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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

Consultants in London on strike earlier this year

Consultants to vote on new pay deal to end strikes

Consultants will vote on a government pay offer that would increase salaries by up...

BMA England GP committee chair Dr Katie Bramall-Stainer (Photo: Sarah Turton/BMA)

GPs' willingness to take collective action will underpin contract talks

GPs' willingness to take part in 'once in a generation' collective action will underpin...

GP consultation

GPs out of work 'because practices can’t afford to hire them', warns GP leader

Growing numbers of GPs are struggling to find work - with some considering moving...

computer and stethoscope

Petition demanding SCA exam refund collects almost 2,000 signatures

Almost 2,000 people have signed a petition demanding refunds for doctors whose GP...

Dr Katie Bramall-Stainer, chair of the BMA's GP committee in England

Dr Katie Bramall-Stainer: 'The GMS contract is not broken - it has been broken'

BMA England GP committee chair Dr Katie Bramall-Stainer received a standing ovation...

LMC conference sign

LMCs demand formal ballot on outcome of GP contract talks

LMCs have demanded a formal ballot on the outcome of talks over next year's GP contract,...