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Consortia will reduce range of services to prevent ‘middle class tourism’

By Gareth Iacobucci

The Government’s plans to place GPs in charge of rationing could result in a perverse incentive for consortia to reduce the range of services they provide, a senior GPC leader has warned.

The plans, tabled as part of the Government’s NHS reforms, will remove the job of deciding which drugs are available on the NHS from NICE, and hand the responsibility directly to GP consortia.

But GPC deputy chair Dr Richard Vautery has warned that consortia may shy away from making decisions that run contrary to those made by their peers elsewhere in the country, and may end up discontinuing expensive services such as IVF in order to stay within budget and avoid potentially troublesome postcode lotteries.

Speaking at a Westminster Health forum event this month, Dr Vautrey said the move could perversely lead to ‘a national standard’, despite the Government’s emphasis on local decision making, because GPs may be reluctant to invest in areas that are potentially more expensive.

Schellion Horn, an economist at Deloitte, questioned Dr Vautrey about the possibility of GP consortia choosing to reduce the types of care they provide to prevent ‘middle-class health tourism’, which could lead to services like IVF no longer being available.

Dr Vautrey replied that he felt this was a very real concern. He said: ‘I think we are very worried about the prospect of NICE losing its power to make a decision.

‘What effectively might happen is what you describe. Consortia may be very fearful of making commissioner decisions that step out of line significantly from their peers elsewhere in the country, because they would be worried that individuals would effectively shop around for services that they are providing and willing to pay for, but their home consortium is not willing to do so.’

He added: ‘So actually perversely it might lead to a national standard because nobody would be willing to actually take the risk of investing in areas that are potentially that bit more expensive and would lead to particular financial pressure on their budgets.’

Janice Barber, managing partner at Hemspons Solictors, also speaking at the event, warned it would not just be IVF under pressure when consortia are in charge of rationing.

She said: ‘PCTs all over the country are abandoning funding IVF. If PCTs feel under that kind of constraint now, the idea that consortia aren’t going to, I think is fanciful. They are going to, and it won’t just be IVF coming round the corner.’