Intended for healthcare professionals

Rapid response to:

Observations Body Politic

The role of NHS gatekeeping in delayed diagnosis

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2633 (Published 17 April 2014) Cite this as: BMJ 2014;348:g2633

Rapid Response:

Re: The role of NHS gatekeeping in delayed diagnosis

Sir
Nigel Hawkes subtitles his piece "How can people who need specialist care get it more quickly?" and then answers the different question "How can people with money who want specialist care get it more quickly?"
Briefly skating over the virtue of gatekeeping in controlling costs, he suggests that this barrier to care can be circumvented by paying for it. What is not made explicit is that for most people paying to access specialist care is beyond their means, and it is precisely because of this paucity of moneyed elite that he can buy his way round the gatekeeper.
If more people could buy this access then specialists would quickly be swamped by demand where priority was set by bank balance and not by clinical need and health care would become a bidding war. The role of the gatekeeper is to stop the whole tottering edifice of care according to need, not want, from falling over.
Faster access to specialists for all requires additional specialists and wider gates, but unless MPs think people are prepared to see more of their taxes spent on the NHS, Nigel Hawkes is simply advocating buying a seat on the lifeboat ahead of the poor who cannot swim.

Competing interests: NHS Gatekeeper

20 April 2014
Gareth D H Richards
GP
Saxmundham Health GP practice
Saxmundham Health, Lambsale Meadow, Saxmundham, Suffolk, IP17 1DY