DOCTORS

Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone. Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.

About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients but critics believe that patients are being denied care simply to save money. The Government announced plans to offer fat people cash incentives to diet and exercise as part of a desperate strategy to steer Britain off a course that will otherwise see half the population dangerously overweight by 2050.

Obesity costs the British taxpayer £7 billion a year. Overweight people are more likely to contract diabetes, cancer and heart disease, and to require replacement joints or stomach-stapling operations. Meanwhile, £1.7 billion is spent treating diseases caused by smoking, such as lung cancer, bronchitis and emphysema, with a similar sum spent by the NHS on alcohol problems. Incidentally, the tax revenue from tobacco is around £8.5 billion. Among the survey of 870 family and hospital doctors, almost 60% said the NHS could not provide full healthcare to everyone and that some individuals should pay for services.

One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements. Gordon Brown promised that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restric­tions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments. (Source: Sunday Telegraph, Jan/08)

Family doctors are threatening to turn away new patients and cut services in retaliation for the government’s refusal to give them a pay rise. They say they face financial difficulties, despite lucrative new contracts paying them an average of £100,000. The British Medical Association has circulated guidelines for what amounts to a work to rule. Under a deal introduced in 2004, GPs were able to opt out of out-of-hours cover, taking a small pay cut for doing so, while earning more money for extra services such as checking blood pressure and weight.

The changes saw their pay rise by around 30% for working fewer hours. After accusations that the Government badly misjudged the deal, Chancellor Gordon Brown decided not to increase payment rates this year. Now the BMA, which decided not to ballot on industrial action, is telling GPs which services they can cut without breaking legally-binding contracts. The BMA said they might want to "consider whether to take on new patients", as well as reviewing "enhanced services" like minor surgery, including ingrowing toenails and the removal of warts and suspicious moles. (Source: Mail on Sunday, Apr/07)

Patients will have to pay £16 a month for the right to see a general practitioner under plans being drawn up by the British Medical Association. The proposals amount to a wholesale privatisation of the GP service, with thousands of family doctors potentially leaving the NHS. The BMA's General Practitioners Committee is drawing up the plans as a result of grow ing frustration with intransigence from the Department of Health, which is trying to impose a new contract.

GPs insist they are having to deal with far too many patients, with the average appointment time now down to seven minutes, and that their pay is too low. Morale among GPs is at rock bottom, with 86% voting to leave the NHS if negotiations over the new contract failed. The proposals, based on the system in Guernsey, are aimed at boosting recruitment, improving pay, increasing the amount of time they have with each patient, cutting paperwork and reducing interference from the Department of Health.

Under the new system, adults would have to pay £16 a month in insurance to cover visits to a private GP, who would refer the patients to NHS hospitals or consultants if further treatment was needed. Insurance for children would cost £8 a month, and it would be free for those on low incomes. If they wanted, patients could choose 'pay as you go', paying for each appointment to the GP.

The plans are being developed by a new BMA committee, the Special Advisory Group, which is looking at alternatives to the NHS. A draft report on the plans said, "There is a radical alternative to the UK method of providing general practitioner services which already exists within the British Isles. The Guernsey option would allow the General Practitioner Service to expand once again. The UK would no longer have the unhappiest GPs in Europe."

Dr Jonathan Reggler, the member of the General Practitioners Committee who originally proposed the Guernsey option, said, "I've received very favourable support from colleagues. The majority of the General Practitioners Committee believes it is viable to run an alternative to the NHS system." The GPC is responsible for negotiating on behalf of GPs with government, and if it formally recommends the Guernsey system, it will be a critical blow to the government.

It is certain that Alan Milburn, the Health Secretary, who has promised to keep all healthcare free, will refuse to co-operate with the new system, but doctors believe they may be able to force his hand. 'If a sufficient number of GPs in an area resign from the NHS, it will be impossible for health authorities to reallocate all their patients to other doctors. The Government will have to step in,' said Reggler.

Muslim doctors in Britain are refusing to treat patients for diseases that develop as a result of 'sinful' behaviour. They believe certain conditions, mainly sex diseases and AIDS, are 'punishments from God',and say the Koran forbids them from helping sufferers. Some Muslim students refuse to accept the theory of evolution or to study abortion, euthanasia and fertility procedures. Female students have also insisted on wearing veils to class, which is against strict rules.

The Council of the Heads of Medical Schools said, "As a doctor you must ensure your personal beliefs do not prejudice your patients's care. Students must be aware of their responsibility to treat patients regardless of gender, sexual orientation, ethnicity or religious belief." The General Medical Council added, "Doctors must not refuse or delay treatment because they believe patient's actions have contributed to their condition." If Christian doctors refused to treat AIDS patients on these grounds, or insisted that female students wore veils, there would be an outcry against them and they would be forced to resign. And supporters would be accused of being racist.

The cost of an NHS prescription in England is to rise by 10p to £6.50. It is estimated that prescription charges alone will generate more than £400m for the health service in 2006. The cost of a prescription prepayment certificate will also rise by 50p to £33.90 for four months, and £1.40 to £93.20 for a 12-months. NHS dentistry charges will also go up, with the maximum cost for a single course of treatment rising £6 to £384.

Rosie Winterton, the Public Health Minister, said, "We have held the increase to 10 pence for the seventh consecutive year, well below the rate of inflation, to ensure that people can get the prescriptions they need at prices they can afford. Through our extensive exemption arrangements, 86% of prescription items are dispensed free, with another 5% dispensed to people with prepayment certificates at no additional charge. This modest increase will contribute £452m towards the cost of the NHS."

Shadow Health Secretary Andrew Lansley criticised the announcement. He said, "From the government that brought you the promise of free healthcare and accused the Conservatives of wanting to introduce charges, comes this announcement of higher NHS charges."

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