Tuesday, October 21, 2008

Patients refer themselves for NHS treatment. Is this real change or lipstick on a pig?

""(DH) Patients to refer themselves for NHS treatment

Health Secretary give go ahead to roll out of self-referral schemes for allied health services. Health Secretary Alan Johnson said: "I am giving the green light to physiotherapists, podiatrists and all Allied Health Professionals (AHPs) that they can accept patients who self refer. This offer maximises the potential of AHPs as autonomous Practitioners."

There are over 76,000 AHPs. The professions are art therapists, drama therapists, music therapists, chiropodists/podiatrists, dietitians, occupational therapists, orthoptists, orthotists and prosthetists, paramedics, physiotherapists, diagnostic radiographers, therapeutic radiographers and speech and language therapists ""


It is difficult to know whether Alan Johnson is playing lip service to patient based services or whether the NHS could truly become patient centred. A significant proportion of the people I see, would benefit from open access to physiotherapy and allied health services.

But I want him to take this further. I want open access to all doctors, specialists, and investigations. In short to anyone who offers a reasonable service that benefits a person's health.

Payment for these services won't be about meeting targets. Payment for service depends on the provider showing they have benefitted the individual by providing a service. For example, if my treatment doesn't work, I don't get paid. If I damage someone, I am insured and I pay damages, and only when I improve their life can I claim a reward. Doctors and others will have to make sure they leave a person in a better state than they found them

Doctors' salaries are regularly over £100,000 a year. A well organised GP Principal can double that as can a consultant with private practice. But it becomes harder to justify if the people would rather go straight for treatment. How many people with a mental health problem/ stress want to start with drugs from their GP rather than talking treatments? How many people with backpain want to start with painkillers rather than physiotherapy? How many people with indigestion don't secretly know it comes down to what they eat and drink?

Treatment should be like make-up. If it doesn't make you look or feel better, then you probably shouldn't wear it or take it. And for the most part, the people on the receiving end are best placed to decide which it is.

Now for the annual 9o million pound question : Is this putting lipstick on a pig or a real shift towards a patient based service?

Copyright (c) Dr. Liz Miller


Deb Acle said...

In ancient China, physicians were only paid when their patients were well. This system worked remarkably well I believe for many hundreds of years.

Let's just see how much of this - what is it? £90mill? - is used, in practice, to erect barriers to patients actually being able to avail themselves of such direct access.

Is this more tinkering at the edges?

Your post raises very interesting questions, thanks for highlighting this scheme.

Dr. Liz Miller said...

Thanks for your comment Deb!

Unfortunately, I cant see many doctors agreeing with us, although "No one" on JD's blog might come along!

As No one says it is only in the UK that patients don't have direct access to who they want - it is ridiculous!!

Dr. Liz Miller said...

PS - Chinese medicine/ culture is fascinating and is the complete opposite of Western medicine

While we look at "organ damage", the Chinese looked at the nerves that supply the organs. Their idea of ideal male and female personalities also differs from our own. Different characteristics are associated with the genders in China as from Western culture

Deb Acle said...

I was just reading the other day about Sweet Wormwood, an essential ingredient of Chinese medicinal treatments for nearly two thousand years (http://www.ncbi.nlm.nih.gov/pubmed/15330172?dopt=Abstract).

Then there's the St John's Wort v Prozac (or SSRI) study that found the former as beneficial as drug company offerings. Milk Thistle is apparently ace for liver problems.

How many other plants are going to be rediscovered as efficacious?

Acupuncture is grudgingly admitted by the NHS now as having beneficial effects also.

If you're not paid when your patient is poorly, then I guess you absolutely have to develop cures and treatments that work! ;-)

From one perspective, it's all about actual connections, isn't it? Our actual connection with the earth from which we have evolved, the actual connections between our cells (no matter where they are in the body), and our connections with each other.

Nope, not getting all Gaia and New Agey here! Just looking at the science which often undermines the Cartesian duality so beloved of the West.

I have such concerns about the way people are routinely turned away from the NHS and then seek treatment from alternative medicine practitioners, some of whom are criminal charlatans. I'm thinking of the recent convictions of two such individuals (I blogged at NHS Exposed about it - 'Animal Farm' I think it was titled: warning - adult content!).

The point is that the NHS has to pick up the pieces - when the problems are even worse. So it might as well just get on and do the job in the first place! More short-termism - does no-one (not our fellow blogger!) at the DOH/NHS ever think about longer term and exponential impact?

And I'd better not get started about how we are so politically correctly engineered in the West to ignore and distort gender differences/talents/shortcomings...

Anonymous said...

Defamatory to the pig :) :)


Dr. Liz Miller said...

Quite right, wrong shade of lipstick ;-)