Rationing

One of the most unpopular parts of the White Paper is that it explicitly says that GPs will have to ration healthcare. An odious task. Well, since there are huge cuts (efficiency savings are cuts) to be made in the next 4 years, many PCTs are thinking ahead and cutting already. Pulse report that cuts are being made to:

• treatments for back pain
• refusing all requests for IVF
• tonsillectomy
• counselling
• hip operations

If you are in pain because of a back problem or a hip problem would you like to know that you will not get the care you need because Cameron lied about not cutting the health service? It is happening now.

But PCOs [Primary Care Organisations] are not cutting for fun. Indeed Pulse this week reveals many are panicking that they are not cutting quickly enough, with mid-year projections suggesting they are heading to bust budgets or miss efficiency targets. The likely outcomes are grim. PCOs may cut faster and deeper, shrugging off concerns over access to treatments and perhaps ignoring the new requirement, at least in England, to consult with GPs. Or they may shirk the budgetary challenge, in the knowledge they won’t be around to carry the can. If that happens, GPs will face a mountain of debt when they take over commissioning – debt the GPC concedes is likely to become the profession’s problem.

...and remember the Daily Mail? They complain all the time about some expensive, ineffective treatment that according to their rather dim, uneducated "journalists" are miracle cures being denied to us by the nasty people at NICE. Well Pulse says that the treatments that NICE recommends will be too expensive for the meagre budget that Lansley is giving GPs:

But it will not only be debt that becomes GPs’ problem. So will the legal duty to provide NICE-approved treatments, with consortia risking being sued if they fall short. As NICE green-lights more and more treatments, without worrying about anything as inconvenient as a budget, so the pressures on GPs will increase.

Pulse say that NICE should not be recommending as many treatments as they do:

NICE, too, should reform, by making recommendations within a notional annual budget, so GPs are not left with all the tough financial calls. Otherwise, the cynics on GP commissioning could be proved right – that it is just a way to shift blame for rationing onto GPs’ shoulders.

Now before you scream "bring in the private providers!" have a look at another report from Pulse.

GPC chair Dr Laurence Buckman told Pulse: ‘PCTs that have contracts with private organisations to provide hip surgery have for a long time had very restrictive criteria given to them by the private providers. So much so that you’ve got to be an Olympic athlete to get your hip replaced in some places.'

The sarcasm at the end of that quote is essentially saying that the private contracts cherry-pick: they will only do the easy cases. The private sector is NOT the solution.
 referral.'Buckman continues:

‘There are several people who presently are offered treatment for various illnesses who may not be offered treatment in the new world. If there’s evidence to show that that’s actually better for them, that the treatment is worse for them, then that’s not bad care, that’s good care. But where restrictions are put in merely to save money, I don’t think any of us would accept that.’

 Rationing will come, and you will have Lansley and Cameron to thank for it.