Financial pressures 'hard to bear'

By Graham Satchell
BBC News

William Robinson does not want to switch to cheaper drugs

Dr Phil Griffin has been a GP for more than 20 years.

He says he has never felt under such pressure to save money.

Last month, for example he received a letter from health managers which tells doctors to keep referrals to "an absolute minimum".

"I've not experienced the sort of financial pressure that we've been under in the last 12 months ever before and it's increasingly difficult to cope with," he said.

One way the NHS is trying to save money is by using cheaper forms of drugs like statins that control cholesterol levels for heart conditions.

The government wants to save money by moving 60% of patients on to cheaper generic forms of the drug.

Tough target

In St Albans the local NHS has a deficit of more than £20m.

Doctors have been asked to move 80% of patients onto the cheaper form of the drug.

William Robinson, who had a heart attack eight years ago, is among those who managers would like to see taking the cheaper drugs.

He is worried about being forced to take the generic version of statin.

Dr Phil Griffin is concerned patients are at risk

"To do something like that pure and simply to save a few pounds here and there against the overall value of a life - why?

"I just don't understand why they need to do that."

At present, Dr Griffin is still giving William the more expensive form of the drug in defiance of the new guidelines.

He says putting 80% of his patients on the generic drug is potentially dangerous.

"If you implement this policy across that population there will be an overall increase in the risk of cardiovascular disease - and in some patients that could be very serious."

The local strategic health authority - covering the East of England region - says generic statins are suitable for the majority of patients - and using them will save the region around £40m.

No autonomy

One generic version - simvastatin - is about £20 a month per patient cheaper than branded versions.

In a statement, the SHA said: "Each patient is clinically assessed before a decision to change their drug is made, and changes will not be made for those patients who have clearly defined contra-indications to the change, or if satisfactory cholesterol levels cannot be achieved on a generic drug."

But doctors see it as just one more example of the way the NHS is trying to balance its books - possibly at the expense of patients.

Dr Rosemary Leonard, a GP in London, said: "I feel my autonomy and my decision making is being taken away from me."

She said some GPs were also very worried about guidelines they had been given.

"For instance, in my area we have been given a checklist for referring women with pelvic pain.

"In that checklist we are supposed to prescribe some very specialist drugs, which if you have done gynaecology training you would feel competent to use, but about which many GPs feel very unhappy.

"We are being expected to do more and more treatments in primary care that we don't necessarily feel competent to do."