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DH ruling on scrapping GP boundaries opens door to ‘medication tourism’

By Lilian Anekwe

Exclusive: Patients denied a treatment by GPs under the Government’s plans to hand consortia responsibility for NHS rationing will be able to become ‘medication tourists’ by simply registering at another practice with different rules.

The Department of Health told Pulse that under plans to abolish practice boundaries, GPs will not be able to refuse registration to a patient from a different part of country who had been blocked from accessing an expensive treatment.

GP leaders and health policy experts warned the combination of abolishing boundaries and handing GPs NICE’s role in regulating the drugs available on the NHS would cause ‘anarchy’ and send patients travelling round the country in search of treatment.

Last week, the DH said it planned to make NICE technology appraisals only advisory and hand rationing decisions to GPs from 2014, with consortia to decide whether to pay drug prices set to ‘reflect the value they bring’.

But GPC deputy chair Dr Richard Vautrey warned the committee had ‘serious concerns’ about the risks of inequalities and ‘health tourism’.

He said: ‘Removing practice boundaries poses serious problems with health tourism and patients moving around the country. Particularly in specialist areas, you do need consistency across the country. To devolve this to consortia would be inappropriate.

‘This will also lead to health inequalities across Scotland, Northern Ireland and Wales where of course there will be no GP commissioners.’

But the DH in England is looking at how to bring the devolved nations into line, with health minister Earl Howe telling the House of Lords last week that ‘officials are in active discussions with their counterparts in each of the devolved administrations on the changes we envisage to the pricing of medicines’.

Professor Alan Maynard, professor of health policy at the University of York and a leading health economist, warned devolving responsibility for rationing decisions would inevitably lead to inequalities in healthcare.

‘We are removing PCTs because they have limited capacity to make rationing decisions. But what will change? It will give the Daily Mail endless headlines, and if your neighbouring consortium is doing something you’re not you will be held up for ridicule and criticism. It will be anarchy.’

Dr Julian Spinks, a GP in Rochester, Kent who sits on guideline development committees for NICE, said: ‘There’s a danger we’re going to get medication tourists. It’s just a straightforward postcode lottery. There’s a risk money will be spent on things that are expensive and not necessarily effective because patients have made life uncomfortable for GPs.’

A DH spokesperson, when asked if a practice could refuse a patient they suspected wanted to register because they had been refused a drug elsewhere, said: ‘GP practices cannot refuse registration of a patient on the grounds of medical conditions suffered.’

But the spokesperson added: ‘Consortia will be expected to take into account relevant commissioning guidance published by the NHS Commissioning Board setting out quality standards for services.’

Dr Richard Vautrey: ‘Removing practice boundaries poses serious problems with health tourism’ Dr Richard Vautrey: ‘Removing practice boundaries poses serious problems with health tourism’