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Commissioning a lady bird guide

This guide explores the Health Bill's aim to reform healthcare by shifting care from secondary to primary settings, aiming for lower emergency admissions and efficient savings. It details the benefits and challenges of GP commissioning, including improving patient pathways, the empowerment of GPs, and the struggle with financial risks and bureaucratic hurdles. Myths regarding GP referral rates are also addressed, revealing common misconceptions about their variance and the implications for clinical practice.

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Commissioning a lady bird guide

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Presentation Transcript

  1. Commissioninga lady bird guide

  2. What is the Health Bill attempting to achieve? • A shift of care from secondary to primary care settings • Reduced rates of emergency admissions • Halt expansion of secondary care spending • An annual 4% efficiency saving until 2015

  3. What is ‘commissioning’?

  4. GP commissioning: benefits • Improvement of patient care/ pathways • GPs empowered to make changes • Encourages review of treatment and referrals • Co-operation and sharing of expertise between practices • Development of management skills and portfolio careers • Generation of practice/personal income

  5. GP commissioning: problems 1 • Lack of expertise/ time/ locums • Difficult for part time doctors to be involved • Reduction in clinical workforce • Inability to drive change in secondary care • Problems with information and the evidence base • Financial risk caused by outliers • Loss of continuity and fragmentation of care • Conflicts of interest /quality premium

  6. GP commissioning: problems 2 • Adherence to pathways and protocols • Conflict with secondary care colleagues • Apathy/ failure to engage practices • Bureaucracy • GPs now responsible for rationing health care • Driven by savings rather than clinical need • “We have already jumped into the abyss”

  7. Myths exploded 1 • Fiction: research has explained the variation in GP referral rates • Fact : the large range in referral rates (1-24 per 100 consultations) remains largely unexplained

  8. Myths exploded 2 • Fiction: referral rate statistics are meaningful • Fact : Where the numbers considered are small, random variation may account for the differences observed

  9. Myths exploded 3 • Fiction: reducing inappropriate referrals would reduce the variation in rates of referral between GPs • Fact : elimination of all inappropriate referrals reduces the 2.5 fold variation in referral rates to 2.1 fold

  10. Myths exploded 4 • Fiction: using referral guidelines is likely to reduce referral rates • Fact : One small study showed an increase in referral rate of 2%

  11. Myths exploded 5 • Fiction: better doctors refer less patients to hospital • Fact : GPs with a particular area of expertise may refer 2-3 times as many cases in that area compared with other GPs

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