Will Lansley's reforms give rise to drug tourists?
As promised, although a little tardy I admit, I will discuss the next strand of the government’s proposal to remove practice boundaries: The threat of Medication Tourism.
Say you want an expensive treatment and your GP practice will not prescribe it to you, you can instead register at a different practice with different prescribing rules and obtain it that way. You become an NHS Tourist. This proposal has sent shockwaves throughout general practice with some predicting “anarchy” with fears of patients travelling around the country.
Will it affect health inequalities? Many, including senior members at RCGP have warned that the changes will have a "postcode lottery" effect. I, would have thought the opposite is true. Postcode lottery is what we have now – some patients are lucky enough to reside by a good quality practices / one that prescribes the drugs they want, and some are not – Currently you are only allowed to register at practices which you live near… that’s a lottery. Healthcare inequalities depending on where you happen to live.
Everyone is aware of the problem the UK has with health inequalities at the moment. Removing practice boundaries in theory should reduce overall variation. Shouldn’t a GP be gratified that even though they don’t want to / can’t afford to prescribe a certain drug, that the patient still has access to it elsewhere?
With a freer market for health, there is greater incentive for GPs to provide better quality care than others, so hopefully, those practices which are finding their patients moving away will be more motivated to improve.
But will it be only survival of the fittest? Then again, as practices attract more patients, so follows more funding. As such, they can offer more services – further, attracting more patients. This is a consequence of the freeing up of the market and is what one would expect from healthy competition. However, as the smaller, lower quality institutions reduce in size, they may not be able to service the needs of those who are able to travel to get the treatment they want. E.g. the immobile or elderly.
This is more than just about free market protagonism, which I am normally always in favour of, there are ethical factors at play. Unless those practices that are servicing those able to travel further can demonstrate that they can service those not able to travel (through teleheath for example) this could also lead the health exclusion. As much as in theory I am in favour of the abolition of practice boundaries, the NHS seems like it is trying to run before it can walk.
This blog is part of a series of blogs providing opinion on the proposed abolition of practice boundaries as part of NHS reforms in the UK.
For questions please contact Melissa Morris, CEO of Network Locum (now Lantum) firstname.lastname@example.org 07827233804