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I’m not budging on personal budgets

I am a creature of logic and reason, so can anybody explain to me why the NHS is steamrollering through something that is, in the words of an independent review from the University of Glasgow and King’s College London, ‘wholly inadequate’?

Their report concluded that the Personal Health Budget scheme costs £4000 more per annum than regular care and that it may well do more harm than good in terms of patient outcomes. Pandering to the half-baked idea that patients know what’s good for them, we’re spending more and getting less.

At risk of repeating myself, the main reason that patients consult is that, in the main, their doctor knows more about their condition than they do. That’s why we have prescription pads and they don’t.

Being superheroes, GPs understand that with great power comes great responsibility. We are the custodians of a massive amount of taxpayer money and almost without exception manage that budget impeccably. We prescribe rationally, we refer appropriately, we encourage self care and we promote healthy activities – we are, lest we forget, the most cost-effective professionals in the most cost-effective health service in the world.

Patients, on the other hand, consider themselves to be special cases. Homeopathy may never have been proven to work for anybody but it works for them. Aromatherapy might do nothing but make a self obsessed placebo responder smell of almonds rather than patchouli for an hour or so but surely there’s no harm in giving it a go, especially as that nice Carol Vorderman recommends it as part of her essential detox routine.

And so what if neurologists don’t advise that every headache gets a brain scan? You really can’t be too careful, can you?

When I was seven years old, I thought that way too. Given a large lump sum, perhaps a fiver from a favourite uncle, I’d be off the the shops in no time to blow the entire wad on a toy, a comic and some sweeties.

Hand over hundreds of pounds to the average punter and they’ll come home with the modern day equivalents – such as a salt therapy salt pipe, a subscription to ‘What Doctors Don’t Tell You’ magazine and a bottle of liquorice root capsules.

And the downside is, of course, that there is no downside. When our Type 1 diabetics discover, after using their allocation of NHS funding to buy tickets for the Comedy Store, that laughter isn’t the best medicine after all, we’ll meekly start picking up the tab for their biphasic insulins and their blood testing strips.

At least we won’t be left to face up to this tidal wave of brain faded bullshit alone. We’ll be able to rely on the strength and the authority of our Royal College to back us up – the self same Royal College that said in 2013 that ‘people may want to use their budgets for treatments where there is no clinical evidence to support their use’.

A regrettable misprint, surely. No reputable academic institution could possibly advise that GPs should approve,’aromatherapy, reflexology and dance classes, on a case-by-case basis, thinking holistically about the individual’. I’m all for being open minded, but I’m worried that someone at the RCGP is so open minded that their brain just fell out. 

At times like this I look to our colleagues across the North Sea for wisdom and guidance. The Dutch health service set up a similar scheme back in the late 1990’s. Between 2002 and 2010 spending on patients holding their own budgets increased by 23% per annum, fraudulent claims abounded and the private sector made a killing out of acting as go-betweens linking the gullible with the charlatans. 

The paper outlining the abject failure of the scheme appeared in the BMJ back in 2012, subtitled, ‘What can England learn from the Netherlands?’ The answer would appear to be a resounding, ‘Bugger all.’

Dr Tony Copperfield is a GP in Essex. You can email him at and follow him on Twitter @DocCopperfield