GPs challenge PCT rationing plans

PCT restrictions on access to NHS treatment has led to a huge rise in GPs having to submit requests for patients to access care, GP has found.

According to our survey, one in 10 of the GP funding requests are for bariatric surgery (Photograph: SPL)

Individual patient funding requests are made by GPs on behalf of patients for treatments that PCTs will not routinely offer.

The number of such requests rose by 17 per cent from 2008/9 (53,000) to 2010/11 (62,000), according to responses from 103 PCTs to our request under the Freedom of Information Act. Over the same period, the proportion of requests approved fell by 22 per cent, from 59 per cent in 2008/9 to 46 per cent in 2010/11.

The NHS Constitution forbids PCTs from making blanket bans on access to treatments.

Around one in 10 requests relate to funding for bariatric surgery. Requests were also submitted for asthma and diabetes drugs.

Leicestershire GP Dr Dermot Ryan said that, although some therapies should be restricted, such decisions should be made by clinicians. 'These decisions are being made by bean counters in isolation from the clinical front line,' he said.

'Each drug needs a different approach and the current system doesn't allow that.'

GPC prescribing subcommittee chairman Dr Bill Beeby said PCTs had to provide clear guidelines on any restrictions.

Many dermatological treatments are restricted because PCTs deem them to be cosmetic.

  • Around half of requests are approved, but approval rates vary from less than 10 per cent in some PCTs to more than 80 per cent in others.
  • The number of requests made to PCTs varies from one request per 250 patients to one per 10,000 patients.

Source: Freedom of Information Act responses from 103 PCTs in England

RCGP vice chairman Professor Nigel Mathers said GPs may have to submit requests to ask for special consideration, such as when a patient is suffering distress from a condition.

Neil Churchill, chief executive of Asthma UK, said it was 'not acceptable if PCTs are restricting drugs and patients feel they have to take campaign for funding'.

Diabetes UK said access restrictions were 'worrying and short-sighted' since effective treatment for diabetes cuts the risk of complications.

NHS medical director Professor Sir Bruce Keogh said decisions on the appropriate treatments should be made by clinicians in line with NICE guidance.

'We would not recommend creating definitive lists of ineffective or inefficient procedures without a clear consensus from clinicians who are experts in the field,' he said.

'We are working with the Colleges and surgical specialty associations to identify what effective operations the NHS should purchase and which ineffective procedures we should be withdrawing from.'

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