Editorial: NHS must be honest about rationing

This fortnight's GP magazine reveals the results of our exclusive Freedom of Information Act investigation into treatment rationing.

It finds GPs are increasingly being forced to fight to obtain treatment for their patients as NHS managers restrict access to care.

Individual Funding Requests (IFRs) made by GPs for patients rose 19% in a year. Appeals rose 60% in three years and appeals not funded increased 74% over the same period. Given these results, it is difficult not to conclude that rationing of care is worsening.

Is the charity RNIB (Royal National Institute of Blind People) correct in its accusation that PCTs are using IFRs to restrict access to a treatment without being seen to put in place a blanket ban?

There is a view that the NHS should be more open and be clearer about therapies PCTs will not fund. But would this lead to a lowest common denominator list of treatments available nationally?

Currently, PCTs are allowed to decide not to fund particular therapies unless a treatment has been recommended by a NICE technology appraisal. But the NHS Constitution says this cannot be a blanket ban.

Where does this leave GPs? Increasingly, stuck between a rock and a hard place.

The lack of consistency in the current system raises the possibility that some GPs may be more successful than others in appeals.

The birth of clinical commissioning groups (CCGs) in April 2013 means GPs at those practices making appeals on behalf of patients will be signed up to the bodies making decisions on them.

This potentially risks splits between CCGs and practices and means GPs who could previously blame the 'PCT down the road' for rationing are left with a less convincing argument.

The hope is that involving clinicians in CCGs more closely with decisions previously taken by PCTs will allow a more common-sense approach, where patient need and quality trump cost.

If GPs are to continue to be trusted advocates for their patients, what is most important is that there must be greater honesty with those patients about who is making decisions and why.

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