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Wednesday, January 20, 1999 Published at 08:14 GMT


GPs admit to rationing care

GPs admit they have to ration care

Nearly six out of 10 GPs say they are not giving their patients the best possible treatment, mainly because of NHS rationing.

The BBC's Richard Hannaford on rationing
A report by the Association of the British Pharmaceutical Industry (ABPI) found that 58.5% of doctors think patients are missing out on the best treatment.

More than half of these said their health authority had rationed treatment.

The report flies in the face of the government's continued assertions that rationing does not exist in the NHS.

The ABPI admits rationing has always existed in the NHS, but says the current system is "dishonest and obscure" and shuts patients out of the debate on how rationing decisions are made.

And it says the government's solution to variations in healthcare - to set up the National Institute for Clinical Excellence (NICE) to make across the board decisions about drug availability - may make matters worse.

"We are in favour of initiatives which drive up standards of care and iron out inconsistencies, and NICE could be a means of achieving this," said Dr Trevor Jones, director general of the ABPI.

"But there is a grave danger that such an activity could be used as a barrier to prevent patients getting prompt and ready access to innovative new medicines."


The ABPI fears NICE could become a "bottleneck" for innovative new therapies.

It wants patients to be involved in the rationing debate.

Its report, Hard rations: Getting the right treatment for the NHS, looks at who decides over rationing and how the issue is dealt with.

It concludes that people across Britain are failing to get the medicine that it best for their illness.

It says some rationing decisions are very short-term and could actually lead to greater long-term expense for the NHS and social security budgets if patients get sicker and have to be admitted to hospital or go on benefits.

"The pressures to pull up the drawbridge with new treatments are likely to become more powerful in the eyes of some health managers and doctors, unless a wider perspective is taken of different social values and savings downstream to other budgets," it says.

It specifically looks at rationing of treatments for cholesterol-reducing medicines which cut heart attacks by a third, treatments for Alzheimer's Disease, motor neurone disease, schizophrenia drugs which reduce side effects, cancer treatments and drugs for multiple sclerosis.

Rationing is a fact of life

[ image: Dr Judy Gilley: rationing will become more explicit]
Dr Judy Gilley: rationing will become more explicit
Dr Judy Gilley, joint deputy chairman of the British Medical Association's GP Committee, said she thought most GPs were ensuring that patients received drugs when there was a genuine clinical need.

But she said rationing had been a fact of life in the health service for many years - the most obvious example being the waiting list.

Dr Gilley said the creation of NICE and of primary care groups run by GPs to decide how NHS resources were spent would open up the allocation process to greater public scrutiny than ever before - and increase pressure on the government to make more resources available..

"The rationing agrenda is not going to go away, but effectively we are having a taking off of the wraps," she said.

"PCG meetings will be open to the public and that means if cutbacks have to be made because there is no money in a health area there will be a much greater chance of such decisions hitting the local press. GPs must learn how to use that working relationship with their patients."

Government defence

The Department of Health defended the Government's efforts to ensure the most effective treatments reached the patients who needed them.

A statement said: "The take-up rate of some new treatments has been too slow, and needs to be speeded up. That time lag is nothing new, it has always existed.

"This is all about how fast patients get extra and better treatment, not about cuts and reductions. In the past the NHS had little or no machinery for identifying best practice and spreading it. That is one reason for the problems involving new drugs."

The statement stressed that NICE had been established with the full support of the medical profession.

"The job of NICE will be to appraise new treatments, new drugs, and new medical devices, and issue authoritative guidance to the professionals who wish to use them.

"That will give individual clinicians more help than they have ever had before when they have to make decisions about the treatment of individual patients.

"As a result, best practice should be spread much more quickly and ineffective treatment discouraged."

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