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Health Care Rationing and the NHS London’s Troubling Precedent

Posted in Analysis, Healthcare by Eric Back on August 13th, 2006.

NHS London is the Strategic Health Authority for London, England.  A paper leaked in April of this year openly acknowledged NHS London’s new mandate for cost containment through health care rationing, this, despite it’s stated mission to “deliver world-class care.”

Among the cost cutting measures:

1) Panels were established across London to monitor the rates at which General Practitioners refer patients to hospital. Local health trusts were instructed to cut GP referral rates to the levels of the lowest 10% nationally at an estimated annual saving of 25m pounds.

2) Consultant to consultant referrals are also to be limited, effectively denying second opinons.  In an earlier draft paper Hammersmith and Fulham reportedly found that a fifth of consultant-to-consultant referrals were “clinically not necessary.” Trimming back referrals accross London is expected to save another 7 million, though the administrative burden is estimated at 1.6 million.

3) Emergency care practitioners in emergency departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres.  If they treat those who could have been treated non-emergently, they will not be paid.

The British Medical Association condemned the plan. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died.

From the article:

“The plan, which is still in draft, was produced by the London Transition Team, led by John Bacon, a senior NHS manager. It is typical of the action being taken nationally to save money by reducing referrals, or, putting it more plainly, treating fewer patients.

There are serious questions about whether such systems will work. say two experts in general practice in this week’s British Medical Journal.

Myfanwy Davies and Glyn Elwyn, of the Centre for Health Services Research at Cardiff, say there is little evidence that referral management centres work to improve the quality of referrals or save money.

They say that the centres have “appeared overnight in an evidence-free zone”.”

For Feedback:

America’s costs for publicly funded healthcare are similarly spiraling out of control.  How closely should we look at London’s model?  Should healthcare be rationed?  If so, how?

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