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GPs face the flak as NHS rationing drive accelerates

Exclusive: GPs are bearing the brunt of increasing pressure to ration NHS services, with three-quarters saying local rationing of treatments is now adversely affecting their relationship with patients, a Pulse survey reveals.

The survey of 237 GPs comes at the midpoint of the so-called ‘Nicholson challenge' to identify £20bn of savings in the NHS, with nine in 10 GPs reporting the pressure on them to ration treatments or services has worsened over the past year.

Two-thirds said local rationing decisions were adversely affecting patient care, while 75% said the doctor-patient relationship was suffering – leading to renewed calls from GP leaders for a national list of low clinical priority treatments.

Over 40% of GPs said they had had to switch patients to a less effective therapy because of local rationing guidelines in the past year. Over a third said they had struggled to get patients to guideline-directed targets, citing restrictions on statins, newer diabetes therapies and referrals for orthopaedic surgery as particularly problematic.

Common examples of rationing were for GP referrals for bariatric, hip and knee and cataract surgery. Mental health services were also badly affected, with half of GPs experiencing rationing of cognitive behavioural therapy and 30% for child mental health services.

GPs also said patients were being hit by subtler forms of rationing, with 89% saying they had had a patient referred back to them because of missed hospital appointments, and 31% claiming hospitals were deliberately overemphasising the risks of surgery to prevent patients choosing it.

Dr Terese Tubman, a GP in Portscatho, Cornwall, said patients were often angry as they were told the cuts were about reducing waste. She said: ‘If the public were told to expect restrictions in clinical services, GPs would not continually have to explain the funding shortfall.'

Dr Claire Lehman, a GP in Dorset, said rationing was having an adverse affect on clinical practice. She said: ‘It is difficult to maintain an effective doctor-patient relationship when you appear like the big bad ogre forbidding certain referrals. If there is to be rationing, we need to do so on nationally, so the playing field is level.'

RCGP chair Dr Clare Gerada said rationing should be led by politicians, not GPs: ‘GPs are waking up to the problems of the Health and Social Care Act, which will, in the eyes of patients, make them seem responsible for making these cuts in services.'

The Department of Health said rationing on cost alone was wrong, and it would be writing to the NHS to remind it of this.