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Author Topic: Commissioning and Choice or Cover for Privatisation and destruction of local NHS  (Read 2074 times)


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Huge bill looms for patient choice information

    * Published in Health Service Journal
: 05 February 2009 01:00
    * Author: Helen Crump
        * Reader Responses (5)

Huge bill looms for patient choice information

 The health service faces a bill of millions for reminding patients of their legal right to choose their own secondary care provider under the terms of the NHS constitution.

A Department of Health impact assessment reveals it could cost as much as £31.9m nationally or £210,000 per primary care trust to provide the information on choice.

DH economists say to break even PCTs would have to ensure seven in 10 patients switched to a provider "more aligned to their needs".

Even under the best case scenario of a cost of £5.2m per year (£33,000 per PCT), 5.5 per cent of patients would need to switch provider.

But DH survey figures released this week show fewer than half of patients remembered being offered a choice.

PCT powers

The news comes amid growing concern that PCTs do not have the power to hold providers to account on choice. At a DH conference last week co-operation and competition panel chair Lord Carter queried if PCTs could ensure patient choice.

At present, PCTs can pay GPs extra to co-operate through local incentive deals - but HSJ understands the DH hopes to negotiate choice into the core GP contract.

This would mean PCTs could impose financial penalties on non-participating GPs.

PCT Network director David Stout said current arrangements with GPs were "largely based on goodwill and exhortation". He said: "If it were contractually based, it would be easier."

East and North Hertfordshire PCT chair Pam Handley said it would be "unfair" to require GPs to act without also requiring hospitals to increase their flexibility. She warned the added financial pressures could knock PCT strategies.

    * Author: Helen Crump.

Reader Response

Added: Saturday, 7 February 2009 00:00 GMT
Clive Peedell, Nr Bedale, United Kingdom

Choice is a very clever rhetorical device with multiple meanings. On the one hand it can be seen to empower patients and is therefore almost impossible to argue against. On the other hand, choice is a prerequisite to competition and marketisation. Unfortunately for the marketeers, patients donít want choice and that is why Choose and Book is failing. The majority of patients just want good local care. Julian Le Grand may suggest otherwise, but his argument for choice is fundamentally flawed because most of his data is based on public choice, not patient choice. He seems to misunderstand that choice can be dramatically affected by how you feel i.e if you are ill you are less likely to want to travel long distances and more likely to want family nearby. There is no emprical or theoretical evidence about patients adopting or desiring a consumerist approach to healthcare in the UK (Fotaki et al Report for the National Co-ordinating Centre
for NHS Service Delivery and Organisation R&D (NCCSDO) 2005). Until the health policy hierarchy understands this, we will continue to see billions of pounds of taxpayers money wasted on a healthcare market.
When are health managers (and doctors) going to understand that the market in healthcare has nothing to do with patient care and everything to do with transferring public funds to the private sector?

Added: Friday, 6 February 2009 11:54 GMT
Peter Smith, Weston Super Mare, United Kingdom

Choice was always a laudable and democratic aspiration but somewhere along the way our politicians forgot that people also want advice, guidance and advocacy when they have become ill. This is what GPs do best. The trouble is that everyone else in the Government-controlled health service thinks they know how to do our job better, so we are being submerged by one intiative after another, which all eventually founder under their own weight.
To have to advertise choice confirms that the system is fundamentally flawed. There is no choice if Trust hospitals "grey out" their availability to protect their waiting time performance. There is no choice for people who lack mobility to go to the slick new foundation hospital a hundred miles away, whilst their own local DGH moulders away through lack of investment.
It is a poor "choice" when the referrals are bundled into the first available slot without an opportunity for the secondary care specialists to prioritise referrals according to need, because there is no longer a dialogue permitted between the GP and Consultant. But of course that goes back to the first premis that every one other than a GP knows what patients need. How could I have forgotten?

Added: Friday, 6 February 2009 10:58 GMT
Michael Preece, Stevenage, United Kingdom

in response to the previous poster; VFM is:

* A project/scheme which is no more than 3 years behind schedule
* Ensuring that 'consultancy' fees do not exceed 45% of the initial budget
* Delivering a project that does not exceed 3x the initial budget
* Delivering a product that does not actually meet the needs of the NHS and is overlooked by frontline staff

... according to the Government in the latest National IT project update.

Added: Thursday, 5 February 2009 12:28 GMT
Dermot Ryan, Loughborough, United Kingdom

Could someone explain to me why vast sums of monety have been spent on practice based commissioning, where the GP essentially directs the ptient to make an informed choice of where he/she might wish to be referred ( although ou=r PCT does not allow us to do this and directs our referals for us, usualy to the worng place) even vaster sums of money have been spent on choose and book, which has never worked and probably never will, more money is being spemnt on bribing GPs not to make appropriate referrals and now money is to be spent on aligning GPs referrral according to the PCTs priorities.
This form of waste is idiocy of the highest order.
Give the money to us GPs. We will save swathes of money by getting rid of PCTs trust management committees SHA NHS direct walk in centers Health service Commission NICE NHS alliance etc and with all those saving provide a decent interference health service. It is almost aas simple as that.
Of course unemployment would rise massively

Added: Thursday, 5 February 2009 12:16 GMT
Mary Hawking, Dunstable, United Kingdom

I'm not sure how, as a GP, I can impose "choice" on my patients - and make sure they remember that they *were* offered "choice"! (at the time "choice" discussions were being monitored by giving patients a form to fill at the time of referral, the memory of choice discussions was still not 100 - or even 95 - %!)
Has anyone surveyed just patients using C&B? I suspect a fair proportion won't remember any discussion of "choice"!
Getting back to basics: the majority of patients being referred to hospital (and all the emergency attendances) ask to go to the local DGH - which they can reach - unless we agree there is a good reason (which includes patient preferences) to go elsewhere.
Shame patients are no longer allowed a choice of consultant and that many Trusts seem to have difficulties with configuring C&B or manage clinics...

I wonder where the funds for this will be found?
A small proportion of this money would allow the necessary pump priming to allow my PBC Consortium's plans for service redesign to be implemented.

Final question - is this implementation of choice - which everyone had before 1990 - really Value For Money?
If it is, could someone explain what VFM means?