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Self-pay not self-pity!


Self-pay not self-pity!

Frustration with NHS waiting lists has seen more people pay for their own healthcare. Should pharmacies take note, asks our correspondent…


So it’s 2019…One of my New Year resolutions, one that I am prepared to share with you, is that I will not be voting Conservative again. I hesitate to say ‘never again’ because to close off the option forever would be foolish – and let’s face it, there aren’t exactly a huge number of viable alternatives out there at the moment - but having watched the Brexit debacle unfold in Westminster during December it is clear the party in unfit to govern.

I am now becoming really concerned that we might be heading for a ‘no deal’ Brexit and the economic shambles that will ensue. Health secretary Matt Hancock’s December 7 letter updating us on preparations for a ‘no deal’ scenario said that the Government and the EU had agreed the basis upon which the UK will leave the EU in March 2019. Well, they might have done, but Parliament seems to think otherwise, and planning seems to be intensifying for a hard exit.

Mr Hancock (why do I always think ‘comedian’ every time the name is mentioned … most unfortunate! Must be my age…) restated his message that community pharmacies should not stockpile medicines. I won’t be buying in extra stock – after this month my cashflow probably won’t support the strain, and I haven’t got much space anyway – but I have looked at my top 20 dispensing lines and I am thinking about it. Not stockpiling, you understand, but building up my stockholding slightly…

If Mr H is worried about stock shortages then he ought to be, because any prudent proprietor will probably be thinking along similar lines to me. The last time I looked there were 45 price concessions in December on some pretty bog standard lines, and if the past two years have demonstrated anything, it is just how flaky the supply chain can get.

The last thing my pharmacy needs right now is a rising tide of medicines in short supply, particularly where there is a significant difference between the price I can buy at and the concessionary price the DHSC comes up with.

Mr H also needs to remember that when it comes to dispensing we are a service industry, and the immediate needs of my customers/patients are more important to me than some unhelpful (and unenforceable?) edict from the Department of Health, particularly when it is the Tory government’s internecine squabbling that has got us into the situation in the first place.

I hope that if Disaster Day does come to pass on March 29, PSNC will have managed to firm up some of the rather woolly contingency proposals outlined on its website.

I am also aware that, given the speed at which the Brexit situation is evolving, things might have changed completely by the time you read this. There could be another referendum coming up. There might be a general election in the offing.

Article 50 might be revoked. The Tory rabble might even have swallowed fresh assurances from Brussels and been persuaded to back Mrs May’s deal.

Before Christmas (on Dec 16 to be precise) the bookmaker William Hill was saying that a second referendum was now a “probability rather a possibility”. It was the first bookie to give a second referendum a greater than 50% chance of happening, and was offering odds of 8/11 on another EU vote, assessing that there is a 54% chance of it being held in the next two years. The bookmaker also lengthened odds that Prime Minister Theresa May’s Brexit deal being approved by Parliament before March 31 to 5/2.

At the moment I am more inclined to trust in the bookmaker’s judgement than put any faith in the hot air billowing out of the House of Commons.

(I couldn’t help noticing the bookmaker’s marketing pitch when I was on its website. Did you know that ‘these days political events are as exciting and suspenseful as sports, and people the world over have come to realise that politics betting is a thing’. I think I’ll stick to sport.).

It is but a short leap from stockpiling to rationing, since one not infrequently follows to other. The growing number of restrictions on what the NHS is prepared to pay for as it attempts to manage its budget and keep pace with demand means it has to ‘de facto’ ration what it can provide.

In an example of market forces at work, this is leading to dramatic growth of a parallel ‘self-pay’ healthcare sector. Many citizens, it would appear, are not content with what the NHS can provide. NHS England data shows that there were more than 4.1 million patients waiting for planned NHS surgery at the end of September 2018, the highest number since 2007 and an increase of 6% compared with 12 months earlier.

Frustration with NHS waiting lists means that more people are paying for their own healthcare, says a report on the private healthcare market by an outfit called LaingBuisson. It claims the market for self-pay surgery has more than doubled in five years, accounting for £11bn of revenue for independent hospitals and clinics in 2017.

Since it is the chosen provider of independent healthcare market data to the Office for National Statistics, it should be taken seriously.

Key drivers for this growth include the cancellation of elective procedures owing to pressure created by non-elective admissions in the NHS. This is coupled with increasingly restrictive funding criteria for elective procedures on the NHS, especially in orthopaedics, ophthalmology, gastroenterology, gynaecology and urology, says the report.

Independent healthcare providers are also more actively promoting their services, demonstrating that private healthcare is affordable even for those without private medical insurance. Prices for ‘fixed price surgery’ are now published on the websites of all major private providers.

In addition, in the past 18 months new types of service are being offered, including direct access to private GPs, diagnostics and consultants; these are a growing and important part of the self-pay market.

It seems to me that ‘supply and demand’ is fundamentally reshaping how people access healthcare. Is the switch to self-pay something community pharmacies should be looking at more closely?

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