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More pain ahead for NHS

From Dr Paul Charlson


East Yorkshire

If you think the NHS is bad now wait until after 2008 when it is set to get a lot worse. The rises in NHS spending of 4.5 per cent per year are set to slow after 2008 to about 2 per cent.

Despite this the Government continues to announce new initiatives. Can we really afford the luxury of personal trainers for the obese?

To date, funding deficits have been handled as local problems with the blame being laid squarely with PCTs. GPs have also been blamed, yet about one-third of the reduction in waiting lists has been due to fewer GP referrals because of increased primary care activity.

It is clear the NHS cannot continue in the current manner. We need firm guidelines on a variety of peripheral issues, such as the removal of cosmetic lesions and the treatment of overseas residents.

The current prescription system needs an overhaul. Doctors need real incentives to save money on prescribing.

For instance, our PCT could save about £1 million by switching from branded to generic cholesterol-lowering drugs and PPIs. Yet this is not happening because of the extra work it entails.

Currently GPs are lukewarm about commissioning. For it to work, the paucity and quality of information about secondary care activity needs to be radically improved. Incentives need to be attractive and initially there needs to be a decent payment to kick-start activity.

There still exists snobbery among many clinicians and managers that non-NHS providers are second-class. But without a transition to a more mixed economy there is little chance of making major productivity gains.

I have concerns about PFIs. LIFT schemes have greater local accountability in both design and funding and should be used in preference. These schemes are needed to produce the new types of diagnostic and treatment centres, which will be required in the coming years.

When I flick through the medical newspapers at breakfast time and read the views of some of my colleagues, I sometimes feel like screaming 'wake up and smell the coffee' before it hurts not only your patients but also your back pockets!

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