RESTRICTING CLINICAL FREEDOMS
GPs offered cash to refer fewer people to hospital (The Guardian, 28 February 2018)
GPs are being offered cash payments not to refer patients to hospital, in a move which leading family doctors have criticised as ethically questionable and a risk to health.
NHS bodies in four parts of England are using schemes under which GP practices are given up to half of the money saved by sending fewer patients to hospital for tests and treatment
The disclosure by the GP website Pulse about the controversial “profit share” initiatives operated by the four NHS clinical commissioning groups (CCGs) has triggered a row.
Critics said the schemes were the latest example of NHS bodies increasingly resorting to the rationing of care to help them operate within their budgets.
NHS Coastal West Sussex CCG has offered to give groups of practices working together in its area 50% of savings made from GPs referring fewer patients for dermatology care, ear, nose and throat treatment in the community, and minor surgery and wound closure.
Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly it is insulting to suggest otherwise.” Family doctors did need help to ensure they were refer the right patients but that should not involve “ethically questionable initiatives that prioritise cash savings over patient care”, she said.
Peter Swinyard, chair of the Family Doctor Association, said: “From a patient perspective it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”
England’s 207 CCGs hold the budget for the NHS locally and decide which services are provided for patients. NHS West Leicestershire, which is offering federations of GP surgeries 30% of savings resulting from fewer “first referrals”, said the scheme was designed to cut the number of “clinically unwarranted and unnecessary referrals, particularly into secondary care” and would let hospitals treat the most needy cases. ...read more
Care access to be rationed in the hope it will force through extra funding (The Guardian: 30 November 2017)
NHS bosses are to meet to discuss plans to ration and delay patients’ access to care, which could set them on a collision course with ministers over health funding.
NHS England’s board will publicly debate what the service will and will not be able to afford to do next year after Philip Hammond gave it less than half the extra money it said it needed.
Thursday’s meeting comes amid unprecedented tension between the organisation’s chief executive, Simon Stevens, and Theresa May and Philip Hammond. Stevens antagonised both of them with a dramatic pre-budget plea that treatment waiting lists could spiral and mental health and cancer care be hit unless the NHS received a £4bn boost in last week’s Budget. The chancellor awarded it just £1.6bn extra....read more
Hospitals to postpone non-urgent operations due to squeeze on funding (The Guardian, 16 November 2017)
The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.
NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.
They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.
A Liberal Democrat MP, Norman Lamb, a former health minister, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.” ...read more
CCGs demand patients lose weight or face indefinite wait for surgery (HSJ: 17 October 2017)
People in Hertfordshire who smoke or are obese face indefinite waits for routine surgery unless they quit smoking or lose weight, commissioners have decided as they try to save £68m this financial year.
In a decision that could potentially affect more than a third of their population, East and North Hertfordshire Clinical Commissioning Group and Herts Valleys CCG said obese patients “will not get non‐urgent surgery until they reduce their weight” unless there are “exceptional circumstances”.
Smokers will not be referred for non-urgent surgery “unless they have stopped smoking for eight weeks or more”. Patients will be breathalysed before referral but a spokeswoman for the CCGs said “a switch to vaping would count as ‘stopping smoking’”.
The CCGs said: “In exceptional circumstances, clinicians will allow surgery to go ahead even if the smoking and weight loss criteria are not met. Exceptions would be made when waiting for surgery would be more harmful for the patient.”...read more
Antibiotic shortage puts patients at risk, doctors fear (The Guardian: 1 July 2017)
A major shortage of one of the most widely used hospital antibiotics is putting patients at risk, doctors have warned.
There is an international shortage of of piperacillin-tazobactam, an antibiotic and antibacterial combination drug known by the trade name Tazocin, which is usually used intravenously in intensive care. It is also used to treat a wide variety of conditions including cystic fibrosis, pneumonia, urinary tract infections, diabetic foot infections and neutropenic sepsis – a life-threatening condition that can arise in those receiving anti-cancer treatment.
The Department of Health and Public Health England have issued guidance on the problem and hospitals in Scotland have been given advice by the Scottish Antimicrobial Prescribing Group (SAPG). A document from NHS Fife dating from early May says “there is a high likelihood that in the near future piperacillin-tazobactam will not be available at all… this is a major challenge to our prescribing practice.”
The cost of piperacillin-tazobactam and other drugs had shot up, the microbiologist added, while the workload for microbiologists had also increased, due to the number of calls from doctors and emergency meetings to discuss shortages... read more
Smokers trying to quit hit by postcode lottery as GPs ration help (The Guardian: 19 February 2017)
Smokers in England wanting to quit face a postcode lottery as cash-strapped councils and GPs restrict access to services that can help them.
The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision.
Evidence obtained under the Freedom of Information Act shows that an increasing number of clinical commissioning groups – the 200 or so organisations that deliver NHS services in England – have been instructing GPs to stop providing the services. Many of the groups argue that it is no longer their responsibility.
In 2012, local authorities were made responsible for improving public health and given £2.8bn of ring-fenced grants to pay for it. But, as the grants have been pared back, councils have pulled their funding for stop smoking services...Read More
Cash-strapped hospitals face 'unpalatable' choices over care levels, warns NHS chief (ITV: 11 September 2016)
The NHS is close to breaking point and hospitals will have to make "unpalatable" decisions about care levels and jobs, unless the they receives more funding, the head of one of the service's largest trade bodies has warned.
In a number of media appearances on Sunday, Chris Hopson, the head of NHS Providers, warned that without further funding the NHS would need to consider greater rationing of care, staff layoffs and a relaxing of targets.
Writing in The Observer, he said the health service was "increasingly failing to do the job it wants to do, and the public needs it to do, through no fault of its own", and said there was a need for "an open, honest, realistic, national debate on what gives" if no more money is made available…read More
PrEP rationing is symptomatic of NHS bid to cut costs, at all costs (The Guardian: 2 August 2016)
NHS England’s setback in the high court over its attempt to get one set of cash-strapped public bodies (local councils) to foot the £10m-£20m a year bill for PrEP treatment rather than another – itself – is the latest manifestation of the health service’s increasing efforts to reduce the number of treatments it pays for, or the number of patients who receive them, or both.
Gradually, and largely unacknowledged, the NHS is rationing access to more and more types of care in order to try to balance its books, even when doing so includes treatments – such as PrEP, with its 90% success rate – that are proven to work but deemed prohibitively expensive in the midst of its decade-long funding squeeze.
Doctors, patients and health charities routinely insist that lives will be lost as a result, but still the process rolls on, affecting different groups of patients every time a decision is made....read more
NHS 'abandoning' thousands by rationing hepatitis C drugs (The Guardian: 28 July 2016)
NHS England has been accused by a charity of “abandoning” thousands of people to a potential death sentence by rationing drugs that can cure hepatitis C.
An estimated 215,000 people in the UK have chronic hepatitis C infection (160,000 in England), which new but costly drugs can cure. Addaction, a charity that helps people overcome drug and alcohol abuse, says the decision to treat 10,000 people a year is “manifestly unfair”.
Addaction is backing a judicial review application brought by another charity, the Hepatitis C Trust, over NHS England’s decision to cap the annual numbers on cost grounds.
“The decision by NHS England to limit access to treatment is manifestly unfair on a group of vulnerable people who suffer from a terrible disease,” said Simon Antrobus, chief executive of Addaction. “Those who are infected can go on to develop cirrhosis of the liver and liver cancer. Denying these people life-saving treatment is a potential death sentence for thousands.”
GPs told to ignore NICE statin prescribing guidance in cost-cutting drive (Pulse: 2 June 2016)
GPs have been told to ignore current NICE lipid modification guidelines on statin prescribing in low-risk people, under a cost-saving policy at one CCG.
NHS Stockport CCG has advised GPs should only prescribe statins to people if they are found to be at a 20% or greater risk of cardiovascular disease – and not at the lower NICE-recommended threshold of 10%-20%.
The CCG has also stipulated that GPs should prescribe simvastatin first-line rather than the NICE-recommended lipid-lowering drug atorvastatin, as part of measures to control spending.
NICE condemned the decision, which it said meant people were being denied the opportunity to lower their risk of a disease that 'maims and kills one in three'.
The GPC said that the CCG's decision was 'strange' and 'born out of desperation'....read more
NHS England stalls plans for HIV prevention drug (The Guardian: 21 March 2016)
Charities and campaigners have reacted with anger and disbelief that plans to roll out a widely anticipated HIV prevention drug have been stalled by NHS England.
The sector had been waiting for the announcement of the first ever public consultation on the use of pre-exposure prophylaxis (PrEP) in the UK, now overdue by a month. Instead today NHS England announced it was not their responsibility to commission the drug.
The HIV treatment pill Truvada containing PrEP can be taken on a daily basis – in a similar way that women take the contraceptive pill – by men who have sex with men to dramatically reduce the risk of HIV transmission. In February 2015, a Proud (pre-exposure option for reducing HIV in the UK: immediate or deferred) study reported that PrEP had effectively reduced the risk of HIV infection by 86%.
Terrence Higgins Trust, the largest provider of HIV and sexual health services in the voluntary sector, expressed shock and disbelief as structured plans for introducing the drug were shelved...read more