Senior doctors have warned that patients are given drugs and tests they may not need because GPs and hospitals are paid for the quantity of treatment
By Laura Donelly, Health Editor
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NHS patients are being given drugs and tests they may not need because GPs and hospitals are paid for the quantity not quality of their treatment, senior doctors have warned.
The Academy of Medical Royal Colleges said patients should be encouraged to ask if their medical procedures were really necessary, in a bid to halt over-diagnosis and needless treatment of swathes of the population.
In an unprecedented intervention, the medics – who represent all 21 medical royal colleges in the UK- said too many patients were being forced to endure tests and treatments which could do more harm than good.
They said the payments system in the NHS, which means hospitals are paid according to the number of procedures they perform, and GP pay linked to diagnosis and treatment, could act against patients’ interests.
The senior doctors said it was time to “wind back the harms of too much medicine” and replace a culture of “more is better” with balanced decision making.
Patients should be encouraged to ask questions such as, ‘Do I really need this test or procedure? What are the risks? Are there simpler safer options? What happens if I do nothing,’ the doctors say.
It comes as a leading scientist said millions of people should stop taking antidepressants, because their long-term risks outweighed the benefits.
Prof Peter Gotzsche, director of a Danish research centre said drugs given to patients with depression, attention deficit and dementia were responsible for the deaths of more than half a million people each year in the Western world.
Writing in the BMJ, Dr Aseem Malhotra, a cardiologist, Prof Terence Stephenson, a former chairman of the Academy of the Medical Royal Colleges, and Prof Sir Muir Gray, from Oxford University, said doctors needed to be more honest with patients about the potential harms of treatment.
They said the current payment system in the NHS encouraged doctors and hospitals to carry out tests and provide treatment which offered limited benefit, and could result in harm.
“The system has no incentive to restrict doctors’ activity; the NHS in England has a system of payment by results, which in reality is too often a payment for activity and encourages providers to do more in primary and secondary care,” the doctors write.
They said family doctors were “increasingly pressured to focus less on open dialogue with patients and treatment options and more on fulfilling the demands of the Quality and Outcome Framework,” a system which pays GPs for performance.
Under the scheme, GP pay is linked to prescription of certain drugs, such as statins to protect against heart disease, and participation in checks for conditions such as diabetes, and screening programmes against cancer.
Hospitals are paid for the number of patients they treat, with a tariff of prices for each operation and test, prompting the concerns that NHS trusts end up being paid for the amount of activity they carry out, rather than the outcomes for their patients.
…The doctors said a “culture of ‘more is better,’ where the onus is on doctors to ‘do something’ at each consultation,” meant patients were too often left anxious after a diagnosis they could do little about.
They said this had led to unbalanced decision making and patients, “sometimes being offered treatments that have only minor benefit and minimal evidence despite the potential for substantial harm and expense.”
“This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and a lack of understanding of health statistics and risk,” they write….