This site is intended for health professionals only

At the heart of general practice since 1960

Calling time on the all-you-can-eat NHS buffet

Dr David Turner

Dr david turner duo 3x2

4,700 cataract operations, 1,200 hip operations or a lot less people with dandruff?

This is not the opening gambit to an elaborate joke. NHS England recently revealed the health service currently spends £4.5 million annually on anti-dandruff shampoos.

Now whether or not you think this is good value for money, whether or not you believe that a shiny-haired workforce is more important than a few thousand people with blurred vision or several hundred with hip pain, what you cannot do is ignore the rationing debate.

In the year to June 2017 the health service spent £569 million on prescriptions for medicines that can be purchased over the counter: vitamins, head lice treatment, indigestion remedies, athlete’s foot cream etc.

The NHS was established at a time when a significant percentage of the population was dirt poor

Of course it is not a simple as saying stopping over-the-counter prescribing would free up £500 odd million a year for use elsewhere in the NHS. For a start, it would need to be ringfenced to stop the money just being swallowed up paying off trusts’ deficits.

And then there are those who simply cannot afford the cost of, say headlice treatment. Would we just have to accept some schools will be overrun with the critters so some people can see more clearly?

The NHS was established at a time when a significant percentage of the population was dirt poor and literally could not afford any medicines no matter how cheap they were. Times have thankfully moved on, and on the whole people are healthier and wealthier than ever before and certainly better off than when the concept of free universal health care for all was first conceived.

Any debate on rationing is usually dominated by a loud chorus of complaint from the ‘I paid my taxes’ brigade. Well yes, you probably did, but for many of you it was a long time ago and when you paid tax nobody could have imagined the enormity of the range and cost of the treatments the NHS would be providing now. So, to be blunt, you need to get beyond the idea that what you paid in tax can cover all the health needs for a population who are increasingly living into their 90s and 100s.

What is needed is an open and honest discussion about rationing and it needs to be led by clinicians not politicians, whose main concern is winning the next election.

There are two main choices: pay a lot more tax and fund the health service properly, or accept that we are no longer able to pay for every health-related cost for everyone from cradle to grave.

Dr David Turner is a GP in West London

 

Rate this article  (4.64 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (8)

  • How. Can. A. Clinician. Promote. Debate.?

    People like stuff for free.

    If "Free Universal Health Care" is the famous leftie mantra, then food is as much a human right as health care. Yeah? So why isn't food free at the point of eating ?

    People are also, let's face it with TOny Copperfield, really thick. Did you see the utter effect of the smallest price signal in that real-life experiment of making plastic bags cost 5p or whatever?

    At the level of primary care, a TINY cost signal will wreak a massive change.

    But it requires the law-makers to do their job

    they won't , hey

    Unsuitable or offensive? Report this comment

  • Monty makes a good point which I always make about the outcry about the poor paying for a 16p packet of paracetamol.

    We do not provide toothpaste, shampoo or sanitary protection for free so why isn't there a revolt about this?

    All of these items should be stock in our bathroom cabinets and we need to shed the suffocating nanny state which has mushroomed as it is not doing anyone any favours - particularly the poor.

    Unsuitable or offensive? Report this comment

  • The Problem is politicians will never admit that the state cannot afford free health care for its public. Which politician would want to commit political suicide? Hence we will have this gradual deteriorating health service till public comes to accept that what is being provided is not good enough and they should make some alternative provision themselves (aka private health insurance).

    Unsuitable or offensive? Report this comment

  • Most patients and doctors agree that otc medications should not be allowed on prescription, but when it’s suggested the BMA always have to state that we are contractually obliged to prescribe if we recommend. Surely a simple contractual tweak isn’t beyond the wit of man? This point has gone round in circles for years, someone needs the cajones to push it through.

    Unsuitable or offensive? Report this comment

  • please introduce a national formulary rather than debating each medicine in turn eg coeliac at present.

    Unsuitable or offensive? Report this comment

  • I have this discussion often with patients:

    "Could you buy this medicine over the counter?"
    "But it's free if you prescribe it"
    "Free to you maybe, but not free to the NHS"
    "Oh but it's not too expensive for them, is it?"
    "Well, the tablets cost pence, but add in my time prescribing, pharmacist time dispensing, the dispensing fee, that's the real cost..."

    Some of these patients canoeing, and I prescribe. Others agree to buy the paracetamol.

    Then again, I did see a GP who was prescribing stretch mark cream to a patient a while ago. So maybe not everyone is up for an argument.

    Unsuitable or offensive? Report this comment

  • Canoeing - complain.

    Though I would probably prescribe canoeing if I could.

    Unsuitable or offensive? Report this comment

  • Special Baby milk is free if you have intolerance. But it only costs a few pence more.
    So, if your baby has intolerance you get milk free and if your baby is well, you pay for it. Soon,all babies will have intolerance. Cheaper that way. Just one example of ' bananas'

    Unsuitable or offensive? Report this comment

Have your say