Lest any of my foreign readers not understand the concept of a bung, it’s a more derogatory word than its synonym ‘bribe.’

Medical managers in Oxfordshire are thinking about giving ‘a financial incentive to reduce prescribing costs.’ That’s a bung, in other words. Here’s how it’s going to work. GPs will get back half of the savings created by prescribing fewer drugs to elderly people in care homes. That’s a particularly specific target group, isn’t it?

I’ll admit that GP prescribing in the elderly can be a bit hit and miss. Older people absorb and metabolise drugs differently from younger people, and this has a tendency to increase the risk of drug interactions. As a working rule, if you take five or more different drugs, the chances are about certain that there’ll be an adverse interaction. I know this from when I worked in the pharmaceutical industry. Often the only way round that is to stop using one or more of the offending drugs. I can see that makes sense.

However, older people, especially those in care homes, tend to have multiple pathologies. They’re prone to infections, they often have musculoskeletal problems, their mental status is often precarious, they’re more likely to suffer conditions such as Parkinson’s disease… I’m sure you’re getting the picture.

The particularly villainous aspect here is the focus on cost cutting, not maintaining patient care. That’s pretty far down the agenda. There’s the problem also of unscrupulous GPs* seeing this as a bit of a cash cow. If I were a bit of a wrong ‘un, I might be tempted to increase my prescribing before the scheme starts, then cut back to get my share of the ill gotten gains.

Let’s also not forget that the elderly are often on borrowed time, and in care homes have precious little voice, as all the abuse cases show. They’re of no political importance, especially to the Toffs. They’re expendable.

On the upside, the local medical committee has rejected the whole shooting match as being flawed. This is not least because, as a spokesman said, ‘those doing the work are not directly rewarded for the time they spend.’

On another downside, this debacle comes just weeks after a decision to reward GPs for making fewer hospital referrals for screening for conditions up to and including cancers. Meanwhile Rhyming Slang is flogging off he NHS via the backdoor.

*If you think all doctors are altruists, interested only in the welfare of their patients, you’re wrong, as this week’s jailing of Ian Paterson should tell you.

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