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Independents' Day

A bit wobbly over balance

I understand the grand plan for this financial year in the NHS is to achieve financial balance. It won't be easy.

The NHS seems to have been split into two teams: 'The Providers' and 'The Commissioners'. GPs are in The Commissioners. And we are the underdogs, trying to keep patients out of hospital as opposed to patching them up once they are there.

Let me explain. Hospitals have always controlled the NHS power base, and as a result just about all of the cash. We have to ask, are things going to be any different?

Payment by results rewards hospitals for treatments and procedures and is very useful as a transaction system. The trick for GPs will be to find financial ways to reward us for keeping patients fit and healthy. The old adage a wise GP told me, 'Your job is to keep patients away from hospitals', is as true now as it has ever been.

Another problem will come as the mysterious 10 per cent of secondary care 'overtreatment' is magically moved into primary care. The most obvious result may well be a few DGH threatened closures. But as the lowest hanging fruit are stripped out of hospitals, higher overheads will be applied to the remaining treatments. The pressures for hospitals to treat will increase or face the world of efficiency and productivity gains.

Problems come in threes

And a third problem. GPs will have to commission to counter problems of supplier-driven demand. As a medical student I saw my consultant walk down a corridor, approach a member of the public with a thyroid mass, and invite her to his next clinic. Public-spirited no doubt, but what would happen to your budget if every admission was screened for hearing loss and offered a hearing aid? Providers under fire are likely to fill up their capacity and treat more invasively. This will mean more operations and investigations.

The final point is that as we start to think about outcome and quality we will need to define at what point more care is enough. The third greatest cause of death in the Western world is not thought to be stroke, diabetes or COPD. It is the process and errors of hospitalisation.

Worried that influencing this situation might be a

tall order? Me too.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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