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Welfare Reform on the Web (July 2010): National Health Service - primary and community care

GP budget holding: lessons from across the pond

C. Ham

Birmingham: Health Services Management Centre, 2010

This report looks at the potential benefits and dangers of GP budget holding based on experience in the USA. Precautions need to be taken to ensure that GPs do not maximise their profits by skimping on care while reducing genuinely unnecessary treatment and hospital admissions. The government will also need to: allow both large and small practice groupings to hold budgets; ensure that practice consortia and GPs themselves have the necessary skills to manage budgets and negotiate contracts; fill large gaps in primary care datasets; and protect practices against budgets being set at a level close to the minimum cost of providing appropriate services.

Huge A&E attendance gaps revealed

B. Clover, S. Gainsbury and G. Clews

Health Service Journal, June 3rd 2010, p. 4-5

Unpublished data shows that the proportion of patients attending accident and emergency (A&E) departments who are not sick enough to require hospital admission varies widely across England. Nationally, 20% of patients attending A&Es during normal GP opening hours require admission. However, at some primary care trusts the average is as low as 6%, suggesting that significant numbers of patients are visiting A&Es in place of GP surgeries.

Let us exploit our canny GPs

J. Deffenbaugh

Health Service Journal, June 3rd 2010, p. 12-13

This article argues that GPs are entrepreneurs who can be incentivised to reduce demand for NHS services. They need to be encouraged to offer services promoting wellness and preventing illness, in partnership with local authorities and community services. Availability of information about service standards should be extended, so that patients can make rational decisions about switching to another practice if quality is poor. This will incentivise GPs to improve the quality of the services they offer.

More patients unable to see doctor within two-day target

R. Smith

Daily Telegraph, June 18th 2010, p. 1 + 2

A patient survey commissioned by the Department of Health has shown that:

  1. one in five cannot book an appointment to see their GP within two working days
  2. one in four cannot book an appointment in advance
  3. 7% find it hard to get through to their surgery on the phone.

Now tell us how much you drink

R. Smith

Daily Telegraph, June 2nd 2010, p. 1 + 2

Under new guidelines issued by the National Institute for Health and Clinical Excellence, all patients attending their GP, hospital or pharmacist are to face extensive questioning about their alcohol consumption. Questions include how often and how much alcohol the patient consumes, and even whether they are left feeling guilty after drinking. The object of this screening is to identify patients who may be abusing alcohol. The guidance also recommends a minimum national price per unit of alcohol, a possible ban on all alcohol advertising, and cutting licensing hours at public houses, clubs and off-licences.

Patient choice: how patients choose and how providers respond

A. Dixon and others

King's Fund, 2010

Report of a survey of 2000 patients which shows that 75% wanted to choose where they are treated. However, less than half had been offered a choice of hospital provider by their GP. Only 8% of those who were offered a choice said they had been given the option of choosing a private provider. Very few patients are making use of performance data to inform choice, with only 4% consulting NHS Choices. It is concluded that GPs underestimate the importance of choice to patients, and that the main focus of competitive activity among providers is to secure GP referrals, rather than directly compete for patients

PCTs to lose responsibility for GPs

S. Gainsbury, D. West and C. Santry

Health Service Journal, June 10th 2010, p. 4-5

Reports that the health secretary is developing plans to scale back the responsibilities of primary care trusts. These will be responsible for public health spending, act as patient champions, and commission residual services. GP consortia will become responsible for commissioning care worth up to 60bn and will contract directly with a new NHS board.

The use of overseas doctors in providing out-of-hours services

Health Committee

London: TSO, 2010 (House of Commons papers, session 2009/10; HC 441)

In 2004 new arrangements for out-of-hours general practice were introduced as part of a revamped General Practitioner (GP) contract with the aim of addressing inadequate standards and difficulties in retaining doctors in general practice. Many consider the new system an improvement on its predecessor, but it has some serious weaknesses, in particular in the use of EEA doctors and the failure to check their language skills and clinical competence, which led to the killing of a patient, Mr Gray, by Dr Ubani, a German locum. The report recommends that the Government seek to make the necessary changes to the Directive 2005/36/EC before it is due to be revised in 2012, to enable the General Medical Council to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen the risks of employing another unsuitably trained or inexperienced doctor in out-of-hours services.

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