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The BMA blog



Over to you on growing blight of bureaucracy

It can be very strange reading about yourself in the third person. So, I had a slightly odd feeling on Saturday morning when I saw my views about the effects of NHS reform and rationing staring back at me from the front page of the Guardian – the result of my first major interview as BMA council chair.

Although, of course, the headline put the case more simplistically than my actual comments I’m glad to have been able to put forward the concerns of BMA members about the direction of travel of the NHS.

The thrust of what I said was that doctors across the NHS are experiencing, in different ways, a bureaucracy that interferes with their relationship with their patients. Not only that but the combination of rationing and resource restrictions with the creation of a market in the NHS is taking us in a worrying direction — one where we could ultimately see the nature of what the NHS offers patients becoming much less comprehensive.

I made particular reference to the use of referral management schemes, by primary care organisations and clinical commissioning groups.

We’re hearing about more and more of these, and while we would clearly not oppose initiatives that are supported by clinical evidence, and improve productivity by improving quality, it seems that GPs are increasingly being incentivised to achieve blanket cuts in referral rates.

One of the starkest examples came from Harrow where, under proposed plans, practices would receive additional funding for helping to meet the Nicholson challenge, provided they met key criteria – including reducing referral rates by 10 per cent.

In my view, this is simply immoral. Paying doctors, in any form, on the basis of having reduced referrals as an outcome in itself, is contrary to the principle that as professionals, our first duty is to provide the best possible care to the patient in front of us.

We want to continue to highlight your concerns about what’s happening to the NHS, so if you have any more examples of the bureaucracy interfering with your relationship with your patients, let us know by commenting below.

Mark Porter is chair of BMA council