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Guidelines 'force GPs to act against patients' best interests'

By Gareth Iacobucci

Exclusive: GPs are having to make prescribing and referral decisions that they feel are against the best interests of their individual patients because of local guidelines designed to deliver cost-effectiveness to the whole population.

Pulse's survey of 350 GPs reveals that 20% of GPs regularly felt compelled to follow clinical guidelines they did not believe were in a patient's best interest, and that a further 58% of GPs sometimes felt in this position.

Similarly, 64% of GPs said adhering to their local prescribing formulary meant they sometimes or, in the case of 13% of GPs, regularly denied patients drugs they thought were best for them personally.

There was concern too over the degree to which finances have been allowed to constrain referral decisions, following a series of Pulse reports showing primary care organisations have been restricting referral criteria for common procedures such as hit and knee replacements. Some 69% of respondents said they sometimes felt compromised in their referral decisions by financial interests, with 47% occasionally feeling this way, and 22% regularly so.

Dr Mary McCarthy, a GP in Shrewsbury, said GPs were feeling increasing pressure on their behaviour due to the cold financial climate.

She said: ‘We are continuously being pressed. The budgetary restrictions are making it increasingly obvious as to what the NHS can and can't afford, but it isn't filtering down to patients. We need an open and honest debate.'

Some GPs are having to make prescribing decisions they feel are against the best interests of individual patients Some GPs are having to make prescribing decisions they feel are against the best interests of individual patients Click here for more from our guest editor issue Guest editor issue Guest editor: Professor Martin Roland

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