The real priorities in the current NHS.
SummaryIt is easy to take a surf on the internet and look at the priorities stated in NHS policy and strategy documents. However, does this really reflect the true picture on the ground? What are the big issues for NHS customers at the moment?
- Practice Based Commissioning: Practice based commissioning grew in importance and caused more frustration as time went by in 2005. The target of having 80% of practices commissioning by the end of the year has clearly been missed.
- Payment By Results: Standardising cost per patient episode is a major concern. Patients are people, not machines. Episodes are far more unpredictable than the model acknowledges and the variation caused by individual patient complications is rapidly blowing budgets. To add to the customers worries, the standardised tariff figures are not well informed. Planning for management of additional patient costs not covered by the tariffs is complicating local flows of funds and budget monitoring is made more difficult.
- HR Issues such as agenda for change and job insecurities as PCTs merge was foremost in many customer minds. Many managers report change fatigue and stress and a remarkable number of senior managers throughout the UK are off on long term sick. Even senior managers in general practice are reporting job insecurity and redundancies as the practice is being run as a small private business with changing staff requirements.
- Reducing Emergency Admissions ranks as number four priority. This goal means customers are more focused than ever on aggressively managing long term conditions. The business case for funding “Walk In Centres” is supported as this model reduces visits to hospital accident and emergency units. However the changes and related problems in provision of out of hours care is causing an increase in emergency admissions. Furthermore those patients being admitted are sicker and more expensive for the hospital to treat.
- Balancing the Budget ranked number five. Yet it seemed to be the underlying theme in all the priorities. Managers and clinicians are talking about bankruptcy strategies. This is a very new concept and is not just relevant to the hospitals and PCTs. There is discussion that poor performing practices should “loose their franchise”.
- Contracting Services from GPs, pharmacies, hospitals, dentists and opticians and the management of these contracts is clearly also a high priority. The work load is growing as each new service profession contract commences. From the service provider perspective, managing and fulfilling the contract adds a new burden and they reported that patient care resources were being diverted to manage the contracts and of course to secure the contracts and the accompanying funds. The PCT mergers also caused concern in terms of management and contracting of services during and immediately after the merger period.
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