GPs are facing restrictions in access for their patients to a bewildering range of services from infertility treatment to hernia operations, vasectomies and diagnostic scans, as the budget squeeze that started in April leaves PCTs desperately scrambling for cash.
A Pulse survey lays bare the full scale of the restrictions GPs are experiencing in accessing care for their patients, and follows our previous investigation which found 41 trusts have added new procedures to their ‘low clinical priority' lists this financial year.
It also follows the revelation last month that PCTs are using referral management centres staffed by nurses, podiatrists and physiotherapists to screen out GP referrals, and comes as Pulse launches a new initiative – CutsWatch – to track rationing of NHS care.
As many as 22% of the 300 GPs surveyed said their patients were facing restrictions in access to operations for uncomplicated hernias, 17% to hip and knee operations and 11% to vasectomy or female sterilisation. One GP in 10 said their PCT was rationing direct access to MRI and CT scans, 16% said there were cuts to routine blood glucose testing, 29% were facing barriers in access to fertility treatment and 25% to services for obesity treatment and prevention.
The NHS is also retreating rapidly from some treatments whose value has been questioned, with 55% of GPs saying their patients faced restrictions in access to varicose vein surgery, and 36% to nutritional supplements.
GP leaders said the survey highlighted the scope of restrictions enforced by PCTs, warning that it was vital to track their impact.
Dr Chaand Nagpaul, a GPC negotiator and a GP in Stanmore, Middlesex, said: ‘The QIPP agenda means we are seeing very local short-term decisions to reduce costs and a huge variation in approaches from PCTs, many of which have not been thought through. We are seeing significant postcode variation, which is not compatible with the Government's commitment to provide equitable access to healthcare.'
Dr Brian Balmer, chief executive of Essex LMC, said GPs in south-west Essex had seen a ‘huge' number of procedures rationed in the last financial year. NHS South West Essex currently restricts hip and knee replacements, cataract surgery, varicose vein treatments and hernia repair.
Dr Catti Moss, a GP in Guilsborough, Northamptonshire, said: 'Some alterations to care pathways can improve patient care as well as cutting costs but we need to target prevent silly rationing decisions where PCTs are seeking quick fixes that ignore the long-term health issues.'
Dr Philip Fielding, chair of Gloucestershire LMC and a GP in Cheltenham, said: ‘The rhetoric is about service redesign, cost effectiveness and efficiency savings but the reality, of course, is about redefining criteria and thresholds for NHS care. Short-sighted restrictions on care can save for a year or two by delaying treatments but you are building up a potential clinical time bomb.'
'Clinical conditions get to a point where they progress – osteoarthritis is a lifetime condition, it doesn't get better. Something like a cataract doesn't miraculously resolve itself and disappear, it will only get worse.'
‘My concern is that it is very easy to restrict activity by delaying referrals but can you permanently reduce activity year-on-year? That is the challenge facing commissioners. I think we have to be realistic about the capability of holding back the tide. King Canute couldn't do it with the tides and I don't know if GPs can do it with the tide of clinical care.'