Reply With QuoteWhat went wroing last time?Originally Posted by Pebble
Any thoughts on this?
http://www.dh.gov.uk/prod_consum_dh/.../dh_117352.pdf
Research is dismissed in a single paragraph: 3.16
A big role for NICE: 3.12
A potential bonanza for alt med:
"2.20 However, we do not see choice as just being about where you go and when, but a more fundamental control of the circumstances of the treatment and care you receive."
Consortia that fail will be left go bankrupt???
"Consortia will be required to take part in risk-pooling
arrangements overseen by the NHS Commissioning Board; the
Government will not bail out commissioners who fail."
Haven;t we been here before?
"4.5 GP-led purchasing has history. Practice-based commissioning was an attempt by the last Government to build on the successful parts of previous Conservative approaches, such as total purchasing pilots. There have been some examples of practice-based groups making progress, in spite of a flawed policy framework that confuses the respective responsibilities of GPs and PCTs, and fails to transfer real freedom and responsibility to GP practices. Our model is neither a recreation of GP
fundholding nor a complete rejection of practice-based commissioning. Fundholding led to a two-tier NHS; and practice-based commissioning never became a real transfer of responsibility. So we will learn from the past, and offer a clear way forward for GP consortia."
Oh. yes, but this time it will be different. Amazing!
What went wroing last time?
Funny how no-one mentioned any of these changes in the 'What will help the NHS' thread!
I'm gutted. I deal with the issues around ISPs all the time in social care, it's chaos, expensive chaos. I have to admit I'm genuinely scared - this is lousy news.
I must admit I have never understood how the present system , with PCTs and LHTs and commissioning and all that works and what it is for. Patient goes to GP, GP makes diagnosis or sends patient for more tests, GP treats pateient, patient gets better or if not GP refers to hospital consultant, consultant orders more tests and treats (other drugs, surgery, chemo or whatever). Patient discharged.Where does all the other stuff come in? Where does the money side of it come in - NHS pays for GP/ consultants's time, the drugs, the surgery, whatever the clinical needs. What is the big problem and why do we need all the bureaucracy? Genuinely dont get it.
When you have an organisation as large and complex as the NHS it is easy, without meaning to, to lose spectacular amounts of money. Therefore, the management of the organisation is crucial. While Labour was in power they threw vast amounts of extra public money into the NHS without any obvious vast improvement (though obviously it depends how you define and measure improvement). This implies the current structure is not as efficient as it could be.
http://www.rcgp.org.uk/pdf/ISS_INFO_08_NOV04.pdf
This will get you started.
Essentially what you describe would work on an individual basis for acute conditions, but not on a population basis, and would not cover chronic conditions (ensuring follow up), screening programs, prevention programs (e.g. vaccination, coronary risk management) or drug recalls etc. For all the more complex operations one needs a huge bureaucracy - if anything what the NHS has suffered from is inadequate bureaucracy - not always too little, just as often incompetent or misdirected (by politicians).
Think of what has been wrong with the NHS - poor appointment management, inflexibility, lost notes, poor communication, delayed response to complaints, inadequate crisis planning, duplication of tasks and tests, inappropriate staff allocation, failure to learn from the mistakes of others etc. All things that depend of a properly functioning back office.
Putting GP's in charge of hospital funding is like instructing all actors work together to manage film budgets including distribution and advertising. Wrong skill set.
Interesting analogy as it show that this can work vis a vis [wiki]united artists[/wiki]
When the front line see what management are doing wrong and set about to do things better this is often a good thing. What we have here though is policy makers imposing this obligation rather than it being sought. I suspect that's the difference.
Thereby hangs a tale. For a very few highly motivated groups of GPs fundholding worked a treat - for most of the others it was either a waste of time and money or a disaster. The difference there was that you had to express an interest to get in on the scheme.
"Putting GP's in charge of hospital funding is like instructing all actors work together to manage film budgets including distribution and advertising. Wrong skill set."
But why not have the primary care funding done by the GPs (or their practice managers), and the secondary care by the hospitals? I stll dont see where the "budgets", "funding" and "commissioning " comes in, even with the chronic cases, preventative schemes and so on. Surely, it should be driven by need and the NHS pay for what is needed. I still dont get all this stuff about one part of the NHS paying another part. How did they do it years ago back in the 1960s when there didnt seem to be all this palaver.
There are a number of issues.
1. Health inequalities - without oversight (and even with) the articulate get more than their fair share of anything that is going, minimising this requires access to vast amounts of information relevant to risk data, healthcare delivery data, health outcomes data and the ability to analyze or construct appropriate studies to understand blocks to equality - none of which is immediately relevant to GP-patient interaction.
2. Lack of standardization of healthcare. Different doctors draw very different conclusions from the same consultation, order different tests, prescribe different treatments, follow up variably, etc. Some are very committed to prevention, others are frankly out of date and dangerous. Outcomes can vary hugely as a consequence, further those who spend most often have wrose outcomes than those who do only that which is necessary.
3. Monopolisation of local healthcare system. If getting patients through the door is the method of getting income, then those who attract business can squeeze out the competition (if any) and ensure that their limited vision is the only show in town.
4. Trust, as Shipman exemplifies, but more generally the negotiations about out of hours work showed, doctors cannot simply be trusted to have the patients interest as their primary focus. Input from healthcare professionals should inform the healthcare delivery, but as shown by Kaiser Permante in the US properly incentivised and managed healthcare can be standardised to a very great degree with improved outcomes.
5. Cost benefit justification. The NHS consumes a vast amount of the tax take, this must be transparently justifiable in terms of value for money. The problem is how to measure benefit. If it is just benefit in terms of how the patient perceives the interaction, then buying a nice car for chronically ill patients unable to walk very far, may well be cheaper and more beneficial than treating them with expensive drugs or doing major operations.
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