BMA representative Dr Laurence Buckman has voiced his opposition to the rationing of NHS services.

Dr Buckman, Chairman of the Association’s General Practitioners Committee, has written to the General Medical Council (GMC) proposing that quality premium payments and the rationing of care be stopped.

In the letter Dr Buckman said the BMA “think this is appallingly unethical”.

The BMA chair asked the GMC to investigate these “incentive schemes” after CCGs and PCTs had ignored warnings by the Association to end the practices.

“Taking money from patient care and pocketing it for reducing something you do for patients by a fixed percentage or number is wrong,” he said in the letter. “We have said that repeatedly. We don’t think it is a good idea to tell doctors that if you reduce your referrals by 10% you will receive a payment.

“Although you might be mindful of expenses, you should not be chopping an arbitrary piece of patient service and then taking money which you are allowed to keep. There are lots of reasons why that is bad including the fact that patients will not trust you because they will think that everything you do will be dependent on making a profit out of it, from them.”

Dr Buckman’s letter follows a survey by Pulse Magazine which revealed that doctors believed the rationing of minor treatment services was affecting their relationship with patients.

NHS rationing is affecting the relationship between doctors and their patients, a new survey has found.

The survey by Pulse Magazine revealed that three quarters of GPs believe the doctor-patient relationship has been tainted by cut backs to certain treatments.

Dr Clare Gerada, Royal College of General Practitioners, said the problems of the Health and Social Care Act have resulted in patients holding GPs responsible.

Typical treatments which have been affected by a rationing include GP referrals for bariatric, hip and knee and cataract surgery.

Out of the 237 doctors questioned, nine out of 10 reported pressure to ration treatments or services over the past twelve months. Two-thirds of respondents admitted local rationing was adversely affecting standards of patient care.

More than 40% of doctors said they had changed the therapy of patients to less effective options due to rationing guidelines in the past twelve months. A third also raised issues with getting patients to guideline-directed targets.

GPs also exposed other forms of rationing with 89% finding patients had been referred back to them after missed hospital appointments and 31% claimed hospitals were overemphasising the risks of surgery in an attempt to off put individuals.

A spokesperson for the Department of Health said they would be writing to the NHS to remind them that rationing on the grounds of cost was wrong.

Less than a quarter of salaried GPs are involved with developing clinical commissioning groups across England, a new survey has revealed.

The survey by Leeds Local Medical Committee found that only 18% of sessional doctors had been invited to contribute to their local CCG.

Dr Richard Fieldhouse, Chief Executive of the National Association of Sessional GPs, said the findings were a “big concern” with a number of doctors feeling disengaged with the whole process.

More surprisingly, research also found that several GPs questioned said they were involved ‘against their wishes’, while other doctors said they were expected to contribute their services in their own time.

Dr Fieldhouse commented that CCGs should not be overlooking the opportunity to work with salaried GPs in favour of practice partners. “There are a lot of good reasons why it is a fantastic opportunity for salaried GPs, particularly as they don’t have any conflicts of interest and could make it their priority,” he said.

Dr Vicky Weeks, Chair of the GPC's sessional GPs subcommittee, said the survey’s findings reflected a “lack of understanding” by certain CCGs “about the shape of the GP workforce.”

An earlier survey by Pulse Magazine found that less than half of the seats on boards of clinical commissioning groups were filled by GPs – despite them being an integral part of the Government’s future plans for the NHS.

Dame Barbara Hakin, the National Director for Commissioning, believes reduced numbers of doctors on CCG boards is actually a positive development.

The Government’s commissioning tsar was responding after research found that financial restraints were causing CCGs to find alternative board members.

She called CCGs “mature” for searching for a “wide variety of individuals on the governing bodies”.

An investigation by Pulse magazine found that on 44% of CCG boards fewer than half of members were doctors.

Critics argued that GPs were being forced to accept limited roles in overseeing the commissioning process – despite being placed at the heart of the reforms by the Government.

Speaking at the monthly meeting of the NHS Commissioning Board, Dame Barbara said there were actually initial concerns that GPs would dominate CCG boards when the new measures were announced.

“There was, initially, a great degree of concern that because CCGs are membership organisations, built from the basis of the practices… that the governing bodies would be absolutely dominated by GPs and would not start to reflect their communities and key stakeholders,” she said.

“It is interesting that we are starting to get some evidence that the organisations have been really mature and that they aren’t absolutely dominated by GPs.”

GPs fill less than half of the seats of boards of clinical commissioning groups, new research has found.

Clinical commissioning is at the heart of the Government’s NHS reforms but in some parts of the country GPs fill just a fifth of senior positions.

The study by Pulse Magazine found that on 44% of CCG boards fewer than half of members were doctors – mainly due to financial restraints.

Despite the findings, a spokesperson for the Department of Health said the statistics were “encouraging” with “twice as many GPs than managers on CCG governing bodies”.

The study of 1,325 positions across a hundred commissioning groups in England discovered that only 645 seats were occupied by practitioners. Managers and finance officers accounted for a further 267 positions, whilst there were 140 lay members and a further 65 nurses.

Surprisingly, hospital doctors were only allocated positions on 36 CCG managerial committees despite a requirement from the DH that each board should include a specialist. To date, research found, only 7 of the 36 positions have been filled.

Bob Senior, Head of Medical Services at RSM Tenon and Chair of the Association of Independent Specialist Medical Accountants, said that management allowances had influenced the number of clinicians included on CCG boards. “The economies of scale don’t work so smaller groups are having to use that money judiciously, which means you can’t have quite as big an involvement from GPs.”

“The main driver for Andrew Lansley’s reforms was to put budgets in the hands of frontline clinicians – if GP-led commissioning is to have any chance of succeeding, it must be led by GPs,” said Steve Nowottny, acting editor of Pulse.