Chris Lancelot: To hell with PCTs unwilling to take responsibility

I have always believed strongly that no-one should be punished for their actions, however devastating the consequences, if they had no ability to behave differently.

The GP Record, by Fran Orford: www.francartoons.com
The GP Record, by Fran Orford: www.francartoons.com

This principle is about to fall apart. We GPs are accustomed to taking full responsibility for our medical decisions. But to save money, PCTs are increasingly trying to force GPs to change their behaviour - to prescribe certain drugs preferentially, and to reduce referral rates. So who should take the blame when it goes wrong?

Blanket bans are easy: if your PCT won't allow you to refer particular conditions then it is clear whose responsibility it is if the patient sues. The real problem comes where pressure is being applied to force GPs into a particular mode of action, but where there is still (in theory) a choice - for example, whether to use the cheaper statins.

To my mind, simvastatin has a poorer risk-benefit ratio than atorvastatin, and a much higher incidence of side-effects once you start looking for them. Despite this, my PCT is pressurising all its GPs to use simvastatin as a first choice: indeed, it will publicly vilify my practice (under its 'traffic light' assessment system) if I resume prescribing atorvastatin first-line.

But what if I bend to its pressure, prescribe simvastatin, something goes wrong, and the patient sues? Can I truthfully stand in front of a judge and say I believe simvastatin was the best drug to use? Clearly I can't. So will the PCT take responsibility for its pressure and its threats? You can bet your life it won't. It'll hide behind: 'It's a clinical decision, and the person responsible for clinical decisions is the doctor.'

PCTs will use the same argument over referrals, disclaiming all responsibility while simultaneously threatening practices with losing premises' money (or even being closed down) if they don't reduce their referral rates

All medical decisions involve risk. Clearly, in these straitened economic times, PCTs will have to take tough decisions on spending: but if the PCTs make the decisions they must also take formal responsibility for the risks these decisions create. If PCTs refuse to accept their share of responsibility for their diktats, then our legal duty is clear: we must act solely in the patient's best interests, and to hell with NHS finances.

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