After a couple of rather long blogs on NHS reforms it's time for some simpler ones.
One glaringly obvious reform that the NHS must undertake is to ban GPs from operating dispensaries from which they can profit.
In rural areas many GP practices can dispense to their patients even though a perfectly good dispensing chemist may be available for those patients use nearby.
The practice is unacceptable for three reasons. First, such dispensaries are unlikely to challenge the doctor's judgement and so a valuable level of double-checking of prescriptions is lost.
Second, these dispensaries are - more likely to supply branded rather than generic versions of drugs, as there is a greater profit margin for the dispensary when a branded version is prescribed ‚ and the doctor benefits from that at cost to the NHS.
Third, such dispensing undermines the viability of pharmacies in rural areas when such pharmacies are essential if a full range of health services is to be provided.
It's wrong that GPs gain from prescribing too much, or non-generically, when the patient does not gain.
It's wrong that GPs can claim this subsidy when already well paid when almost invariably there are commercial services available nearby.
And it's wrong that patients lose the protection of an independent pharmacist.
All three are sure signs that, regrettably, GPs cannot be trusted to commission in their patient's interests. Lansley got that wrong.
Dispensing GPs tend to make at least £20,000 a year more than non-dispensing GPs. This has to stop in the interest of patients.
It's a simple reform, but an essential one.
Disclosure: I am married to a (non-dispensing) GP
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I agree that this practice should be stopped. I live in Ely and my own doctors’ practice is able to dispense prescriptions despite the fact that there are 2 commercial pharmacies in the town centre which are probably within 10 minutes walking distance from the surgery. I had not realised that doctors were able to make such profits from this ‘business’ and this surely indicates that they will be looking to make further profits from commissioning. I expect that now Cameron and Co. are ‘listening’ to concerns about the reforms they will take onboard our concern about this ‘nice little earner’, but somehow I doubt it.
Three very interesting blogs on the NHS, Richard. Well argued, consistent and logically sound. I can also tell you that those of us who researched the impact of privatisation and contracting out in local government through the 1990s, and the advent of such animals as the ‘enabling authority’, can well remember the many – but seldom reported – downsides. One of the most costly in terms of the amount of time people had to spend compensating for its multiple effects was the fragmentation of organisations, services, and functions, leading to loss of coordination of policy and the development, delivery and oversight of services. There were multiple effects at a lower level (such as one council I came across that no longer had an email system that covered the whole organisation) but I don’t have the time to recount them here. The same outcomes have been clear to see in the NHS since new Labour came along with marketisation – as your first blog made clear.
I’m afraid that despite new Labour’s claims to support evidence based policy making they seldom did, in my experience, though I have to say that having just read the Government’s new ICT Strategy (Cabinet Office, March 2011) I don’t think they ever let ideology trump evidence as much as the ConDems now are.
Morality and money are rarely found together.
Just for reference Mr Murphy….now the police can be more tax-efficient (or so):
http://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Pages/OperationQuest-ImprovingPolicePerformance.aspx
The British Medical Association has weighed in on the new Prime Minister David Cameron’s health care proposals.
The allergists voted to scratch it, but the dermatologists advised not to make any rash moves.
The gastroenterologists had a sort of a gut feeling about it, but the neurologists thought the administration had a lot of nerve.
The obstetricians felt they were all labouring under a misconception.
Ophthalmologists considered the idea short-sighted.
Pathologists yelled, “Over my dead body!” while the paediatricians said, “Oh, grow up!”
The psychiatrists thought the whole idea was madness, while the radiologists could see right through it.
The surgeons were fed up with the cuts and decided to wash their hands of the whole thing.
The ENT specialists didn’t swallow it, and just wouldn’t hear of it.
The pharmacologists thought it was a bitter pill to swallow, and the plastic surgeons said, “This puts a whole new face on the matter….”
The podiatrists thought it was a step forward, but the urologists were pissed off at the whole idea.
The anaesthetists thought it was a gas, and the cardiologists didn’t have the heart to say no.
In the end, the proctologists won out, leaving the entire decision up to the a$$holes in London.
Just for the record, JohnM, the (NHS) podiatrists think it is a step backwards, actually!