We all know them - those patients who make appointments then don't bother to turn up; who regularly call the ambulance or visit casualty for trivia; who insist they are too ill to come to the surgery but are up and about when the GP visits; and those who try to manipulate staff into giving them exactly what they want - prescriptions, referrals, third opinions - however inappropriate their demands. How often have your staff given a precious emergency appointment to a patient because 'it's very urgent', only to find that they've had the problem for a week?
We've all had patients like this and they currently have the upper hand. Try to educate them, try to discipline them and they threaten us with a complaint to the PCT or the GMC. Yet those same PCTs are pressurising us to reduce the unnecessary use of secondary care. We cannot win.
Only a handful of patients behave inappropriately, but the upheaval they cause and the resources they waste are disproportionately large: they must be stopped.
So we need two things: the creation of a statutory misdemeanour of 'wasting NHS resources', and a small specialised unit to deal with persistent offenders. This body would also be responsible for dealing with those who threaten, bully or assault staff.
Clearly clinicians cannot be held responsible for policing the NHS: we shouldn't be the ones to issue fines or collect the payments. On the other hand, a separate, statutory NHS unit could do it easily.
All NHS staff should be given the legal right and duty to report those who were abusing the NHS by persistently wasting its resources. The central body would be responsible for investigating, issuing warnings, and if the offending behaviour continued, fining or prosecuting the perpetrators, then collecting the fines.
Hopefully the use of such powers would be infrequent - but the threat would be real. Currently there is no mechanism by which doctors and nurses can discipline patients who misuse NHS facilities: a method of redressing this imbalance is long overdue.