GP - patient relationship continuity is probably the most important predictor of best patient centred total outcomes and yet it is being undermined by efforts to commoditise GP.
"There is overwhelming evidence supporting continuity of care from self-employed family physicians as the most effective way to deal with medical complexity and uncertainty; reduce healthcare inequity, unnecessary healthcare activity, total healthcare costs and population deaths.
Health economists usually assess the bureaucratic aspects of health inputs in association with commoditised and fragmented outputs before often offering policy opinions. They rarely consider total population outcomes. The well-proven value of continuity of personalized care and superior medical professionalism in patient and population outcomes is never monetized"
Why is this the case?
Who benefits most from proposed healthcare policy changes?
Irish EARLI Pilot link http://www.mphc.ie/wp-content/uploads/2014/05/EARLI-POSTER-6..pdf
I suppose it depends who is performing the case management, how the cases are identified and the level of continuity of care.
A joint HSE (Irish NHS)/University College Cork/Mallow Primary Healthcare Centre EARLI Pilot Study presented at WONCA & National Primary Care Conference suggests a different result to this meta-analysis but I have not seen the original paper to see the differences between the EARLI project methodology and the various studies in the meta-analysis
See conflict with recent evidence:
Small US Primary Care Physician Practices Have Low Rates of Preventable Hospital Admissions
Survey of 1,045 primary care practices found that:
Practices with three to nine physicians had 27 per cent lower unnecessary admission rates compared to larger practices
One or two doctor owned practices had 33% lower preventable hospital admission rates than practices with 10 to 19 physicians
The largest practices had in place significantly more patient-centred medical home processes which were not associated with lower rates of preventable hospital admissions
Small practices have unmeasured characteristics that may contribute to their lower rates of preventable hospital admissions (Patient-staff relationship)
Practices owned by physicians had significantly lower ambulatory care–sensitive admission rates than those owned by hospitals - possible due to hospitals hovering up general practice in order for them to provide a conveyer belt of fee-per-item activity
I have had 2 complaints against me by patients to the Irish Medical Council in over 20 years practice. Both frivolous by serial complainants. In both cases I received a written reply to my initial response within a few weeks stating that I had no case to answer to and the case was closed. Surely nonsense complaints are dispatched as efficiently in the UK?
This plan just isn't going to work. See slide 13 http://www.slideshare.net/mobile/DrWilliamBehan/presentations
Its all about administrators taking more control and patients losing out
Small Primary Care Physician Owned Practices Have Low Rates Of Preventable Hospital Admissions http://content.healthaffairs.org/content/early/2014/08/08/hlthaff.2014.0434.abstract
Continuity of care seems to be the most important predictor of good care that is measured as preventable admission.
I think that corporatising care is the best way to increase the administration costs and reduce patient centred productivity: http://www.slideshare.net/fullscreen/DrWilliamBehan/dr-william-behan-national-primary-care-conference-nov-2014/1
UK GPs' lead the fight against corporate care in favor of evidence based patient advocacy.
Here's my tuppence worth - but Irish public healthcare policy decisions are even more corrupt than you could imagine so it will have no effect here. It might provide some ammunition in your battles.
Keep up the good work girls and guys.
Excellent article. Tiny point: US assessment of foetal heart takes (negligible) time but it has to be multiplied by the number of times it is done nationwide annually to see the true cost. It diverts time and effort away from more productive activities in order to only provides false reassurance.
If no GPs did it we wouldn't be expected to conform to patient expectations
Remember: UK Inflation is up 12% since 2010 alone therefor you are looking at a much bigger drop in real terms.
NHS Manager | 11 September 2014 11:00am
Obviously NHS managers are as clueless to progressive primary care policy as HSE (Irish) management.
Larger practices lead to erosion of continuity of care resulting in poorer outcomes http://content.healthaffairs.org/content/33/9/1680 … Personalised care is superior to corporate care with regards to patient satisfaction, reduced unnecessary admissions and general care.
Corporate care is superior to traditional GP on bureaucratic criteria only, but is much more expensive and a/w poorer outcomes in the long run.