At what cost?
The HSJ suggests that the delayed Commissioning Services Framework (ASCC) is finally happening with the official announcement due next week. It will be interesting to see just who made it onto the list but the possibility exists that the contract is not that important anymore due to the change in emphasis at the DoH.
And it looks like Leicester will not be getting a new PFI hospital after all with the collapse of a £921 million scheme.
The University Hospitals of Leicester Trust (UHL) has pulled the plug on its Private Finance Initiative (PFI) after a nine-week review of the project.
The trust had planned to spend £711m developing three sites in Leicester but the review showed costs would increase to an unaffordable £921m.
A total of £23m had already been spent preparing for the PFI scheme.
Atleast they took the decision now rather than going ahead with the plans in a fit a of bravado & saddling the people of Leicester with an unaffordable white elephant. Now to see if other trusts in a similar position gain the courage to do the same.
An interesting argument from a PCT PEC member regarding the importance of diversity assessments while commissioning. I’m glad to see someone applying their mind here instead of just filling in check-boxes. But it is action that is required, not just waffle.
This post from Hospital Phoenix hits the bulls-eye regarding the complicity of the Royal Colleges in dumbing down medical training.
While the midwives go to war.
Something from the BBC & Lancet.
Not to mention this surprising turn of events with Isoft ditching IBA at the altar to elope with Compugroup! Though with CSC having taken over all responsibility for the NPfIT contracts, the relevance to UK healthcare is reduced.
While this is an argument for increasing the priority allocated to sexual health.
And finally the official write-up of the work done by the NHS Service Delivery Organisation (SDO) that was covered here previously describes the importance of continuity of care to eventual outcome even where choice might have initially been seen to have the upper hand in the patients mind.
Patients need help with choosing which service mode and/ or practitioner will suit them best.
As far as I knew, that is what GPs do!
Service developments that make relational continuity less easy to deliver will impair patients’ experience of care, particularly those patients who have more complex problems. For these patients, informational continuity promoted through electronic record systems cannot substitute for relational continuity. And as the structure and range of services becomes more extensive, some patients may find increasing difficulty in negotiating for the aspects of care they prefer. A service is needed that is simple to use and allows for both convenient access and continuity depending on the patient’s preferences and needs.
And regarding the movement of services closer to home, there is a reiteration that not all is as rosy as it seems.
Our review broadly suggests that transferring services from secondary to primary care, and developing strategies to change the referral behaviour of primary care, may be effective in increasing the effectiveness and efficiency of outpatient services.
Relocating specialists in primary care and developing joint working arrangements between
primary and secondary clinicians have been of more doubtful value.
Although the evidence is still limited it does suggest that any initiative to move care closer to
home needs careful design and evaluation, as we cannot simply assume cost-effectiveness and high quality.
Many of the new models of care have been introduced to meet the important objective of improving patient access. However, those responsible for service improvement should be aware that they might face potential trade-offs between the goals of access, cost-effectiveness and quality.
And regarding the fashion for GPSIs, the message appears to be unequivocal.
The most important benefit to patients of GPSI services appears to be in terms of accessibility. The location of a GPSI service is crucial to maximise accessibility and convenience for as many people as possible. In the case of the first study, it appeared to provide care which was more accessible and preferred by patients, with no evidence of difference in clinical outcomes. These benefits were obtained at considerably greater
cost.
I wonder if policy-makers will take this into account, not to mention of course the above-mentioned commissioners?
September 29th, 2007 at 2:37 pm
I am bemused and would appreciate enlightenment. Once a “patient” is registered with a GP practice in the UK iit seems that other choices are not possible apart from hospital “emergency” services - who complain about routine enquiries. Surely this is a monopoly inefficient medical market position. If health consumers are willing to pay for GP choice why is private investment not favoured? Apart from this, GP businesses are essentially private affairs bloated by generous government (public/health consumer/taxpayer) subsidy. The most important benefit to consumers of primary health services is surely value for money. The present system does not provide for this.
October 5th, 2007 at 10:41 am
Simple explanation - You buy your electricity from Supplier X who serves your area. You do not decide to change to Supplier Y when making a cup of tea & then on to Supplier Z to use the microwave.
And roughly £52 per year for an adult is what the government pays your GP to see you as many times as needed. Private consultation fees are around thrice that for one appointment. Somehow I don’t think that qualifies as generous or bloated.
In the “Land of the Free ™”, current reports are that administration charges swallow up a third of healthcare costs. The NHS used to spend less than 10% on admin, now up to 12% or more & climbing with all the new “reforms” which leaves a smaller sum of money to actually treat you.
Efficiency is rather misleading as a concept. Just how do you define it?
October 8th, 2007 at 12:25 am
I refer to those customers who may want a second independent medical opinion (outside the practice) and those customers working elsewhere and who want to pop into a local NHS GP centre for someone to advise on a rash, a sore ear etc - ie things that hospital “Emergency” services do not want to be bothered with (I have been reading the book “In Stitches”) Australia/NZ allow you to attend any government subsidized GP practice tho you may pay more to go outside your registered area, and pay rates according to your income. This does not seem possible here. If it is I would like to know how, because I do not find the GP practice I (randomly) registered with satisfactory but it does not seem worth while shifting to another local practice - who will surely be their mates anyway.
“There are two sides to welfare economics: economic efficiency and income distribution. Economic efficiency is largely positive and deals with ‘the size of the pie’ Income distribution is much more normative and deals with ‘dividing up the pie.’” see Wikipedia for more - it’s generally good on economics.
Both relevant concepts for NHS priorities?
NB 1/ Not too impressed with electicity as a model for medical services.
2/ I have been quoted 100BP for a visit to a private consultant.
Surely GPs don’t charge more than this?
October 8th, 2007 at 2:50 am
If you request a second opinion from your GP the two of you should be able to come to some agreement on a suitable alternative provider (other local GP or hospital doctor) for that particular condition / episode. This is pretty unexceptional & happens everyday. You do not need to pay extra for this. However the defensive / suspicious attitude damages your own interests, there being no cabal of medics.
The rules do not allow GP’s to mix private payment with NHS provision primarily for fear of double-billing.
I meant “efficiency” in the healthcare context, both in the case of a specific treatment episode & in terms of the wider picture. There is no agreement on its attributes, depending as it does on the viewers priorities. Do you measure it economically or on patient satisfaction or on outcomes?
1) The NHS has signed a long term bulk supply contract with the GP, hence the low rates. There are disadvantages with each model but this semi-monopoly (there is quite often an overlap in practice boundaries allowing for alternative suppliers) is one of the cheaper ways of providing such service. Ask for recommendations from locals.
2) My solicitor charges me in excess of £200 an hour & I suspect that most consultants are cheaper. I fail to see why GP’s should charge less just on principle. In practice rates can vary.
October 8th, 2007 at 9:45 am
I fail to see why there is no real patient choice. I have not been impressed with the behaviour of most GPs I have encountered in the UK and would favour a system that allows non-GP referred independent opinions. As I see it the GP system here is a monopoly which locks customers in because there appears to be no way to find out who are the better suppliers of medical advice and services. It is not “transparent” just like the errant financial markets that are causing the banks to seize up. This is inefficient, where “inefficient” is referred to in an economic context. It’s no wonder the NHS squanders its public funds.
October 8th, 2007 at 10:06 am
There are ways for you to judge the quality of services provided by your GP & they are the same as those you use in other areas of your life. Reputation is one, personal recommendations is another, their QOF performance is available publicly etc. However they perform a dual role, serving as gatekeepers to healthcare provision on behalf of the PCT (trying to cut NHS spending) in addition to their role as patient advocates. That balance might not be consistent.
October 8th, 2007 at 11:53 pm
There is no way to choose a “good” GP because the info is not available. They are starting to do the right thing with cardiac surgeons (index=deaths) .. not perfect but really the average client has no way to judge unless the Dr shows clearly objectionable behaviour .. and most customers aren’t brave enough to complain. Thta’s why you need your compensation industry in UK - does give feedback on the worst behaviour. or lack of it - or sheer inefficiency in the delivery of services.
November 8th, 2007 at 11:32 am
Noel Plumridge in the HSJ is looking to register with a GP. Let us see what his readers have to say. Especially since his analysis so far seems to focus on the soft skills as opposed to the mounds of data that the NHS wants to collect. Glad to see some recognition of their importance. Now where is the resource that lets me find a plumber / accountant / lawyer / random assorted professional the same way?