Monetarism and the General Practitioner

The government has decided that its monetarist policy should extend into the management of the NHS. In 'Working for Patients' the government outlines its policy which, in essence, is a blueprint for controlling the ever-escalating costs of health care. It seeks to exert this control by a two pronged budgetary approach, one at regional level and one at the basic provider level. The regional budgetary control is very similar to that in existence at present, except that it encompasses the whole of national health care, not simply that provided by the district health authorities. The Family Practitioner Committee services are being put under the authority of the region and budgetary control will extend into prescribing, staff and rent reimbursements and, ultimately, into the cost of referral to specialist services. The other budgetary control that is proposed is new and introduces a potentially damaging principle concerning our current health service. General practices of over 9,000 patients are being encouraged to accept budgets of their own. When a region accepts a practice as a budget holding practice, the practice will be allocated a sum of money out of which it must provide all NHS prescriptions for their patients, all NHS investigations such as pathological and radiological investigations and the costs of the NHS referrals made to specialists. The only exclusions to this are those referrals made 'as emergencies'. These budgets will require constant monitoring and computer software is being manufactured which will enable each practice to determine how its expenses are going. This second system of budgetary control can be seen to have a number of advantages as far as cost control is concerned. The provider (general practitioner) will be intimately involved in the costs of health care and will be forced to make judgements about the value of certain procedures. The GP will be encouraged to consider whether a prescription or an investigation or referral is crucial for good patient care. Is it essential for a patient to have an investigation to check that all is now well, or should that investigation not be performed* thus saving some of the practice budget? The evidence that those rural doctors who dispense their own prescriptions have considerably lower prescribing costs than their colleagues who simply write prescriptions that are dispensed by a pharmacist , supports those who claim that having a financial interest in providing care will force the provider to control costs. …