Following on from our first musing a recent conversation with a fellow grunt in the field opened our eyes to some other “free” market activities that most patients may not be aware of. Our fellow grunt works in a dispensing practice in deepest rural Northernshire which is one of the anomalies of the NHS for while most drugs are dispensed by chemists in certain areas of the UK, for example in rural locations where there might not be enough patients to support a profitable pharmacy, local GPs are allowed to dispense drugs under slightly less onerous regulation than would a chemist.
Our fellow grunt was bemoaning the fact that in the recent past their normal wholesalers have suddenly been unable to obtain drugs from certain drug manufacturers in the free market. In our colleague’s view the manufacturers have started to act as cartels. A few years ago our colleague said that there were only 2 local wholesalers from which they bought their drugs.
Only certain “newly” created “wholesalers” can supply these particular drugs from these particular drug manufacturers and these “new” wholesalers only supplied drugs from one particular drug manufacturer. So their dispensing practice serving an isolated rural community now has to order only from what is termed in the NHS a “preferred bidder” in contrast to the previous NHS “choice” option of 2 wholesalers who could possibly compete on price for a particular drug.
In order to maintain their patients’ supply of drugs our colleague’s dispensing practice has HAD to sign up to a certain (preferred bidder aka any willing provider) wholesaler or face the alternative of not being able to supply their patients in spite of the “free” market.
Several months later although our colleague had paid the “market” price for their drugs they suddenly noted several hundreds of pounds being added to their drugs bills per month.
Further enquiries led to the fact that the pharmaceutical industry, champions in the eyes of politicians of the free murkeet, had not only restricted supply for previously freely obtainable drugs from 2 local wholesalers down to one preferred bidder aka any willing provider only but had also added a “premium” for doing so.
If you did not order enough drugs from this “preferred bidder aka any willing provider” of goods for the NHS “internal market” the provider can charge you extra per month in our colleague’s case several hundred pounds a month per month for a “target” shortfall of a much much smaller amount for not ordering enough drugs per month.
So the “choice” provided by the current NHS murkeet and the free market means you now have only one choice of supplier (instead of 2) and if you don’t reach a “target” (set by the supplier using the “choice” agenda) your costs rise. No restriction of the free murkeet here comrades or supply cartels.
As our colleague said to us you cannot predict illness and hence the need for drugs but the pharmaceutical industry feels it can and shafts you accordingly each and every month as you now in the NHS murkeet have a “choice” of only one supplier not “any willing provider” for dispensing practices.
Can we now see the new NHS Tripartite murkeet doing the same if it has not already done so?
Think ISTCs and Darzhole centres.
ISTC charge fixed block contract costs and if they don’t do all they are contracted to do they trouser the costs but do not give a refund for things not provided but charged for. Anything else, including their failures, the NHS picks up the pieces for.
Darzhole centres agreed to treat a certain number of patients and when this number had been treated they shut up shop and the local NHS picked up the pieces for extra work at no extra cost while the Darzhole centres ceased working but were still getting paid.
Examples of NHS “world-class commissioned” fixed price contracts charging above market prices to provide less than the then current NHS “providers” (hospitals and GPs) and then when you don’t use them enough (because the contract says you can’t) they cost more to terminate than run and more to pick up the pieces of what they haven’t done.
In our colleague’s case they have not bought enough drugs but they have treated their patients and been penalized for doing so by the current and soon to be NHS murkeet. In the case of ISTCs and Darzhole centres the NHS has bought both too much from each and received too little and the private sector has won hands down.
Will the nice new (MRC)GP commissioners do any better then the previous “world-class” commissioners? We wonder who the bookies would put money on to make a profit based on previous form? Nice but (commercially) dim GPs or market savvy private sector friends of the Tripartite NHS coalition?
How many GPs or anyone else reading this will know how the free market works outside of NHS "internal market" healthcare or be able to work out how Marshall NC/DC new murkeet will work? Who do you think will win?
You the patient or nice Mr Andrew’s NHS murkeet friends?
Praise be to the Party and its Tripartite healthcare policy for providing the same as before by charging more to ultimately deliever less in the process for ones tax pounds. Darzhole centres and ISTCs were but the beginning of the shafting of the NHS towards the weapons of AWPs’ mass destruction.
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Northern Doc was once a blog originally written by a group of GPs in Northernshire and expressed their experiences and frustrations of working in today's NHS. The pieces were compiled at social meetings after work and published anonymously in a once free society. Following the Government's Medical Council clamp down on freedom of thought, speech and expression by doctors and our belief that the views of a few doctors DO NOT represent the views of the profession as a whole their views will now be written by and published by a journalist who has previously contributed to the blog by virtue of social ties. Any inference that the word Doc means a doctor is now purely coincidental. This is as of the 22 April 2013.