The BMA blog



Over to you on growing blight of bureaucracy

It can be very strange reading about yourself in the third person. So, I had a slightly odd feeling on Saturday morning when I saw my views about the effects of NHS reform and rationing staring back at me from the front page of the Guardian – the result of my first major interview as BMA council chair.

Although, of course, the headline put the case more simplistically than my actual comments I’m glad to have been able to put forward the concerns of BMA members about the direction of travel of the NHS.

The thrust of what I said was that doctors across the NHS are experiencing, in different ways, a bureaucracy that interferes with their relationship with their patients. Not only that but the combination of rationing and resource restrictions with the creation of a market in the NHS is taking us in a worrying direction — one where we could ultimately see the nature of what the NHS offers patients becoming much less comprehensive.

I made particular reference to the use of referral management schemes, by primary care organisations and clinical commissioning groups.

We’re hearing about more and more of these, and while we would clearly not oppose initiatives that are supported by clinical evidence, and improve productivity by improving quality, it seems that GPs are increasingly being incentivised to achieve blanket cuts in referral rates.

One of the starkest examples came from Harrow where, under proposed plans, practices would receive additional funding for helping to meet the Nicholson challenge, provided they met key criteria – including reducing referral rates by 10 per cent.

In my view, this is simply immoral. Paying doctors, in any form, on the basis of having reduced referrals as an outcome in itself, is contrary to the principle that as professionals, our first duty is to provide the best possible care to the patient in front of us.

We want to continue to highlight your concerns about what’s happening to the NHS, so if you have any more examples of the bureaucracy interfering with your relationship with your patients, let us know by commenting below.

Mark Porter is chair of BMA council

Posted in:  NHS system reform Reconfiguration and integration

Tags:  BMA council chair Mark Porter NHS reform Health and Social Care Act rationing


  • Dr David Shuttleworth

    10 September 2012

    Please, in the interests of clarity, could you desist from using the rather amorphous term 'incentivise' and revert to the rather more accurate and better understood term 'bribe'.

  • Andrea Franks

    11 September 2012

    Look at THIS!

    If this happens there will be no going back.

    BMA must oppose this strongly and VERY publicly

  • Dr Arthur Rushton

    11 September 2012

    I have recent experience of inefficient delivery of health care to a relative of mine. Many months ado she was referred to the dermatology dept our local Foundation Trust Hospital for biopsy of a very small nodule on her nose. Following this silence for a month and then a letter arrived to her home informing her that she had a skin cancer(basal cell) but without any guidance about this type of cancer. options for treatment or prognosis.

    The letter also said that she would be referred to the plastic surgery dept for treatment. What then appeared after another delay was another outpatient appointment following which she was listed for surgery. The appointment for day case surgery involved another delay of about 6 weeks, The surgery has been carried out and hopefully will be curative.
    I find it difficult to understand why, after the biopsy result she could not be directly listed for surgery on the basis of the report. photographs of the lesion and a short internal referral letter. It would be easy to put these delays down to 'bureaucracy' but I suspect that clinical governance failures also played a role.

  • 7096993/Webuser/BMA

    12 September 2012

    We have been experiencing a problem with breached patients - beyond 18 weeks, patients are no longer allowed to be listed for surgery without management approval - instead, we are made to do patients who are just about to breach to meet targets - in other words, once a patient has passed 18 weeks, they could wait much longer whilst others 'queue barge' ahead. This is not a Trust directive but comes from the DOH and so we are made to comply - this makes the service unfair and strains our relationship to our patients. Are other units faces with similar restrictions to 'massage' the breach figures?

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    24 January 2013

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