners here are out of step with neighbouring CCGs which have agreed to prescribe it. Dorset is one of very few areas in the south west where Flash is not available and is effectively imposing a postcode lottery on diabetes technology.”

The rising trend in fraud in the UK health services.

My calculation for a population of 70 million is that this “fraud” costs us all around £16 each. The known parts are £5 loss to staff, £1 loss to patients, and £10 the professionals.  How can an organisation be run by administrators and leaders so much in the dark? We know purchasing power is reduced in smaller Health Services (Wales, Scotland and N Ireland), and now we know more about what they have been unable to correct due to the perverse incentives in the system. How many families have crutches, walking sticks and other accessories no longer needed? A small co-payment, is needed, with partial refund when returned undamaged. The managers need a breakdown at the touch of a button, of all missing items. Can you imagine a company like Screwfix or Argos not knowing what was where? Whilst the figures are not high, the rising trend shows it might become a real problem in future. 

Fraud is also a concern in other countries, especially the USA. Some comfort…

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Kat Lay reports 8th October 2018 in the Times: Fraud in the NHS could have paid for 40,000 nurses

Fraud costs the NHS £1.29 billion every year, according to the health service’s anti-corruption watchdog.

The money would be enough to pay for more than 40,000 staff nurses or buy more than 5,000 frontline ambulances, the NHS Counter Fraud Authority said in its annual report.

The organisation was established on November 1 last year. The new figure is higher than the £1.25 billion identified at its launch. The estimated total loss includes £341.7 million from fraud by patients and £94.2 million by staff.

Fraud by dentists adds up to about £126.1 million, the watchdog said, and opticians £79 million. Fraud in community pharmacies is estimated at about £111 million and in GP surgeries it is worth £88 million. People accessing NHS care in England to which they are not entitled is thought to cost the health service £35 million. The rest included fraud involving NHS pensions, bursaries and legal claims.

Simon Hughes, the authority’s interim chairman, said: “Ensuring public money pays for services the public needs and doesn’t line the pockets of criminals means we all benefit from securing NHS resources.”

Sue Frith, its interim chief executive, said: “Fraud always undermines the NHS, with every penny lost to fraud impacting on the delivery of vital patient services. If fraud is left unchecked, we believe losses will increase.”

The report said there was “no such thing as a ‘typical’ NHS fraudster”. It noted that there were barriers to tackling the issue, including a lack of understanding of the problem in many NHS services. It added: “There is also sometimes a mistaken assumption that reporting fraud casts the organisation involved in an unfavourable light.”

At the end of March there were 45 criminal investigations in progress, the report said. In July a neurology nurse from London was jailed for 16 months for fraud by false representation. Vivian Coker, 53, from Camberwell, took sick leave from August 2014 to May 2016. During this time she received pay of £32,000 from St George’s University Hospitals NHS Foundation Trust, but had also registered with two agencies and worked shifts. Coker initially denied the charges but changed her plea at Kingston crown court.

In March the authority helped to jail Andrew Taylor, a locksmith employed by Guy’s and St Thomas’ NHS Foundation Trust. He was sentenced to six years for defrauding his employer of £598,000. He had charged the NHS mark-ups of up to 1,200 per cent.

Taylor, 55, from Dulwich, was found guilty at Inner London crown court of fraud by abuse of position. Financial investigators “established that Taylor was leading a cash-rich lifestyle beyond his legitimate means, which included paying for his son to attend a private school whose fees were £1,340 a month and purchasing a brand new Mitsubishi L200 vehicle at a cost of £27,400”, the report said.

It also described the case of Paula Vasco-Knight, 53, chief executive of South Devon NHS Trust, who made fraudulent payments of more than £11,000 to her husband, Stephen. She admitted fraud by abuse of position in March 2017 and was given a 16-month prison sentence, suspended for two years, and ordered to do 250 hours of unpaid work by Exeter crown court.

The couple said that they did not have sufficient assets to repay the money but investigators found that they had access to personal pensions that could be surrendered.

The advantages of mutuality are being shunned. Purchasing power in small regions is little. Choices are disappearing.. Hammond is unlikely to help ..

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