GP incentives – a dangerous tool of NHS privatisation

“I will use treatments for the benefit of the ill in accordance with my ability and my judgement, but from what is to their harm and injustice I will keep them.”

Proletarian writers

Proletarian writers

Doctors no longer recite the words of the ancient Hippocratic oath, and though the majority of people going into the healthcare profession still accept its traditional ethic, the General Medical Council (GMC) now gives ethical guidance, such as: “if patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should put the matter right if that is possible,” and that “you must promote and encourage a culture that allows all staff to raise concerns openly and safely”. (Good Medical Practice, 2013)

Unfortunately for doctors with a conscience (and their patients), these GMC guidelines have become difficult, if not impossible, to implement. There is the recent example of Dr Chris Day, a junior doctor who has been effectively blacklisted since 2014for speaking out about extremely unsafe staffing levels at Queen Elizabeth Hospital in south-east London. (Exposing NHS crisis wrecked my career, says junior doctor who believes there is too little protection for whistleblowers by Tammy Hughes, Daily Mail, 23 February 2016)

Public money for private profits

Paradoxically, while the recent demonstrations across the country have been calling for increased funding for the National Health Service, NHS funding has actually been continually increasing. It turns out that the issue is not so much ‘funding’ but where the money is actually going.

Instead of being spent on healthcare, a large part, perhaps the majority part, funds the NHS privatisation deals (PFI), exorbitant prices set by the drugs cartels and equipment providers, and the management and administration costs of privatisation. These latter charges tripled to 14 percent in 2014 after the introduction of the internal market, and now cost an extra £10bn per year.

Servicing PFI loans for new buildings and the ever rising salaries of the bloated bureaucracy, employed specifically to oversee the carving up of the health service for private interests, take much of the extra billions supposedly allocated to the NHS, but in reality allocated to the privatisation swamp.

Under this prevailing culture, where (as per the GMC guidelines) whistleblowers are officially encouraged, but in practice risk severe reprisals,the incentive schemes that are being introduced by some GP consortiums (known as Clinical Commissioning Groups or CCGs), offering financial inducements to GPs who reduce the number of patients they refer to hospital, are particularly worrying for all those concerned with patients’ best interests.

Paid not to treat

“An investigation into referral incentive schemes being run by NHS clinical commissioning groups (CCGs) across England found some regions offering GPs as much as 50 percent of any savings they can make … Of the 180 [CCGs] that responded, 24 percent had some kind of incentive scheme aimed at lowering the numbers of referrals.” (NHS GP practices offered cash rewards to not send patients to hospital by Alex Matthews-King, Independent, 28 February 2018)

These incentive schemes are being spun as an encouragement to reduce unnecessary hospital visits, but the reality is that although GPs are highly trained doctors, they are not specialists, and, importantly, they do not have specialist diagnostic equipment (such as MRI scanners) in their surgeries, and so cannot always know beforehand whether a hospital visit will prove to have been necessary or unnecessary.

The financial incentives for non-referrals put GPs in an invidious position: either they refer a patient who may turn out to have nothing very much wrong with them (and lose funding), or they take a risk and don’t refer them, and secure extra funding for their understaffed and underfunded practices.

While we would like to think that GPs would be entirely indifferent to such calculations, the reality is that career progression rests in part on meeting such incentive targets. And even the most ethical of doctors may be subconsciously influenced by them and decide that a patient might not need a referral, at least for the moment.

As Proletarian found last year, incentive schemes have an important role to play in eroding the NHS. Here are some other examples that have been brought to our attention:

“GPs are currently being incentivised (paid bonuses) to perform highly-inaccurate dementia screening tests on all over-65 patients who walk into their surgeries (no matter what they actually come in for), despite the fact that the screenings have been shown to result in a large percentage of false positives – that is, people being told they are suffering from dementia when they are not, with all the resultant stress and upheaval that such a diagnosis might be expected to bring.

“This costly and counterproductive ‘screening’ process has nothing to do with improving outcomes and everything to do with helping private providers set their premiums and decide who should be granted and who denied insurance when the time comes.” (Cloak and dagger: the operation to kill the NHS, Proletarian, April 2017)

It’s privatisation, stupid

On a positive note, it appears that public awareness about the privatisation of the NHS is now increasingly allocating blame where it is due. Professor John Appleby, chief economist and director of research at the Nuffield Trust has reported:

“When we asked people why they are dissatisfied, it is increasingly less to do with pointing the finger at the NHS, and increasingly switching the blame to bigger issues – funding, staffing – which are of course the responsibility of government policy.” (GP practices given cash back for not sending patients to hospital, Laura Donnelly, The Telegraph, 28 February 2018)

Of course, it is not just government policy, but the capitalist class which is to blame. Capitalism and capitalists will always, seek new avenues of profit, especially so in times of crisis – whether by war or by eroding the temporary social-democratic concessions granted to the British working class after the second world war, when the socialist Soviet Union offered an example of an alternative future to workers.

The only way we can secure the NHS is by establishing a centrally planned and socially-owned system whose sole concern is the health and best interests of the working people, not providing profits for capitalist leeches.

Save our NHS; kick the parasites out!