Commissioning to cut admissions by 4%
Practice-based commissioning will lead to only a modest reduction in elective admissions, researchers have predicted.
The researchers from the National Primary Care Research and Development Centre (NPCRDC) predicted it would reduce elective admission rates
by 4 per cent, based on the effects observed for fundholding, writes Helen Crump.
Professor Hugh Gravelle,
associate director of the NPCRDC's centre for health economics at the University of York, who led the study, said that fundholding practices' chargeable elective admissions rates were 7 per cent lower than non-fundholders' over the periods 1997/8 and 2002/3. After fundholding was abolished, the difference shrank to 3 per cent.
And waiting lists for patients at fundholding practices were 5 per cent shorter than at non-fundholding practices for both chargeable and non-chargeable admissions.
This suggested hospitals competed for business by offering shorter waiting times to all fundholders' patients, not just those for whom fundholders paid, he said.
Once hospitals were banned from keeping separate waiting lists for fundholders and non-fundholders in 1998/9, the difference was reduced.
The study warns that the implementation of commissioning must be monitored in order to detect 'negative effects on other aspects of patient care'.
Dr James Kingsland, chair of the National Association of Primary Care, said the research confirmed his belief PBC was an
attempt to recreate the best of fundholding.
But he said commissioners must not lose sight of the importance of individual decisions if they wanted to reap the rewards of PBC.
He said: 'The efficiency of fundholding was the practitioner, with the patient, determining at what level they referred. The idea that we can do PBC without that is just nonsense.'
Dr Kingsland added PBC's blanket coverage should remove the other drawback of fundholding, where patients from non-participating practices were disadvantaged.
Dr David Jenner, practice-based commissioning lead at the NHS Alliance, said: 'It's difficult to extrapolate fundholding into PBC because the two were fundamentally different.'
The quality and outcomes framework, clinical governance, fixed-price tariffs and targets developed since the end of fundholding would all make a difference, he said.
Warning to GPs on PBC's hidden costs
GPs are being warned to take
account of the hidden costs of providing services themselves under practice-based commissioning.
LMCs and practice-based commissioning experts say
infrastructure costs must be taken into account when calculating tariffs for procedures shifted to primary care.
Steve Mercer, chief executive of Avon LMC, said tariffs should be itemised otherwise practices would not be able to calculate
accurately whether it is worthwhile providing the service.
'If you take work out of hospitals, when you take that cost back, you should also take responsibility for training and factor that back into the surplus,' he said.
'The worst thing will be if the Government says primary care can do it cheaper therefore we're going to pay them a differential tariff.'
Dr Mike Dixon, NHS Alliance chair, said: 'If you replace a service, you've got to train yourself up and you've also got to have the premises, although you might get the PCT to forward funds.'
Dr Dixon said some procedures could be done by GPs without considerable infrastructure costs, but others would require training, continuing professional development work and premises.
Even taking account of this, he said: 'The vast majority of procedures done in primary care will be much less expensive and that will include the cost of improvement, capital and training.'
Dr Brian McGregor, a GP in Acomb, York, and a PBC consortium member, said: 'When setting up your business plan, it's important to make sure you cover as many eventualities as you can think of. As long as you can be fairly robust, you won't lose out too much.'
Better information sharing is key to success of PBC
GPs are demanding that information sharing schemes are
piloted in a bid to develop a model to be used for practice-based commissioning.
An independent steering group of GPs called for the move in a report, The Intelligent Practice, which warned that accurate, 'real-time' information was still not available to GPs in many areas.
The group – which included the Government's primary care tsar Dr David Colin-Thome, RCGP chair Dr Mayur Lakhani and NHS Alliance chair Dr Mike Dixon – said consistent information across all local health organisations was essential for PBC but too often information was 'irrelevant and over-long'.
Commissioners and pro-viders were urged to improve their financial reporting and sharing of information about patient needs and experiences.
The report, supported by Dr Foster, said: 'There is a clear responsibility for PCTs to provide information to GPs in order to enable them to make their commissioning decisions.
'Similarly there is an obligation for GPs to reciprocate with information in respect of their patients' experiences, preferences and outcomes.'