The NHS shake-up risks wrecking GPs' relationship with their patients by turning them into rationers of care who deny the sick the treatment they need, warns the chair of the Royal College of GPs. Family doctors could be "compromised" by having to decide between providing sick patients with the best possible treatment or meeting financial targets, according to Dr Clare Gerada. Giving GPs control of health budgets, the cornerstone of health secretary Andrew Lansley's restructuring of the NHS in England, could diminish the trust between patients and family doctors, she will tell the college's annual conference.
Steve Bell, the Guardian
"We must not risk long-term benefits being sacrificed in favour of short-term savings," Gerada will tell the audience of 1,500 GPs in Liverpool. "How soon will it be, for example, before we stop referring for cochlear implant? An expensive intervention but one that in the long term saves enormous amounts of public money. But not a saving from our budget. How long will it be before we find ourselves injecting a patient's knee joint - at Injections-R-us PLC - instead of referring to an orthopaedic surgeon for a knee replacement?"
In a detailed critique of Lansley's health and social care bill, she will warn that: "As doctors we risk being compromised. We'll have to choose between the best interests of our patients and those of the commissioning group's purse. And, to make matters worse, we'll also be rewarded for staying in budget - and not spending the money on restoring the child's hearing. Now that's what I call a perverse incentive."
Her warning reflects widespread concern among doctors that exercising their financial responsibilities will lead some patients to believe they have been refused treatment on grounds of cost. Lansley's reforms also threaten to create a two-tier health service where the well-off can beat queues by paying for fast treatment as private patients in NHS hospitals, because of the proposed easing of the amount which foundation trust hospitals can earn from that source.
"I worry we're heading towards a situation where healthcare will be like a budget airline. There will be two queues: one queue for those who can afford to pay, and another for those who can't. Seats will be limited to those who muscle in first, and the rest will be left stranded on the tarmac."
The British Medical Association, which represents hospital doctors as well as GPs, said it shared Gerada's concerns. "In general, we would agree with Clare Gerada's comments about the impact of the health and social care bill. The BMA has concerns about the conflicts of interest inherent in the bill as well as the effects of the market on healthcare, and her comments fit with the views of most doctors," said a spokeswoman for the BMA, which wants the bill withdrawn or substantially amended.
A Department of Health spokesperson said: "The NHS is not for sale and this government is committed to a real terms increase in funding for it. We want to give GPs the power and control to make the right decisions on behalf of their patients. Talk of budget airlines is nonsense pure and simple. In the new NHS, everyone will fly first class. Quality will improve as both patients and frontline staff are able to make choices.
"We have already amended the health and social care bill to make sure that clinical commissioning groups are accountable and transparent to patients and the public, and so that each one will have a governing body that meets in public. As both the chief executive and medical director of the NHS at national level have made clear, there should be no blanket bans on treatment for reasons of cost."
Denis Campbell, the Guardian
