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GPs go forth

Patients consulted on charges for walking sticks and knee braces by CCG

Exclusive CCG leaders have asked patients for their views on charging them for the supply of vital equipment such as walking sticks, knee braces and wrist splints in order to improve ‘value for money’, Pulse has learnt.

The proposal to charge for orthotics - made at a public participation group last week - is likely to mark the first time a CCG has considered charging patients for equipment usually provided free on the NHS.

GP leaders reacted angrily to the move, saying that it was a ‘worrying’ development for the NHS.

But the NHS South Warwickshire CCG - who raised the idea at the PPG - told Pulse that the idea of patient charges were raised alongside a ‘number of avenues’ at the meeting and that it was part of several ideas to improve the quality and value for money of the service.

The move comes after the prospect of greater use of patient charges in the NHS was supported by two influential voices. The King’s Fund recommended the Government considers charging patients up to £25 for a GP appointment and a former health secretary also called for GP charges.

The recent meeting with the patient participation group had a presentation on ‘options for self-funded orthotics’ and a GP at the meeting who did not want to be identified said that the reaction to the proposal was ‘hostile’.

Currently, the CCG has in place a £421,000 block contract for orthotics equipment with South Warwickshire NHS Foundation Trust and a spokesperson said that the meeting was discussing ways of improving the way this was run.

A spokesperson at NHS South Warwickshire CCG said: ‘At our latest patient and public participation group, one of our discussions was about how to improve quality and value for money of our orthotics service.

‘A number of avenues were discussed, in particular helpful comments about the equipment returns process and whether charging for equipment should be considered. This has not been discussed further within the CCG since the meeting and no proposals exist to develop this further.’

Gillian Entwistle, chief officer at South Warwickshire CCG, added: ‘The CCG includes patients at an early stage in its thinking about options for the development of services to ensure their opinions can inform its decision making.’

But GP leaders hit out at the proposals. Dr Robert Morley, executive secretary at Birmingham LMC, said that charging for essential equipment was a new development for CCGs.

He said: ‘If orthotics are part of a patient’s NHS treatment then the NHS has a responsibility to provide them free to patients. What are patients going to be asked to do next, pay for cardiac surgery?’

Dr Kailash Chand, deputy chair of the BMA, said: ‘This is definitely new. Things like this have been going on as far as the social care is concerned, but when it starts becoming a part of the mainstream, I think it is worrying.’

Readers' comments (16)

  • I think this is a reasonable idea to float- but suspect there will be widespread disapproval from the public.

    I would also like to see a charge for all food items - perhaps an exception for parental nutrition.

    When in hospital you do not need to save money by not paying for your own food. Paying for food will increase the quality of food - with agencies knowing they will only get money if the food is up to scratch. There would have to be enough competition for it to work.

    At home free nutritional drinks create an absurd incentive not to be able to eat food. There are expensive but less than a meal.

    As far as coeliac foods - this is no longer the 1960s, you can get it everywhere, it is not that expensive and you can just buy other food that does not need gluten.... like vegetables.

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  • Vinci Ho

    (1) As I said ,while Darth Vader and Agent Hunt are 'enjoying' the fame of injecting 50 millions to make GP practices to open 8-8/7Ds , the government is pressurising CCGs to cut out bread and butter spending. Can people see the truth now? Of course, if one has rejoiced about the low inflation rate and catching up average wages reported today, good luck
    (2) Has one also read the news about:
    Figures from the Trussell Trust which reveal the food bank charity handed out emergency food parcels to more than 910,000 people in the last year make front-page headlines.
    (3) The arrogant theory from politicians is of course, all these people are 'abusing' and dependency has was created.
    (4)Those with no virtue denying benevolence and holding high position in a hierarchy , spread the evil through the most.
    (5) I wonder what William Beveridge would say if he was still alive today?

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  • co-pay? never thought i'd here that in the nhs but here it is in the flesh...

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  • I have to agree with "Anonymous GP Partner" - most prescribing has steered away from "all gluten free foods" and now only allows those which support a healthy lifestyle (ie no biscuits) but even so, there is still a lot that could be done. Also, plenty of patients over-order on the basis of "It's free" or "I have a pre-payment certficate and I want to get my money's worth". I often wonder if patients will look after things (eg walking sticks) better if they have to pay for them. If there is one message the recent changes in the NHS/financial crisis have promoted, it is that there is only a limited amount of money and best value has to be gained from it

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  • Vinci Ho

    Argument understood .
    But if one put oneself into the shoes of these patients, have they had a chance to say anything? What if they genuinely cannot afford to pay this money? This cost has been imposed on them. Remember , when the government imposed all these stupid QOF points on us last year. How do you feel ?
    Confucius once said , ' Do not impose things you don't desire on the others'

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  • @Anonymous | GP Partner | 16 April 2014 5:49pm

    I have always paid for every single piece of equipment I've needed - walking sticks, crutches, manual wheelchairs, powerchairs, nebulisers - the list goes one.

    I will not - absolutely not - pay for the execrable food inflicted on patients in my local hospital.

    I spent 10 weeks there last year, in three sessions, and saw the food go from adequate portions of very decent food, prepared in-house, to tiny, repellent, portions of outsourced dog food. And in one week, 14 of my pre-ordered meals - that's all of them - failed to arrive at all.

    Pay for this? They should pay me.

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  • Una Coales

    Co-payments should have been introduced much sooner and the ability of GP partnerships to offer private services alongside NHS, to subsidise and keep their surgeries solvent amidst the MPIG and QOF state cuts. Instead we will see a domino effect of surgeries closing, the public put at high risk as they will not be able to get a GP appointment in a timely manner, and the NHS will collapse faster. For all those who objected to even a fiver or a tenner, you will see instead no NHS and all private at much higher self pay or insurance cost to the public.

    What happened to adopting Ireland, Canada or Australia's system of semiprivate healthcare so we could offer state alongside private as GPs? NHS dentists offer 50:50 state and private services, the latter subsidizing the former as a way for their businesses to stay open.

    The only solution is national strike action as this contract will only lead to the end of general practice and redraw another one that allows GPs to charge patients for private services in their building and also to buy their buildings so they may become semiprivate solvent practices, ie bring Australia to the UK instead of send all our GPs and consultants to Australia.

    For young GPs who must remain, I would suggest you sign up to private practice as a means to have a job and learn new skills instead of suddenly receive your salaried GP redundancy notice from the NHS or receive lots of stress as a GP partner trying to run a business on half the budget.

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  • This is the bear trap set up by the government which the CCGs are blithely walking straight into. It was always the intention of the government to pass the responsibility for charging and rationing on to someone else but them. 'It's your GPs who have advocated charging' they can then say and take away the focus from the inadequate budget that is being given to the NHS.

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  • On the face of it charging patients for medical items is appalling. However, this is already happening. Patients on chemotherapy who lose their hair have to buy their wigs - unless they are on benefits. This is worse than straight charging - it's means-tested!!

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  • I think the CCG is being very brave, in the 'Yes Minister' sense.
    We all know we have to reassess how we pay for health care, the politicians are just too gutless to have a full and frank discussion. They bleat on about a referendum on Europe , what we really need is a referendum on what our health services should look like

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  • Vinci Ho

    Yes. I would support a referendum only if these politicians still know what democracy means......

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  • Many patients get Attendance / disability Living Allowance which my understanding was to help meet the cost of their extra needs.
    Surely this should include walking sticks etc.
    The sad thing is that you can walk around any boot sale and find a vast amount of NHS equipment that is no longer needed, where the patient has died and families have nit returned the items, or where selfish folk have purchased more fancy items e.g. decorated walking sticks!

    It is not unfair to expect patients to pay for smaller items if they are on specialised benefits DLA / AA.

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  • My understanding is that Disability Living allowance and attendance allowance was paid to meet the extra cost of coping with care needed. surely this money should be used to meet the cost of these items.

    Walk around any Boot Sale and see the vast amount of NHS equipment for sale, where the 'owners' have died or the 'users' have just not bothered to return the items to a hospital. In some boot sales you could buy enough items to equip a nursing home!

    All equipment provided by the NHS should be labelled 'NHS Equipment' banning it from being sold anywhere.

    Patients purchase decorated walking sticks then dump the NHS, they do not cost the earth so should be paid for from DLA / AA after all what is this extra money supposed to be spent on?

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  • Vinci Ho

    There are three requirements for a accountable government :
    (1) democratic politics
    (2) responsible politics
    (3) ethical politics (most important)
    At this moment of time , this government is forcing CCGs(hence commissioners) to point the arrow to common people so as to fulfil this fallacy of 'efficiency saving '(we all know who creates this term) . Do you not think these requirements are all betrayed?
    If all commissioners throw their towels and walk out tomorrow , we send a loud and clear message ,and expose the government to common people the conspiracy of wiping out NHS once and for all through the HSCB.......

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  • @ Una Coales "Co-payments should have been introduced much sooner and the ability of GP partnerships to offer private services alongside NHS, to subsidise and keep their surgeries solvent amidst the MPIG and QOF state cuts. Instead we will see a domino effect of surgeries closing, the public put at high risk as they will not be able to get a GP appointment in a timely manner, and the NHS will collapse faster."

    I find this an appalling statement, I do hope the BMA Council won't be making statements like this. Co-pay is abhorrent, it is a tax on the sick. Your comment about dentists is at best naive: many dentists do not have NHS patients (as far as I know, dentists do not have to have NHS patients) and so it is not a case of private subsidising NHS patients, it's a case of private work paying for the dentist's yacht. In desperation many people have to use private dentists, they have no choice.

    As to why we are in this situation, it is clear: the government is abrogating its responsibility to provide the funds to deliver a comprehensive universal healthcare system. They will pay for that at the ballot box. Co-pay increases health inequalities and increases administration (and increases employment for debt collectors).

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  • A point to remember is that many folk get DLA or other benefits which should require them to pay fro aids, that is precisely what the benefit of for.
    Walk around any boot sale and see the amount of NHS equipment you can buy very cheaply, sticks, nebulisers, crutches, wheelchairs, meal trolleys etc. etc.
    If the patient is getting care benefits they should pay, a refundable deposit should be made by all other folk. We pay for medication so why not pay for other types of aids, make them available on POM, at least that would address some of the funding issues.
    We have got to move away from the idea that if you are sick / disabled, everything comes free of charge!

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