Zara Aziz: Make the case for exceptional funding

I have mixed feelings about the roll-out of personal health budgets - no doubt this will empower some, but fail with others.

Take my patient Shelley, for instance. She is 34 and often attends for anxiety and OCD-related problems. Shelley and I usually know where we stand, although sometimes she surprises me.

‘I would like you to refer me to a gynaecologist,’ she blurts out as she settles in the seat.

‘What seems to be the problem?’ I enquire.

‘I want a reversal of sterilisation. We would like to have a baby,’ she says, tapping her fingers anxiously on the desk.

‘I see.’ I am a little surprised. I turn to look at her list of past significant problems. It looks like the sterilisation in question was a good few years ago.

‘This comes under exceptional funding, which means we have to apply to the commissioning group to see if it will fund it,’ I add.

‘I don’t like the sound of this exceptional funding,’ she says. Her eye starts to twitch.

‘I write to the group with your reasons for this request, and you provide supporting information on why you want it. Then we wait,’ I explain.

‘Is it going to take long? My mum has a personal health budget. Why can’t I have this out of my own budget?’ Shelley replies.

‘You don’t have a personal health budget, Shelley. Your mum probably has a different set of health conditions and is in a different area, no doubt.’

We seem to be veering off track. I bring her back. ‘Also, it’s a long, difficult operation, with limited chance of success.’ I remember assisting at this procedure, standing for three hours holding a retractor and given deathly looks by the surgeon if I so much as shifted on my feet.

‘You’re not trying to put me off, doctor, are you? Shelley looks at me suspiciously.

I shake my head vigorously: ‘Certainly not.’

‘Glad we’ve got that sorted. I’ll send Jamie to see you tomorrow. He couldn’t get time off work today. Does he need this exceptional whatever? He had his vasectomy 10 years ago.’

My jaw drops. ‘I look forward to that,’ I reply.

  • Dr Aziz is a GP partner in north-east Bristol

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