Editorial: Patient trust in GPs is the key in drug rationing

Last week, the national media finally caught up with GP newspaper's September exclusive that NICE's role will move away from deciding whether drugs should be given NHS funding towards offering advice on treatment effectiveness.

Last week GP also revealed exclusively that PCTs were threatening to use a clause in the GMS contract to impose fines on practices with low generic prescribing rates.

So it would seem GPs are to be both responsible for rationing drugs (although you'll remember health secretary Andrew Lansley has denied this) and held to account if they don't prescribe in the way the authorities (currently PCTs) would like (although it's conceivable that it could be consortia holding GPs and practices to account via Annex 8 in the future).

This week GP interviewed former GPC negotiator Dr Tony Stanton who is stepping down as joint chief executive of Londonwide LMCs and has worked in general practice for 27 years.

He warns that, when GPs are in charge of services, they could be 'even worse' performance managers than PCTs.

He also worries about how GPs will be perceived by patients and the media, once they control huge swathes of the NHS budget.

Dr Stanton, offering a glimmer of hope, adds that the high esteem in which patients hold GPs may enable them to educate patients.

It is surely this final observation that is at the heart of Mr Lansley's White Paper plans and why they are so politically astute.

At a time when the NHS faces incredible budgetary pressures, who better than most-trusted clinicians to break the news to patients that they can't have the drugs they want?

Why let GPs take on NICE's drug-rationing role, yet fine them for 'inappropriate' prescribing?

Could it be that, in difficult times, it devolves drug rationing responsibilities further from the coalition government than ever before?

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