GP's 'rationing' healthcare already ... and they're not even being 'bonused' on it yet!

The number of patients being referred by their GP to see a hospital specialist has dropped by almost 5% over the past year, prompting fresh concern that access to care is being rationed as a direct result of the pressure on NHS finances.

GPs in England referred about 3.6 million patients for a first hospital consultation between April and July, according to data from the Department of Health (DoH). That was 4.7% fewer than the same period in 2010 – 3.8 million referrals.

The number of patients being seen by consultants after a GP's referral also fell during the same period, from 3.1 million last year to 2.9 million – a drop of 5.2%. The two sets of figures do not match because many patients remain on waiting lists.

The British Medical Association (BMA), the doctors' trade association, said that reductions in patients' access to healthcare were happening more often.

"The NHS is under a lot of pressure to do less, for example through referral management initiatives, which seem to be on the increase. These may save money but for every lost referral there is a patient who is not getting diagnosed or treated, and a hospital that is more likely to encounter financial problems," said a BMA spokesman.

John Healey, the shadow health secretary, also warned that some patients may be missing out on drugs, surgery or other treatment because of the falling number of referrals.

"While it is important to reduce demand for hospital care, patients will want reassuring that they are not being denied necessary treatment," he said. "These figures show the huge pressure on hospital finances at a time when David Cameron is wasting millions of pounds reorganising the NHS bureaucracy."

The NHS in England is struggling as its budget increase this year is just 0.1% – after a decade of big annual rises – while it seeks to save £20bn by 2015. The efficiency drive was ordered by the NHS's chief executive, Sir David Nicholson, in 2009, intending to free resources for the growing number of patients, especially elderly people, with long-term conditions such as cancer, diabetes and obesity. Nicholson has told the NHS several times not to limit services in order to meet the target.

GP's are not being 'bonused' to 'ration' healthcare yet but make no mistake ... plans for GP commissioning has this at its heart ... e.g. the less spent on patient care the more their consortium will profit ... and the more the consortium profits the more the GP's will receive in dividends (i.e. cash straight into their bank accounts) ... to compliment the multimillion pound windfall they'll also receive when they decide to sell off their 'stake' in their consortium. 

Conflict of interest? You bet! Government prepared to fix this fundamental flaw in the reforms plans? Absolutely not! The real reason for these reforms is cut the healthcare budget ... and 'rationing at source' (i.e. at the point where people might be diagnosed and/or referred) is the simplest and most effective way the Government see to do this ... but they know they'll have to 'bribe' the GP's to get them to do this!

Some GP's are clearly already 'signalling' their 'enthusiasm' and 'ability' to do this ... whilst others steadfastly refuse out of principle. What people fail to realise is that not only will they be rationing healthcare, these soon to be multi-millionaires will also be looting the NHS of the finance is desperately needs to spend on healthcare!

Hippocratic oath - or Hypocrasy ...?

When diagnosing patients in the future ... will patients believe and have trust in what their doctor says and recommends? ... or will that vital trust be broken ... with patients trusting them little more than politicians? **

Unsure ... well if you need more information in order to decide ... why don't you listen to what trustworthy and honorable GP's say ... and/or the latest news on GP's being caught charging the NHS for treating patients that don't exist ... or who died years ago!

** Age old saying: 

Question: "When do you know a politician is lying?"

Answer:   "When their lips are moving!"

"Weapons of mass destruction", "I pledge not to raise tuition fees", "I'll cut the deficit, not the NHS" ...

No to GP commissioning ... to ensure good decisions and to avoid conflicts of interest

MP's are heaping yet more pressure on the government now by suggesting GPs should not be allowed to take control of the budget all by themselves - take a look at this article in the Telegraph for instance.

The House of Commons' health committee said they should be joined by a range of staff including nurses and hospital doctors to decide how funds are spent.

The move would improve accountability and decision-making, with the MPs stating that the sole focus on family doctors involved in GP consortia is wrong.

Instead, they said the GP consortia should be re-named NHS commissioning authorities and be overseen by a board with representatives from other specialities.

"The expertise of other professionals was essential to ensure the best decisions were taken and to avoid conflicts of interest".

The MP's in the Health Committee are pointing out the obvious ... e.g. the need "to avoid conflicts of interest" ... Public health vs GP profits (from rationing healthcare).

NB their suggestion will not solve this problem entirely ... as a GP's decision to refer a person for treatment is taken in their head ... so most of the time people won't know whether their GP has rationed their care or not! Hence GP's should not be allowed to profit from decisions they make in any other way! NB if you think all GP's are honorable and trustworthy, just remember how they took the taxpayer to the cleaners the last time they re-negotiated their contracts (whilst dumping out of hours cover) ... which was unfortunately down to the incompetence of the last Government too!*

Let's see if the current Government, who said yesterday that they are 'pausing to listen', actually 'listen' ... or whether they're just trying to avoid a total massacre in the forthcoming local elections (before pressing on regardless).

* NB I raised this issue on Question Time at the time these changes were being pushed through, and a fellow blogger made the following point about a GP's recent comments on Question Time too. 

"In a recent BBC Question Time programme a GP from the area from which the programme was being broadcast stated that he was aware of a conspiracy amongst certain GP's to loot the NHS budget for their own financial interest, which, in his view would be detrimental to patient care".

Another honest and trustworthy GP "spilling the beans" and the public ignore this at their peril - as ignorance blinds ... but apathy kills!

The fightback: by the honorable doctors ... and by citizens telling their MP's

Dr Jacky Davis explains why it's wrong ... but the greedy GP's [enticed/bribed by £300k+ salaries], supported by the BMA chief, ensured such opposition fell short of total rejection [as the greedy GP's want the money]!

By clicking here you can join the thousands of people already telling their MP's to vote against this bill ... and tell all your friends to do this too ... as ignorance blinds, and apathy kills (quite literally if this health bill is passed)!

'Patient Care' vs 'GP Greed' - the real battle within the BMA

Doctors have today called upon the government to put a halt to its overhaul of the NHS in England, but stopped short of opposing the plans outright [nb due to GP greed]!

An emergency meeting of the British Medical Association - the first of its kind for nearly 20 years - urged ministers to withdraw the health bill so the plans could be looked at again -  plans the union did describe as "dangerous and risky".

The emergency meeting was called by the BMA leadership after concerns from its grassroots membership about the plans. The motion voted in favour of by delegates says withdrawing the health bill is needed so that the controversial and more radical elements of the legislation can be considered again. But a motion calling for outright opposition of the plans was narrowly rejected [nb a key moment, and again the result of greedy GP's].

This emergency meeting was called because those members want the BMA to go further and harden its stance following discussions by the leadership on Wednesday. The result could force union's leaders taking a tougher line with government.

However the 'government' - and in particular No. 10 - is 'fully committed' to the plans [even though the Liberal Democrat party - who are part of this coalition government - rejected the plans themselves only two days ago]! The bill is already well on its way through parliament [nb a bill created without a mandate from anyone and which is being forced though by No. 10] and pilots are starting across the country [nb they had no problem bribing a few greedy GP's to try it].

BMA leader Dr Hamish Meldrum said he would rather see the NHS as the preferred provider instead of having a level playing field with the big health companies, and said "We want to put more pressure on the government to change what are flawed and very risky proposals for the NHS" [nb he has deliberately avoided referring to the fundamental conflicts of interests, and GP profiteering, that these current plans create].

More than 300 doctors attended the meeting with many supporting Dr Meldrum's stance. Dr Layla Jader, a public health physician, said: "The NHS needs evolution not revolution - these reforms are very threatening to the future of the NHS. If they go through, our children will look back and say how could you allow this to happen?" [Well said - I couldn't have put in better myself].

Members voted not to support a "damaging and unjustified" shake-up, which will see GPs get control of much of the NHS budget along with the scrapping of primary care trusts and strategic health authorities.

A Department of Health spokesman said: "We are disappointed the BMA has decided to take this step rather than work constructively with us to improve services for patients. The reality is over 5,000 GP practices, covering two-thirds of the country, have already signed up and have started to implement plans to give patients better care" [nb those not voluntarily signing up are being forced to as no alternative is being given].

What they fail to highlight is the moral battle going on in the BMA, where on the one hand there are greedy GP's who see a fantastic opportunity to profiteer  [and who do not want the BMA to intervene] ... and on the other there are all the trustworthy and honorable doctors who are strongly against the plans due to the clear/fundamental conflicts of interest they create [but who have until now had little/no support, as the BMA has till now tried to play a 'passive role' in order to support the greedy GP's).

By 'bribing' greedy GP's, this Government is trying to push through it plans and it has effectively split the BMA [a clear 'divide and conquer' strategy]. But will it work ... IMHO I unfortunately think it will ... though I obviously hope it does not!

This Government is trying every trick in the book and if they do succeed, they will, without any mandate from the people, dismantle the NHS and destroy the trust a patient should have in their GP in the process.

NHS Reforms: Patient Choice or Doctor's Choice?

There is lots of Government spin about current NHS reforms being all about 'Patient Choice' ... but the reality couldn't be further from the truth ... as these reforms are all about 'Doctor's Choice' (or more specifically 'GP choice'), as NHS budgets are handed over to them to manage. 

As my previous blog pointed out, most GP's have already profited very well from previous 'reforms' (e.g. taking massive pay-rises for themselves whilst working far less hours), and have shown themselves to be more than happy to pocket any additional money too (e.g. spending it on building property portfolios).  

So now the plan is give them virtually all the NHS budget (£80bn) to spend ... under a mirage of 'Patient Choice' ... when in reality GP's will be making all the decisions themselves, and ensuring they maximise the amount of money paid to themselves, their consortia and business partners. Deals, bribes, partnerships and back-handers will all undoubtedly be uncovered, in addition to all the additional lucrative Government 'incentives' on offer (for helping the Government to achieve £20bn in 'efficiency savings').  

'GP's Choice' will become increasingly a choice between 'caring for patients' and 'caring for their own bank balance' ... something many honorable and trustworthy GP's have already expressed concern about.

The Coalition have countered this by saying 'Patient Choice' means patients can go to a different GP if they wish, but the reality is likely to be the complete opposite of this, with 'GP Choice' resulting in GP's being more likely not to take on patients with serious conditions, and more likely to restrict the healthcare provided to the most needy/unwell in our society too (e.g. for treatment of expensive chronic conditions).


The reforms being proposed are testing the honor/integrity of our GP's, with many unhappy about how they compromise their unique (and trusted) position ... of being able to provide healthcare in the best interests of their patients. At the same time, others are no doubt quietly look forward to further pay increases and taking advantage of many additional ways to boost their bank balances (e.g. 'buying-in' additional services - provided by themselves!) ... at the expense of patient care.


If "Patient Choice" is really behind this reform, at what point did patients 'Choose it'? ... as it was not part of any of the Coalitions' pre-election prospectuses!  


I'm afraid it's all smoke and mirrors and spin again I'm afraid ...

Update 29/01/2011: More healthcare groups are raising their concerns, including the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing. Many commentators, including the Nuffield Trust research body, are expressing their fear that patients will lose faith in their GPs if they believe they are denying them treatment on the grounds of cost. It also pointed out that the pay doctors receive, likely to include cash bonuses, will be “sensitive”!