NHS cost-cutting in the news: my view

Another day, another NHS cost-cutting measure is in the headlines. In the last week alone we’ve heard about local health bodies not funding as many cycles of IVF on the NHS as the guidance from the National Institute for Health and Clinical Excellence (NICE) recommends; restrictions on cataract surgery and limitations on gluten-free foods.

In my part of the country, I can no longer refer a patient for certain operations, including cataract replacement, unless they tick certain boxes relating to the severity of their condition or how much their life is affected by it. In the past, if the GP referred you to hospital, you would get an appointment with them. Now, my referral will be rejected if the patient doesn’t fulfil the right criteria. When these restrictions were first imposed, with little or no consultation with the doctors concerned, we were horrified. As time has gone on, I have had to accept that there simply isn’t enough money in the NHS for everyone to have all the care they want when they want it. It’s frustrating that as a GP I can’t use my clinical judgement, but I do accept that some major money savings need to be made.

Now we discover that doctors are being discouraged from issuing prescriptions for gluten-free cakes and biscuits to people with coeliac disease. Unlike people with food intolerances, those with coeliac disease can suffer serious long-term complications if they eat gluten.

The rationale for some Primary Care Trusts/Clinical Commissioning Groups imposing a ban on all but a small number of gluten-free foods is that these products are available to buy without prescription, albeit at a higher cost. Inevitably, patients and parents of children with coeliac disease complain they will be deprived of food they need for a healthy balanced diet. But the price of gluten-free foods doesn’t need to be exorbitant – the first online supermarket I tried had a wide variety of pastas at 500 g for £1.50 and 1 kg flour for £1.70. Even individual cakes and pies were about 50p each. The harsh fact is that if I keep prescribing gluten-free pizza dough, some of my patients will have to suffer for longer before they get physiotherapy or the surgery they need.

I get particularly irked when patients phone me up to ask for prescriptions for paracetamol which they take occasionally for headaches. They may see it as their right, but instead of costing the patient 16p in the chemist, the same tablets cost the taxpayer several pounds in prescription and dispensing fees.

Perhaps it’s time we all sat down and realised that if we’re going to keep the NHS we all love free at the point of need, we have to accept some responsibility for it.

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