More free medicines in bid to stop doctors bending rules

The Health Ministry will be proposing to expand entitlement for free medicines to put right a situation in which doctors “misdiagnose” patients to make them eligible for the state-sponsored medication.

New medical conditions will be added to the list of chronic ailments that entitles patients to free medication.

However, a lot of people with these conditions are already benefiting, a Health Ministry spokesman said. The reason for this, he explained, was that they were covered through an “anomalous misentitlement situation”.

In layman’s terms, this refers to a situation in which some doctors choose an ailment that entitles their patient to free medicine even though it is not the condition they have diagnosed.

Consultants from different medical specialities admitted that the practice is relatively widespread.

“Some doctors seem to have the impression that it is up to them to look after the patient’s needs even when these are not strictly clinical,” one doctor said, pointing out that, although this was done in the best of intentions by caring doctors, misdiagnosing patients for the purpose of entitlements meant they could be charged with fraud.

The situation developed because the list of free drugs tends to be restrictive. For instance, in psychiatry, only people suffering from schizophrenia are eligible to free medication.

So patients suffering from depression might be put down by their doctor as schizophrenic so they can get their anti-depressants on the national health service.

The ministry spokesman also said that, to rectify this, in recent years patients have been able to receive these medication under the heading “psychiatric treatment as prescribed”.

It has long been the case that the “narrow description” of the Schedule Five of chronic diseases has not kept up with medical advances which can now alleviate previously untreatable diseases. This left doctors with one of two choices: either to squeeze them under the heading of the broad category of diseases or not sign the entitlement form with an “inappropriate diagnosis”.

The situation affected both doctors and patients because the patients whose consultants refuse to “misdiagnose” them, even if only for the purposes of this form, are not covered by the NHS.

Now they will be covered, if the new proposals are approved in Parliament.

“This decision has been agreed to in principle by the government and will need to go through the necessary legal channels to change the fifth schedule of the Social Security Act,” the spokesman pointed out, adding that amendments to the Act would not take place overnight.

In fact, the changes have been long in coming. Back in 2008, a task force within the ministry was set up to audit a random sample of applications for free medicines, precisely to identify these “institutional misentitlements”.

“Obviously it would have been dangerous from a public health and patient point of view to stop such entitlements, so instead we took stock of the situation and consulted the chairman of each department and drew up a list of entitlements and presented it to the government,” the spokesman said.

Speaking to The Times, consultant doctors presented different views on the matter. While some said they stood strictly by the rules, others admitted “putting the patient’s best interests” before the rules.

Issues such as these have been taken up to the Medical Council, one consultant noted, as they not only endanger the doctor but even the patient, who could be labelled with an inappropriate condition.

“Successive governments have allowed us to wallow in this grey area without having the guts or decency to clarify our condition,” he said, emphasising that the practice needed to stop.