In the report, From feast to famine: reforming the NHS for an age of austerity, published in July 2009, the SMF states that the NHS will need to change dramatically to survive the impact of the economic downturn. The think-tank says the NHS will have to become more efficient due to the reduction in funding, and change its approach to what is fair. The report outlines three possible approaches that the NHS can take: raise more money, use existing resources better, or slow the growth in healthcare demand.
The report says the NHS must recognise that fair does not necessarily mean free. Charges could not be used to raise revenue, as they would need to be set at a very high level to do so, but charging for access to healthcare could force patients to consider whether they need to use healthcare resources.
The report recommends:
- The NHS charging system should be reformed to reflect income not categories such as pregnancy or retirement;
- Anyone receiving tax credits should be exempt from NHS prescription charges - a good deal for the poorest 30% of society;
- A charge of £20 for GP appointments should be introduced to encourage healthier, wealthier people to avoid using the NHS except when absolutely necessary (those receiving tax credits will be exempt);
- NHS charges for GP appointments and prescriptions should be capped at around £100 per year.
The report also outlines that the only way to achieve efficiency is to move from national targets to a model of local provision based around high quality commissioners. Recommendations to improve efficiency include:
- A reduction in national targets to become a minimum service guarantee;
- The establishment of a single body to regulate commissioners;
- Local contracts for GPs and consultants;
- Public petitions that can trigger a review of commissioner performance;
- A new ‘Royal College of Commissioners’ to give commissioning higher status;
- New powers and responsibilities for commissioners to improve the quality of healthcare providers.
However, Dr Chaand Nagpaul, on the GP committee of the British Medical Association, expressed concern that some patients may be put off visiting a doctor because of the fees. He commented, “All patients have the right to free healthcare that is based on their clinical needs, not the size of their bank balance.”
The Department of Health said ministers are also opposed to charges, with a spokeswoman commenting that it would be against “the founding principles of the NHS”.
Further reading - An in-depth analysis of the UK pharmaceutical market, including some background information on the healthcare system, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)