Co-payments to expand as NHS budget shrinks

GP predicts NICE will develop list of services NHS will not fund that patients can choose to buy.

The spread of co-payments in general practice is 'inevitable', a leading GP has said.

Dr David Jenner, GMS lead at the NHS Alliance, believes the mismatch between the number of treatments available and limited NHS funding will lead to more services patients will have to pay for.

Co-payments were 'inevitable' regardless of which party was in power, but Conservative plans to put GPs at the heart of rationing decisions would speed up their progress, said Dr Jenner.

It will begin with the most expensive cancer drugs but as the credit crunch deepens the funding 'mismatch' will worsen.

Eventually, a whole second tier of services will become available to those who can afford them, said Dr Jenner.

'Potentially, NICE will design a free service that is cost-effective, and a menu of treatments that are clinically effective, but not cost-effective, that patients can pay for,' he said.

Health minister Alan Johnson last year announced that NHS patients would no longer have treatment withheld if they had paid privately for drugs, following a review by cancer czar Professor Mike Richards (GP, 14 November 2008).

The Conservatives, meanwhile, plan to remove NICE's power to recommend drugs based on their cost and put GPs in charge of such decisions.

NICE would continue its work assessing drugs but there would be greater 'public involvement' in determining what is affordable, the Conservatives have pledged.

A NICE spokesperson told GP that data on treatments assessed and deemed not to be cost-effective were available to the public. As a result, the information is available to enable patients to browse for treatments they wish to pay for should co-payment rules be relaxed.

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