Irrational rationing

The recent news story about the York GP practice which, having received notice from its primary care trust that certain non-urgent treatments would no longer be routinely funded by the National Health Service, wrote to a small number of waiting-list patients to offer them private alternatives, exposes a number of fundamental fault lines in healthcare funding.

You'll recall that a furore was created when one of these private treatment options turned out to be provided by a company wholly owned by the GP partners themselves. The PCT immediately issued a statement that while it did not intend to: '...routinely commission these services' (such as in-growing toenails and wart removal), it 'recognised there may be exceptions'.

This brought to mind past official statements that while dental implants may not be available routinely, there may be patients for whom such treatment could exceptionally be provided at specialist centres and therefore it was not possible for dentists to state that they were not available on the NHS.