In Yorkshire, where the SHA is overspent, GPs have been warned that some PCTs are seeking a cut in referrals of a third this year. The news has left one GP pondering how to stop his patients getting pregnant. Despite the knowledge that historic levels of morbidity in the general population cannot be changed overnight, the PCTs say referring in Yorkshire is 30 per cent higher than the national average. They plan to commission less in services to reflect this, which is a cut that imposes the referral targets on GPs.
Meanwhile in Stockport PCT, GPs have been told that only those excisions performed with a scalpel and tied with sutures will qualify for payment under the minor surgery directed enhanced services.
Punched skin biopsies, use of electrosurgical machines and most vasectomies would not be paid, regardless of the clinician's judgment over what was the most suitable procedure for the patient. Plus the ruling would seem to go against the policy of moving more services to primary care.
Many PCTs are working closely with clinicians to find more cost-effective approaches and to use practice-based commissioning to create savings.
But while attitudes like those highlighted persist, it will continue to make impossible the necessary changes to ensure high-quality patient care is delivered within a reasonable budget.
Ms Hewitt might well need to save half a billion pounds, but those managing the health service at all levels must remember that its purpose is to deliver healthcare to the population. Deliver it more efficiently by all means, but please do not leave people waiting for care because of bureaucratic definitions.