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Lead 'national debate' on what services NHS should cut, GPC told

Grassroots GPs have instructed the GPC to launch a ‘national debate’ with Government and health bosses on what care the NHS should stop funding.

The policy was devised at the annual LMCs Conference, where delegates argued GPs are getting the blame for ‘postcode lottery’ rationing decisions that are preventing patients from accessing treatments.

Delegates voted in favour of a motion proposing the GPC 'engages the country in debate on what should be rationed' – despite counter-arguments that the new policy would ‘play into the Government’s hands’, and warnings from GPC that it would detract from work on other more GP-specific concerns.

Proposing the motion, Dr Brian McGregor from North Yorkshire LMC said: 'GPs are left holding the baby and having to have that discussion with the patient – yes, we can do something for this but I can’t because the CCG won’t let me, you don’t tick the boxes...

'What we need is for GPC to take a lead on this, get politicians and management involved and actually bring in some guidelines that don’t give us a postcode lottery, that actually give quality of care to everybody and make it clear for everyone that this is the system, this what you need to do and this is where you get your care from.’

But, arguing against the motion, Dr Annie Farrell from Liverpool LMC said passing it meant 'playing right into the current Government’s hands'.

She said: 'This Government is doing much more than just not discussing this, it is actively promoting untruths or “alternative facts” about funding for and availability of care for patients within the NHS.

‘Rather than playing into their hands and doing the Tories’ dirty work for them and colluding with the Government in rationing care, the GPC should be aggressively challenging this misinformation… and promoting the model of a properly funded NHS through taxation which is a viable option if there is a will in the country to do it.’

Speaking on behalf of the GPC, Scottish GPC chair Dr Alan McDevitt also urged conference delegates not to pass the motion.

He said: 'You keep telling us at GPC our job is to represent GPs and we should spend our time, money and effort represent you.

‘The effort to do this to engage the whole nation in a discussion of [wider NHS rationing] could consume all our energies for years to come.

‘We would also be seen as having a vested interest in that.’

But despite the plea, LMC delegates voted to pass the motion.

Later on in the debate, grassroot GPs also set out GPC policy to push for negotiators to ensure GPs are no longer required to write prescriptions for over-the-counter medicines and foods.

Although Dr Shaba Nabi from Avon LMC said this also counted as ‘a form of rationing’ she added: ‘We need it, GPs in deprived areas are drowning in demand.

‘Patients are not coming to see us because they want clinical expertise but because they want a free prescription, because they believe they are entitled to.’

Dr David Wrigley, BMC council deputy chair and GPC member, warned this would be ‘catnip’ to the Government, as ‘GPs making the decision to restrict medicines or services, or introduce co-payments, is just what they want to hear’.

Dr Wrigley said: ‘This will be the thin end of a very large wedge.

‘More medicines will be deemed unsuitable for the NHS to pay for.’

But indicating support for the motion, GPC prescribing lead Dr Andrew Green said that as it did not suggest GPs could not prescribe items where necessary it did not amount to rationing.

He said: ‘It is about protecting GPs from doing work they don’t have to do.’

The motions in full

Rationing

'That conference believes NHS rationing is happening, and politicians will not discuss this due to the implications; conference demands that GPC shows some genuine leadership and engages the country in debate on what should be rationed.'

OTC medicine

'That conference demands that NHS prescriptions are no longer required for the NHS provision of:

I agree with watchdogs principle, the Hospitals and GPs should say what they will treat and patients should pay for the rest possibly by private insurance.Heart and cancer yes, many orthopaedic and physio procedures no etc.

No, what is needed is the concept of top up. As in Australia, most NHS services are free. The important stuff for the NATIONAL HEALTH, after that the more expensive contraceptives for example, some procedures you pay for or top up the NHS subsidy.Currently in the UK top-up is regarded as immoral by the standards of the 1940s, at that time it made sense that the limited offering of medicine should be free to all. Now patients understand choice and medicine is not absolute. That with limited evidence or poor value for the health of the nationals should be subject to top-up. No political party could every suggest this. Political suicide... but it is necessary.

In Ideal world I would like even liposuction/ breast implant on NHS as it may affect some people's mental health quite significantly. Question is what can society/ country afford? Sky is limit for Spending on healthcare. Even if government increases spending on healthcare by few billions for next 1-2 years it will not make problem go away forever because we will need even more money year after that. Society has to decide on what country can afford and what it cannot afford to spend on healthcare & then anything extra will need to be paid directly by public. I am sure GPs who are more stricter or able to say no are not very popular or likely to invite more complaints. So why should they have to pay price to protect NHS meager resources. Saving/propping up NHS is Government's responsibility. Everybody should be treated equally,That's is why it is very important that we have some central directive/ guidelines which will relieves GP stress/unnecessary appointment. Let politician/ government take blame for rationing not us as they are the who have underfunded the system. If we shout for another 100 years asking for more funding NONE WILL COME.

Sounds simple - until you stop and think about it... what about the patients on multiple OTC items? What about paracetamol - do we expect patients to visit the pharmacy every other day to buy 16 tablets? What about nutritional supplements? Dressings? Should we be taking into account our patients' ability to pay, and if so, how? - the state requires a huge slow bureaucratic process to make the decision over who requires the benefits that trigger free prescriptions, am I supposed to make an equivalent assessment during my consultation?

I believe that any scheme for restricting OTC prescribing would have to be binding; one could reclassify certain items as no longer prescribable on the NHS. But any scheme which is at the discretion of the GP is just a recipe for confusion and dissatisfaction.

During summer I notice that lot of patients book in to see GP for antihistamines which are cheap as chips but they do so as they are eligible for free prescription .What about GP consultation cost to nhs ?