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GPs say rationing will get more explicit

Most GPs say NHS will have to make rationing much more transparent

Louise Prime

Wednesday, 29 February 2012

Most GPs in England believe that the Government will have to make much more explicit what the NHS will and won’t provide freely, a nationwide poll has shown. Most are also concerned about the detrimental effect on the consistency of services, when clinical commissioning groups set priorities for local NHS spending.

The Nuffield Trust and Doctors.net said their ‘regionally representative’ survey of 821 GPs across England found that:

  • 85% predicted that the NHS’s financial challenge will eventually force the Government to say explicitly what is and isn’t freely available on the NHS in England
  • 83% believe handing responsibility to local CCGs for setting priorities for spending NHS funds is likely to lead to greater variation in what services are provided to patients throughout England
  • only half believe the NHS will be able to improve efficiency enough over the next 5 years to avoid having to cut back on services that the NHS currently funds.

The survey findings were published on the same day as the Nuffield Trust launched its report into the feasibility of letting the public know clearly what NHS care patients are entitled to.

Rationing health care examines the potential for a nationally specified ‘benefits package’ for the NHS that sets out explicitly what care and services patients are entitled to. It looks at other countries’ experience of trying to set out unambiguously what is covered by their publicly funded healthcare system, and compares the advantages and disadvantages of this with those of the current UK system.

The authors argue that although transparency of rationing in the NHS might help avoid the current public perception of unfairness and a ‘postcode lottery’, the current system allows doctors discretion and flexibility to respond to local and individual patients’ needs.

They conclude that cost and practical difficulties mean the Government should not produce an explicit account of what the NHS does and does not provide. But they do recommend improvements to the current system to avoid perceptions of unfairness. These include establishing a set of principles on how NHS money is spent, to be enshrined in the NHS Constitution and restated in the annual Secretary of State for Health’s mandate to the NHS Commissioning Board; producing a list of treatments on which NHS money should not be spent; and ensuring that CCG decisions are transparent.

The Nuffield Trust’s head of policy Dr Judith Smith (pictured) said: “Many people believe [the current system] is opaque and that your postcode can determine whether or not you get access to certain treatments.”

She said that unless the NHS Commissioning Board works closely with CCGs to ensure that guidelines are followed, and decisions are subject to proper public scrutiny, there could be “greater calls for defining at a national level what is funded on the NHS and what is excluded, which we believe would have significant drawbacks in terms of limiting the autonomy of local clinicians to make decisions based on what is best for their communities.”

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