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Commissioning a lady bird guide

Commissioning a lady bird guide. 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. What is ‘commissioning’?.

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Commissioning a lady bird guide

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  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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