Sunday, 7 November 2010

Diana Watch

Look, it's very simple, if you don't password protect your Wifi I will use it, hence here we all are. Hello from Kent! Come on in the water's muddy.

I think that I may be becoming a little paranoid. Every time I see a story in the press about changes to the NHS all I can see is a concerted conspiracy to dismantle it by a government that values profit over all over things. It's a subtle(ish) accumulation of things, some within the white paper and some coming from outside.
GP's, who have already been technically privatised and are run for profit, will take over commissioning from the PCT's. They already ignore standard NHS terms and conditions for their staff and, in a letter to the BMJ, it has been pointed out that Foundation Trusts will be also be able to ignore Agenda for Change but that is not really my point here.
The Government have announced this week that NICE will be stripped of it's powers to say which treatments should be available on the NHS and GP's will decided for themselves which drugs they prescribe without any guidance.
A new treatment comes on to the market and NICE review it. Does it work? Is it cost affective? Show me the evidence! If it works then you can prescribe it within the whole NHS and if it doesn't then you can't. Sounds like a good idea to me.
This simple idea has got rid of the “system” that existed before where some Health Authorities prescribed some drugs and others didn't. The press hated it, quite rightly (here for instance is the Daily Mail on that very subject. The first paragraph reads “Patients with cancer, heart disease and mental illness are being denied drugs and lifesaving treatment thanks to a postcode lottery of care in the NHS”), and it was nicknamed “a postcode lottery” i.e., where you lived effected what drugs you could have. It was agreed that this was a bad idea and we needed a centralised system and some joined up thinking and that is what we got.
NICE has been controversial in some areas of the press because they have restricted access to some really expensive, not very effective (or least not any better than existing treatment) drugs, mostly for cancer treatments. In fact, it is the same press that was critical of the postcode lottery that existed before (here for instance is the Daily Mail on that very subject. The first paragraph reads “The scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end, ministers have declared.”).
I have a question for these people, what would you do? We don't have unlimited amount of money so we can't do everything, so give us some ideas, all you do is complain and criticise but never offer any alternatives.
Oh, as an aside, a lot of those charities/patient advocacy groups that get quoted in the papers are set up/funded by Big Pharma companies to act as lobbying organisations for certain drugs and treatments.
There are some important practical points in transferring prescribing decisions to GP's such as how do you expect them to keep up with all the new drugs that come to market? There are hundreds of studies a year and they are not always as open and straight forward as they should be. When do they think GP's have time to read all these studies? Aren't they supposed to be seeing patients? If they only read the abstracts of the articles/studies because of time pressures then they will be lead astray as many article abstracts have been shown to misleading.
Anyway, back to my rambling point. So a private company can already set up a GP consortium and now they will be able to prescribe which every drug they like, ignoring such boring, unimportant things as evidence.
This is were my worst case scenario thinking bought me. There is very little standing in the way of a GlaxoSmithKline opening a chain of NHS GP surgeries and prescribing only GlaxoSmithKline drugs. “Have you been to a Glaxo surgery before?”
OK, at the moment there are still a few hopes to be jumped though and barriers to be crossed, fords to be ummmm, forded and boxes to be ticked, but they are mostly PCT based. So we are safe at the moment because the PCT's are quite useful and no one would want to get of them, oh hang on a minute.....

That is all for this week as I'm not really supposed to be doing this.
There will definitely be no blog next Sunday (I know I said that last week but things change) as we will be in Nottingham I think for some art event or other, not sure if I'm honest but I will take pictures and if they are ok I will show you. Have a great week.

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