‘PLEASE support your GP practice – vaccination income is vital to the surgery.’ So reads the latest advert for Covid and flu vaccinations Covid and flu vaccinations from my local GPs. It is a sizeable, vibrant offering displayed in the free magazine that gets posted through every door in my rural area. Similar adverts were also to be found on the surgery’s Facebook page but have mysteriously disappeared since I exposed their magazine advert on Twitter and it was featured on Mark Steyn’s GB News show.
It seems the most basic principle of ethical healthcare that financial incentives and emotional blackmail should play no part in encouraging people to have medical procedures. Yet apparently, when it comes to vaccination, the NHS has thrown out fundamental ethics and no longer puts the patient’s best interests first.
Does this unethical behaviour extend into other areas of healthcare? Are there financial incentives to get patients to have other medical procedures or take certain medication? The murky role of Big Pharma in pushing their latest drugs, often ineffective or even harmful medications, on to the medical profession has been much discussed but there is still no transparency. When it comes to GPs and the funding of their surgeries there are financial incentives to hit targets for patient treatment. A sizeable chunk of funding comes to a GP surgery from hitting vaccination targets for people on the ‘vulnerable’ list. But should helping to fund GPs ever be mentioned to patients in relation to their medical choices?
Quality and Outcomes Framework payments enable GPs substantially to increase their funding by means of gaining QOF points, which are gained by hitting targets in areas such managing chronic diseases/conditions, providing services such as cervical screening, and referrals to secondary care. On the face of it this sounds like a great scheme. Who could object to incentivising regular check-ups for the chronically ill and encouraging GPs to offer cancer screenings? However, having a ‘tick box’ attitude to healthcare motivated by financial self-interest is deeply problematic. For example, one of the targets which earns GPs points and therefore extra funds is getting a high percentage of patients with diabetes and cardiovascular disease treated with a statin. Yet the use of statins is not without its critics, such as leading cardiologist Dr Aseem Malhotra. Even a physician with the best of intentions would be susceptible to being swayed into getting out the prescription pad when QOF points are lurking in his or her subconscious.
The targets for those with serious mental illnesses are also a double-edged sword. Aiming to monitor blood pressure, BMI and alcohol consumption of such patients is laudable. However the points can be secured by merely checking this once every year, which hardly requires careful clinical supervision. The process encourages GPs to feel that they have ‘done their bit’ for these most vulnerable people by doing a woefully inadequate minimum. A GP’s patient no longer exists as a unique individual who needs tailored, holistic treatment, but rather as a cog in a target-hitting and revenue-raising machine. Little wonder that some practices have started presenting the uptake of certain lucrative medical procedures as community-minded fundraising.
Our GP surgeries should not act as though they’re the parish church trying to raise money to repair the roof. In fact my surgery has a ‘friends of the surgery’ group that does indeed put on events such as cake sales, raffles, sponsored runs and such like to raise funds. That is what makes the vaccine advert, which sounded as if it was requesting donations of baked goods rather than attendance for vaccination, so sinister. The medical profession is increasingly relaxed about incursions into hitherto sacred principles of informed consent and bodily autonomy. Far too few spoke out against the blackmail exerted to convince people to get the Covid vaccine, sold as ‘It’s the right thing to do’. Until the NHS as an institution and its medics realise that the right thing to do when it comes to medicine is unique to every human being, it’s the patients who will need saving.