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Please budget responsibly

The BMA are concerned that GP’s don’t know enough about the impending arrival of the personal health budget (PHB) scheme. They even sense a little consumer resistance from doctors at the sharp end. I can understand why.

For those who haven’t been paying attention the PHB scheme will allow patients with long-term conditions such as Gilbert’s syndrome, left handedness and hay fever to collect pocket money and play Pick and Mix with the pills on the chemist shop’s counter. They could also book themselves in for a Lifescan screening or two and purchase overnight care from the Naughty Nurses’ adverts in their local free newspaper.

No less an authority than Lord Darzi himself assured patients that trips to their GP, walk-in centre or A&E department would not eat in to their annual allowance, thus preserving the NHS’s ongoing commitment to the provision of instant access to expert advice on trivial medical conditions.

You know what, if one of my patients want to blow part of his annual health budget on two trips to Paris for some kinesiological treatment for his diabetes, it’s no skin off my nose, it’s just toes off his feet. Except there’s a catch. Come on, there’s always a catch. It’s always the same sodding catch.

Whatever the patient plans to spend his money on has to be agreed and signed off by his ‘care manager’, and how many of you haven’t already guessed who will fulfil the role of ‘care manager’? Who the person is who is ‘ideally placed’ to advise. The person who is oftentimes found scratching their arse with nothing to do? Exactly. And, of course ‘this person will usually be the patient’s GP.’


Consider this real-world example of how the system might work. Expert diabetic patient attends surgery to let his GP know that he plans to spend his pocket money on a toy, a comic and some sweeties. Specifically an Airnergy machine, an annual subscription to What Doctors Don’t Tell You magazine and a few hundred pulsatilla 30C tablets. The expert patient’s decision is final and no correspondence will be entered into.

Some of you, you know who you are, you bearded cardigan wearing loons, will spend long hours trying to dissuade him from this insane course of action. You will advise him of the possible consequences of relying on iridology rather than insulin. You will write letters to the college journal about facing up to such an ethical dilemma. You will reflect on what you have learned from the experience and clip a typed copy of your navel-gazing musings in to your appraisal folder.

But seeing as I don’t give a monkey’s, I’m fine with it. He’s a grown up, he’s an arsehole. I can change neither. He can spend all his money on jelly babies for all I care.

The only problem is, as far as I can tell, there’s no downside. When the budget runs out and he decides that, even if laughter is the best medicine, Lantus and NovoRapid run it a close second, he can point to my counter signature on the bulk order form for Lucozade, blame me for not steering him right in the first place and pick up where he left off with his free prescriptions.

And that’s just plain wrong. A budget should be exactly that. The patient should know that when the money runs out any future prescriptions will be lovingly handwritten on our finest headed vellum notepaper, not dumped out of the printer on form FP10 (Comp) at the taxpayers’ expense. Even a ten year old knows that if there’s a lot of holiday left at the end of his spending money he’s going to be in for a miserable time.

Disclaimer: Your friends at the NHS remind you to budget responsibly.

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