Politicians must be honest about NHS rationing

Earlier this week, GP magazine revealed the huge rise in appeals that GPs are having to make so their patients can access NHS care.

The government is hardly shouting from the rooftops about this sort of rationing or the introduction of low-priority procedure lists by 90% of PCTs. But local GP practices do at least display leaflets explaining individual funding requests and ‘planned procedures with a threshold’.
Other forms of rationing and manipulation of patient referrals are far less visible to GPs and patients.

In February, GP revealed that managers were systematically manipulating referrals to hit financial targets. Every year, the proportion of GP referrals that lead to hospital appointments falls by more than 10% in the run-up to the end of the financial year.

Analysis of data since then, up to the end of September, show the problem has continued to affect referrals. As the graph below shows, the proportion of GP referrals that lead to hospital appointments falls every year in the run-up to the end of the financial year, before recovering again. The data behind the graph are available here.

In fact, there were around 54,000 fewer hospital appointments in March 2012 than would be expected if referrals were leading to appointments at the same rate as during the rest of the year.

As the UK Statistics Authority warned recently, the DH has a long way to go to make the data it releases more transparent. But, even now, there is a huge amount of data showing that limits of patient access to care go far beyond simple rationing.

GPs and patients alike need to know about this, but they should not have to trawl through DH statistics to find out how care is being restricted.

What is needed is political honesty, at a local and national level, about what the NHS can and cannot fund and what care the NHS will and will not provide to patients.

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