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NHS rationing is putting health at risk says doctors’ leader

Dr Mark Porter, the new head of the BMA, says NHS cuts are ‘morally wrong’ and present a serious risk to patients. NHS rationing is putting health at risk says doctors' leaderThe 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 £20 billion by 2015, Porter claimed.

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- postcode lottery- 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.

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.

From:  http://www.guardian.co.uk/nhs-rationing-risking-lives-doctors-leader

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