Thursday, 6 October 2011

Blurring of lines? GPs must operate within clearly marked boundaries

A story uncovered by the BBC earlier this week is a classic example of a good reason to have concerns about handing a large proportion of the NHS budget to GPs.

A GP practice in Yorkshire has apparently written to some of its patients advising them that certain minor dermatological procedures will no longer be available at their local NHS Trust and offering the treatments privately.

If this is true – it is wrong on so many levels.

I support any GP who takes proactive steps to maintain the health and wellbeing of their patients. But removal of skin tags? (£56.30). Is this a public health issue?  I’m aware of the obesity epidemic and the ticking time bomb of diabetes – but an  Armageddon of skin tags? A massacre of benign tumours (£243.20)?

I wonder what the cost of this mail shot was in terms of time and postage. And what was the motive behind it? Giving these GPs the very best benefit of the doubt and assuming they are concerned for their patients’ welfare – one cannot nevertheless deny that that one of the private options offered was a Clinic ‘wholly owned and operated’ by the GP practice.

So – here we have a private company potentially benefiting from a mail shot that is apparently generated using NHS patient details to promote its services. Can you imagine the outcry if a private hospital used an NHS GP practice’s database to promote cosmetic services in the local area?

Clare Gerada – chair of the Royal College of General Practitioners shares the concerns of many, saying ‘We believe that the boundary between what a GP offers under their NHS provision and what is offered for a private fee, is in danger of becoming increasingly blurred’

David Cameron at the Conservative Party Conference said ‘It is our policy to protect the NHS…’ I have no doubt that the coalition genuinely has no intention of privatising the NHS and I support competition for the delivery of some services from the private sector, especially if commissioning decisions are based on quality and price.

But let us not forget that most GPs are self employed, private contractors. I fear that Andrew Lansley, the Health Secretary still doesn’t fully understand that by  handing the lion share of the NHS budget to GPs there is a real danger that in some cases the lines may not only become blurred – in some cases they may disappear altogether.


Chairman Chegwin said...

The interesting thing here is that the PCT is clearly not funding procedures and treatments that are available free at the point of delivery by the NHS in other parts of the country. But I'm not sure why we should be surprised at this - despite the oft-repeated rhetoric of "free at the point of use", rationing has actually existed in the NHS for some time.

Data protection issues aside, can we honestly say that the GPs themselves have behaved incorrectly? Yes, they've been alert to the opportunities that have presented locally, but it seems to me that what they are doing is providing services to their patients who cannot get what they need on the NHS via their PCT funding it?

The real questions should be aimed at the PCT?

Finchers Consulting said...

Apparently the NHS Trust denies that these treatments are not available - and I think this is where the real problems start. Who does the patient believe? I agree that the GPs have probably not behaved incorrectly but it is a worrying precedent and seems a strange use of practice funds promoting a non essential service. Blurred lines and confusion - a taste of things to come!

Chairman Chegwin said...

Indeed - and it will be interesting if the patient gets cheesed off with being mucked around, ups sticks and goes to get treatment in say, France - because under the piece of legislation I'm working on (the EU Cross-border Healthcare Directive) he/she may well be able to put the (French) receipts to the PCT and get them paid from local funds anyway!

They won't like that....

Finchers Consulting said...

I will be very interested to know more about that legislation. True patient choice - and France is one of the highest ranked medical services in the WHO ratings I seem to remember!

Chairman Chegwin said...

As you say, the next big area of patient choice - and with 30 countries to choose from!

The Directive makes it a reality....

Here's something the Confed put together (which I okayed)

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