Sailing into shark-infested waters

Taking on NICE's rationing role will leave GPs wide open to criticism from all sides, warns the Jobbing Doctor

General practice is setting sail into uncharted waters; and they are shark-infested.

The situation is looking grimmer and less appealing by the day, and the Jobbing Doctor does not really want to practise in this new regime.

You might say that the Jobbing Doctor' view is a reflection of times past, a troglodyte that does not move with the times. I have never been like this in the past and have generally embraced change, although it had to be change that you can believe in.

I cannot believe that they new changes will bring anything but chaos and problems, and one issue has brought this into focus: that is the removal of the approval process for new drugs by NICE.

I have not been an enthusiastic supporter of NICE: indeed I may be counted as one of their staunchest critics in terms of their slavish adherence to protocols and guidance. But where they were useful was in the deliberations about new drugs. Now, this task (the only one I think of value) is being removed.

Why has the Government done this? The drugs approval process has been admired in other countries and other health systems have considered adopting this process. The profession generally accept that this is an effective and objective role.

It depends whether you are a conspiracy theorist or a cock-up theorist. Generally, when it comes to process and organisation, the Jobbing Doctor believes in the cock-up theory. Much legislation and regulation is not thought through, and decisions are made that have later ramifications that need correction. The NICE decision could be a cock-up decision. But I don't think that it is.

No, this is definitely conspiracy, and we are walking into a trap gullibly.

Let us consider a simple scenario. A new drug is developed that is used for advanced cancer that can give a further few months of useful life. When you are sitting with the patient you want to give them the best chance. You have that relationship with the patient. But you are a commissioner, and you need to make the finite budget last for the full year. You risk, by denying treatment, ruining your relationship with the patient - and also annoying the oncologist who wants to give it, the charities who support the use of such drugs, the extended family, and also the drug companies who want to make profits out of their drugs.

If you agree to prescribe, that will mean that you will not be able to refer 10 older patients with hip arthritis for a hip replacement.

It is the decision that requires the wisdom of Solomon. The trouble is that Solomon was able to resolve his decision, and you cannot.

This is a potentially nasty situation that Government will neatly avoid by blaming you directly. Can you imagine the headlines in the ? Exactly.

The decision has been made deliberately, and I believe that it is due to pressure from big pharmacological firms, who see a potential for significant profits. The budget will never stretch to accommodating these demands, especially as at least 60% of the commissioners' spending is already decided due to contracts and pre-existing commitments such as Independent Sector Treatment centres, PFI projects and Darzi centres.

General practitioners will rapidly lose their reputation as being the most trusted professionals in the country. The poison and bitterness will quickly be evident.

This is not a situation I observe with anything except a feeling of dread.

We are being set up to attempt and fail at achieving the impossible.

The sharks always win.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.