There has been plenty of assertion / anecdotal evidence to suggest that continuity of care matters. Now there is more hard evidence to show that there is a benefit to patients seeing their own GP instead of walk-in centres & A&E departments. This is in addition to plenty of US research which shows the same.
After adjusting for measures of medical need, demographic characteristics and other covariates, we found that increased emergency department use by elderly patients was associated with lack of a primary physician, lower continuity of care with the primary physician, low overall use of primary care services and residence in a region with more general practitioners per 1000 population. Furthermore, lower continuity of care and low overall use of primary care services appeared to have a stronger effect on emergency department use among urban than among rural residents, whereas absence of a primary physician had a stronger effect among rural residents.
A much bigger & more robust study then than the British one.
Something to consider when commissioning services perhaps?
£91 billion in today’s prices we are told & with interest mounting to over £171 billion over 20 years.
So far that is.
“PFI deals were supposed to give us certainty about the long-term costs of providing public services.
“The reality is different. Benchmarking and market testing of the costs of delivering ongoing services under PFI deals - such as catering and cleaning - have in practice led to increases in prices of up to 14%.”
A third of projects after 2003 attracted no more than two bidders compared with just 15 per cent previously, the Commons public accounts committee reported. Competition was put at risk if a bidder subsequently dropped out or one of the bids was weak, it said.
The committee reported that average tendering time had increased from 33 to 34 months since 2004. Delays to projects had cost the taxpayer at least £67m.
I pity the poor civil servant who has to implement this if indeed it comes to pass.
Britons travelling abroad for health care, ranging from dental work to open heart surgery, will have their treatment funded by the NHS.
They will simply have to pay their travel and accommodation costs, plus any top-up fees if charges in the foreign hospital are higher than NHS costs.
So a trip to Belgium for bariatric surgery perhaps, to Eastern Europe for dental treatment or the Scandinavian nations for infertility treatment that patients might theoretically be eligible for has the potential to wreck PCT budgets as well as strategy.
The plans say that patients should not be given drugs or treatments that their own state system does not fund, and that where there are waiting lists, domestic patients should have priority over foreign patients. Beyond that, EU residents would be free to travel for non-emergency care in any of its 27 countries.
Next week’s directive is an attempt to catch up with a series of European court rulings over the past decade which have ruled that there should be an open market in health care across Europe.
Just how is a hospital abroad supposed to decipher the availability of treatments in every PCT when it is not so clear to doctors within a few miles? A central clearing-house for such information with a clearly codified list of available treatments instead of the juggling of priorities that PCTs have to manage today? If indeed the proposals are accurately described, the devising of a solution to this would be a challenge to relish.
The surroundings were plush. I pushed through a large front door just off ……………………, to find a beautifully decorated room with sunken, red leather sofas, plasma screens showing videos of patients’ success stories, huge windows and fresh flowers on the tables. Everybody was friendly, polite and professional.
Or
………………… was a trek to get to, perched in some industrial estate in north London. No sofas or Tatler here. Just the radio.
Perhaps patient satisfaction questionnaires filled in immediately post attendance are not such a good idea then, do I have agreement?
The verdict of the Better Government Initiative, contained in a series of reports to be released over the next few weeks, is damning.
Government departments have “serious deficiencies”; the combined output of Parliament and the executive contain “too many disappointments and failures”; and “emphasis on ‘management’ has led to more bureaucracy at the expense of substance” in the Foreign Office.
“Health, education and the armed services have had constant change, insufficiently discussed and thought through.
“We’ve had nine revolutions within 10 years in the NHS. We’ve gone away from markets, then back to markets. It’s just disruptive and demoralising.”
“What has really damaged the public’s trust in politics is the failure to live up to promises… Ordinary people want the money spent on the NHS to have brought about the improvements it should have done.”
“Teachers, nurses and doctors can see how much micro-management is going on, that makes their job harder and seems to treat them as unintelligent creatures.” There is a similar problem in Whitehall. “Civil servants are not expected to analyse problems and produce intelligible policy,” he says.
“Ministers come up with an idea and expect civil servants just to do it. You can’t just come down on civil servants if they don’t deliver when you haven’t been very precise about what you mean by delivery.”
“Constant change, often couched in impenetrable jargon has had a depressing effect on morale. People feel that they no longer feel they know whether they are coming or going, that they are unappreciated and ignored… This is not management in any real sense, it is certainly not leadership and it undermines the effectiveness of the organisation.”
Hmm, so where does it absolve the authors from responsibility for standing by while all this was happening? Not to mention the very many failures of years past? After all, it is not as if the civil service has clean hands in all this as can be seen below. But I will take allies wherever I can find them.
Sophia Christie in the HSJ punctures a few bubbles relating to the way in which policy seems to be populated by some remarkably persistent ideas that pop up every decade or so in search of believers.
Several weeks later, Lord Darzi announced polyclinics as the solution to primary care capacity in his interim report for Our NHS, Our Future (or the On/Off review).
The last time I remember polyclinics taking centre stage was the late 1980s when Margaret Thatcher sent teams of civil servants overseas to investigate alternative funding for the NHS. They came back from Germany with polyclinics, which at least diverted attention for a while from personal insurance as the answer.
However, the theme of finding community-based activities for hospital consultants is a recurring one. In his London review, Lord Darzi rightly identified a key principle as ‘localise where possible, centralise where necessary’. However in On/Off he also references US achievements in shifting outpatients to community settings. Given the lack of primary care in the US, much of this outpatient activity would have been seen by a GP in the UK anyway.
Meanwhile the many GP fundholding initiatives of inviting consultants to sit in GP surgeries and see a fraction of the patients they could have in a clinic should have been a lesson in both (in)efficiency and inequality.
At-least someone is paying attention & is willing to display a healthy cynicism. Now to help educate the rest of her colleagues.
The first practices are expected to open to patients in a year’s time and will be funded from the £250 million access fund announced last month. The access fund will also provide at least 150 GP-led health centres across the country.
And if the procurement is to be run by the Commercial Directorate, will they take into account the dossier that the GPC has been collecting as well as the complaints from Third Sector organisations about the way they are being indirectly excluded from the contracts?
The full list of PCTs are: Manchester, Barking and Dagenham, Knowsley, Sandwell,Wolverhampton City, Heywood, Middleton and Rochdale, Liverpool, Sunderland Teaching, Birmingham East and North, Halton and St Helens, Heart of Birmingham Teaching, Barnsley, Leicester City, Oldham, Blackburn with Darwen, Stoke on Trent, Hounslow, Hull, Nottingham City, Blackpool, Ashton, Leigh and Wigan, Dudley, Bolton, Greenwich Teaching, Sefton, Medway Teaching, Salford, Hartlepool, Tameside and Glossop, Walsall Teaching, Newcastle, Redcar and Cleveland, South Tyneside, Calderdale, North Lancashire, Luton Teaching, Havering and Hammersmith and Fulham.
I guess that there will be more batches to follow. Though there has been no definition of an under-doctored area & the criteria by which these practices were selected, in addition to which there has been no explanation of whether these contracts will be available via APMS only or open to PMS & GMS providers as well.
The Department of Health will hold a national conference on Thursday 13 Dec in London for commissioners and providers to discuss advancing plans for increased numbers of GP surgeries and GP led health centres.
The 2007 NCEPOD report on the management of trauma is out & makes for uncomfortable reading, especially with the wide variation in performance of what should be standardised responses to presentation at A&E.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
Consultant led trauma teams would be ideal but even one staffed with registrars would be a start.
All patients with severe head injury should be transferred to a neuro-surgical/critical care centre irrespective of the requirement for surgical intervention.
Hmm, this will require a massive increase in neuro-surgical / rehabilitative capacity & a sea-change in attitude.
Making a virtue out of necessity, Mark Britnell appears to have suggested that the Commercial Directorate will be substantially downsized (neutered is the word used). It is hard to see how its performance over the past few years can stand up to scrutiny.
The DoH’s director general of commissioning and system management Mark Britnell said that the ‘commercial directorate will be reduced in size and regionalised and procurement will be localised’.
Sources close to the discussions confirmed that the commercial directorate will be ‘neutered’.
The plans will be contained in the DoH’s operating framework to be published next month.
As always the devil will be in the detail especially with the question of what will happen to ongoing procurements still open, not to mention the proposed primary care contracts.
I could be acused of unfairly beating up on HMRC but losing personal data from 7.2 million families (25 million people) is not exactly best practice & it is surprising but honourable that the chairman has resigned. Now those affected could change security details / banks / accounts / cards etc but the distress & confusion caused is substantial. Now just imagine if this was a problem with someone’s medical history, leaked from the Spine due to the poor design of the security policies that everyone & their dog have been warning about. Just how do you go about changing that? An increasing number of GPs seem to agree.
The National Audit Office was poised on Friday night to investigate the hugely scaled-back programme to buy £700m worth of private-sector care for NHS patients after it emerged ministers had spent more than £100m on the procurement.
The cost of the procurement so far is £84m, the Department of Health admitted on Friday. In addition, it has already paid £8.4m in compensation to private health companies for schemes cancelled at the last minute, ahead of this week’s announcement.
Industry estimates are that the department will have to pay at least another £20m, maybe much more, for the latest round of scrapped deals.
The NAO, the spending watchdog, said it was “very conscious of parliamentary interest” in the issue, and that it was at the “early stages of preliminary inquiries”.
I guess that we will be seeing more about this in the coming weeks.
To readers from far & wide:
The server logs make for interesting reading, telling me just who is visiting the site & the topics that interest you.
So can I invite you to participate in the discussion, by telling me why I am wrong if indeed I am so & generally shedding a little light on this brave new world we inhabit.
It is more fun that way, honestly!
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