As a GP I see how NHS demand is being managed in ways that are designed to save money rather than improve quality or be in people’s best interests. This can often mean that serious conditions are missed or picked up late. Late diagnosis is one of the main reasons cancer survival rates in the UK are among the lowest in Europe. Where possible patients are diverted to ‘cheaper’ (and so inevitably less effective) options.
They are deterred from interventions such as hip replacements, which are a long-term solution to a painful problem but very expensive to deliver. Health professionals will dissuade patients from taking more costly options by presenting evidence on the pros and cons of treatments or surgery in a particular way. There’s also the tactic of denying access entirely by using tests for suitability or having an age cut off, which can sometimes be arbitrary. Delays can be used to put people off, so some will give up or choose to pay for it themselves. Patients I refer to an NHS consultant might now be seen by anyone (sometimes not even by a doctor – it will often be a nurse acting as a doctor, known among GPs as a 'noctor').
All of this is worrying for anyone relying on free health services. For employers with a commitment to health and wellbeing it changes the whole nature of the environment in which they’re working. A lack of early diagnosis for serious conditions can lead to longer periods of absence and treatment, much bigger medical insurance payouts, and losing staff to serious illness.
Health testing itself is being limited in the NHS despite NICE guidance. The NHS health check initiative is ineffective and appears to offer much more than it really does. Many important new tests for common and serious health problems – such as the PLAC test for heart disease – aren’t available for NHS patients. Employers need to insist on comprehensive and evidence-based health checks in order to pick conditions up early and for employees to be able to make what are typically just lifestyle changes. The only way a GP like myself can guarantee that an individual will see a particular specialist nowadays is to go private.
In June one of my patients saw a consultant, but because of curbs on admin costs the letter was not typed and sent to me until September. This kind of practice can mean more individuals being off sick for unnecessarily prolonged periods. It's in employers' interests to re-examine private medical insurance options to allow staff to access specialists, and to shop around for ‘better value’ alternatives. It’ll be increasingly important for those involved with wellbeing to look at offering private health screening either through salary sacrifice or for free. And not just as a perk for the few, but a fundamental benefit of being with any ’good’ employer. HR and benefits teams need to be planning now for the gradual shrinking of the NHS, and how they may need – and be expected – to take on more of a ‘social’ role.
Nick Summerton is a GP and medical director at Bluecrest Wellness
