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Independents' Day

Payment by Results skewed against GPs

By Gareth Iacobucci

One of the Government's flagship health reforms is working directly against moves to shift more care into the community, a report by the Audit Commission has found.

Payment by Results, which was set up four years ago to make hospitals more business-like by paying them for the number of patients they treat, has failed to increase NHS efficiency it says.

And the report suggests the systems is skewed against GP commissioners, who have been expected to help PCTs find ways of reducing unnecessary admissions by commissioning new, more cost-effective services.

The commission found that the system of tariffs used to dictate trusts bidding for services was being used purely as a driver of costs rather than to improve efficiency of services.

The system is too rigid and fails to allow sufficient flexibility for practice based commissioners who are unable to have sufficient input into the process, it says.

The report also slams the limitations of the Secondary Uses Service adding that the lack of data being provided to PCTs was a ‘major source of concern'.

Dr David Jenner, Practice Based Commissioning lead for the NHS Alliance and a GP in Cullompton, Devon, said PbR had ‘definitely advantaged acute providers over commissioners'

He added: ‘They basically say it isn't quite fit for purpose. PbR was set up to make foundation hospitals work, and it has undoubtedly achieved that. The Government was keen to stimulate a market, and the first thing was around foundation trusts.

Whether deliberate or not, it has definitely had the effect of advantaging acute trusts providers over commissioners. It's the whole way you have to take the money and then challenge to get it back.

‘In terms of policy, and creating a market, they've put the cart before the horse,'

The report added that unbundling national tariffs would accommodate different pathways from primary care more easily, and called for separate funding streams for capital and quality, to ensure that hospitals are not rewarded purely on the number of patients they see.

It said more flexible tariffs would ensure ‘greater flexibility to set local prices and currencies that take account of significant innovations in service delivery that are not currently supported by the tariff.'

Andy McKeon, MD for health at the Audit Commission, said unbundling tariffs would allow GP commissioners to develop primary care services more effectively.

He said: ‘It's the Chinese restaurant analogy. At the moment, you have to have it whether or not you want all the courses, whereas what we're moving towards is that you can have the set meal or go to all the many dishes and then choose your own.'

NHS reforms failing: report slams payment by results NHS reforms failing: report slams payment by results

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