Mark Porter, the new British Medical Association’s chair of council, says cuts and rationing of drugs may harm patients
The NHS is putting patients’ health at risk by denying them drugs and operations because of growing rationing being imposed to save money, the new leader of Britain’s doctors has warned.
The drive to meet demanding efficiency targets is so serious that the NHS is offering some GPs surgeries extra money if they send fewer patients for tests and treatment in hospital — a move condemned as “morally wrong” by Dr Mark Porter, the British Medical Association’s recently elected chair of council.
In his first interview since taking up the post Porter said the NHS was offering fewer and fewer services to patients and that many had been “cut out”, often against doctors’ wishes.
The shrinking of the NHS’s “offer” to the public was being hastened by the coalition’s health reforms, creeping privatisation of services and the system’s need to save £20bn by 2015, Porter claimed, in remarks that are likely to irritate the health secretary, Andrew Lansley.
Those pressures mean the fear that a patient may be harmed because they are denied a test or treatment “is a realistic concern”, said Porter. The same changes, especially the growing number of private firms providing NHS services, also threaten to fragment the health service by making it less of an integrated system and have a severe impact on recent improvements in the quality of care, he added.
The NHS has come under growing criticism for making it harder for patients to have operations for routine conditions such as hernia, cataracts, grommets, wisdom teeth, or hip or knee replacement, and denying infertile couples IVF.
Rationing of access to certain procedures deemed not worthwhile by the NHS, which is still piecemeal and localised, will soon become much more widespread as the spending squeeze in the service tightens, said Porter. “You see it happening in examples now, but it’s when it becomes service-wide in a few years’ time, if the current policies continue, that the population will notice in the wider sense.”
NHS organisations’ lists of treatments they will no longer pay for mean that “bits of the NHS are being parcelled off and taken out of the NHS offer year by year”. Although the NHS constitution guarantees universal and comprehensive healthcare “there’s lots of areas where bits of the NHS have been taken out of the offer”, Porter said. “It’s no longer a comprehensive service. We can see the effect of people to whom we have to say: I’m sorry, this treatment is no longer available.”
The use of referral management centres, in which family doctors’ decisions to refer a patient to hospital are analysed by a third party before any treatment can be given, “are particularly distressing for GPs who know how they would like to deal with patients but find their ability to do so is more constrained than ever before”. The situation was in stark contrast to “rhetoric” from ministers about how patients and GPs are being given more power than ever before as a result of their changes to the NHS in England, Porter added.
Both existing NHS primary care trusts (PCTs) and the clinical commissioning groups (CCGs) led by local GPs that will replace them next April are offering GP practices money in return for sending fewer patients to hospital to receive what can be expensive care there, despite NHS leaders and ministers having told them to restrict access only on clinical, and not financial, grounds.
For example, Harrow PCT in north-west London has offered local GP surgeries up to £4 extra per registered patient if they “optimise the use of outpatient appointments to reduce the inappropriate variation in referral rates across Harrow practices”, among other measures.
The PCT has to save £14.2m in the current financial year in order to meet targets set as part of the Department of Health’s “quality, innovation, productivity and prevention” cost-cutting drive. It has written to practices proposing to pay them £1 a patient if they appoint a GP who will review all their colleagues’ referrals before they are approved and another £1 of the £4 a head if the 25% which refer the most patients to hospital cut that by 10% “where clinically appropriate”.
Porter said that while the BMA supported schemes to improve the quality of referrals, such offers potentially gave GPs a conflict between their clinical judgment and personal self-interest, as GPs who run a practice can decide either to spend income on improving services or use it to boost their salaries. “It’s morally wrong and professionally wrong. Paying a direct financial incentive like that can be a direct financial incentive to the person themselves and that incentive shouldn’t be there. Doctors’ minds should be on what’s best for the patient, not on whether the PCT will sub them for certain types of financial behaviour,” he said.
The Department of Health said last night it would stop PCTs and CCGs from offering GPs such deals. “If patients need treatment, they should get it when they want it and where they want it. If local health bodies stop patients from having treatments on the basis of cost alone then we will take action against them,” it said.
In a broadside against some of the coalition’s main health policies Porter also warned that the introduction of “any qualified provider”, which from this autumn will force PCTs to let private firms provide NHS services in 25 different forms of treatment, would destabilise local NHS services by deliberately creating a market where none currently exists.
In addition, some centres offering both trauma and orthopaedic surgery were at risk because the orthopaedic service was being opened up to competition from private firms, he said.
Letting hospitals raise 49% of their income in future from private patients ran the risk of hospitals neglecting both NHS patients and patient safety because many would be too busy trying to exploit new-found commerical opprtunities, he added.
Andy Burnham, the shadow health secretary, said: “When the leading doctor in the land warns that the government has put the NHS on a fast track to privatisation then it is time for people to sit up, take notice and rally to its defence. The N in NHS is now under sustained attack.”
But the DH rejected Porter’s fears over rationing. The Department of Health said: “The NHS is treating more people and we are increasing the NHS budget in real terms. The NHS made £5.8bn in savings in 2011-12 while keeping waiting times low, performing more diagnostic tests and planned operations. It is showing it can meet the financial challenge set.”