Commissioning a lady bird guide
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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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Commissioning a lady bird guide

Commissioninga lady bird guide


What is the health bill attempting to achieve

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

What is ‘commissioning’?


Gp commissioning benefits

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


Gp commissioning problems 1

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


Gp commissioning problems 2

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”


Myths exploded 1

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


Myths exploded 2

Myths exploded 2

  • Fiction: referral rate statistics are meaningful

  • Fact : Where the numbers considered are small, random variation may account for the differences observed


Myths exploded 3

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


Myths exploded 4

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%


Myths exploded 5

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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