NHS rationing to become responsibility of consortia

By Susan McNulty

Consortia will have to take on responsibility for NHS rationing with GPs accountable to patients for their decisions, health secretary Andrew Lansley told the recent NAPC annual conference.

He said: ‘We cannot dispense with the concept of rationing, but who should do that? Currently, the person trusted by the patients is the GP in front of them, but the GP is not in a position to make the decision that really matters for their patients.'

‘The position we are moving to is not to dispense with the need for prioritisation, but to have prioritisation where patients have a reasonable expectation and discuss it with their clinical adviser.'

Mr Lansley's comments came as it emerged stemming rising referrals will be one of the biggest challenges ahead for GP consortia, with some PCTs already imposing emergency caps on referral numbers.

NHS Richmond plans to limit overall GP referrals to a level 5% below current rates, while NHS South West Essex has identified cuts in GP referrals as essential to managing the predicted £43m deficit it faces at the end of the financial year.

In its response to the Government's consultation on the NHS white paper, the NHS Alliance's GP Commissioning Federation has called for information about individual GP referrals to particular specialties to be shared.

It says consortia should not be afraid to use leverage if peer-to-peer scrutiny uncovers ‘unexplainable and unwarranted variation'.

A report by the King's Fund, published in August, also forecast many consortia having to establish tight peer-to-peer controls over practice's referrals.

Lead researcher Candace Imson, deputy director of policy at the King's Fund, said: ‘Consortia are about to enter into a cold, potentially arctic financial climate. The need to control demand will be overwhelming and many, if not all, might turn to referral management.'

Consortia will also have to tackle the complicated area of emergency admissions that account for 10% of NHS spending and, says the Nuffield Trust, have risen by 11.8% over five years – faster than the rise in illness – mainly due to very short admissions, while the length of longer bed stays has been reduced by hospitals.

One of the report authors, Dr Jennifer Dixon, told a conference organised by Westminster-Briefing last month: ‘What we think is happening here is if you reduce length of stay, you effectively free up bed capacity to help at the front end.'

A&E clinicians, faced with a patient at 10pm who is a ‘little bit risky', might well admit them to see how they get on overnight – if there were beds available, she said.