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GPs buried under trusts' workload dump

Payment by Results is delivering, say academics

Payment by Results (PbR) has delivered real change in the delivery of healthcare in hospitals, according to a major new study.

Payment by Results (PbR) has delivered real change in the delivery of healthcare in hospitals, according to a major new study.

A team of researchers, led by Shelley Farrar at the University of Aberdeen, looked at measures of volume, cost and quality of care in hospitals across England during 2004/5 and 2005/6 and compared with a control group – Scotland, which has not implemented PbR.

The results, published in the BMJ, show unit costs fell more quickly where PbR was implemented. Evidence of an association between the introduction of PbR and growth in acute hospital activity (volume of patients treated) was also found.

There was little evidence of any change in the quality of care associated with the introduction of PbR.

However, further analysis on the longer-term impact of Payment by Results found that the quality of care in foundation trusts increased in association with the tariff's introduction.

Given the results did not show quality of care suffered as a result of PbR, the researchers said cost reductions had been attained through increases in efficiency rather than through reductions in quality.

Dr James Kingsland, NAPC president and national PBC clinical network lead, said the focus should be on quality introduced by PbR rather than cost reductions.

‘The principle of PbR was that it meant you could forget about cost and focus on quality,' he said. ‘Cost saving was going to be a nice side-effect but wasn't the underlying principle. It should be about the results of the transaction, not the cost.'

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