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Tough times, tough decisions

This month our diarist has to defend a decision to refuse an ultrasound scanner bid while an echocardiograph scheme was given the green light

http://www.pulsetoday.co.uk/practical-commissioningl

This month our diarist has to defend a decision to refuse an ultrasound scanner bid while an echocardiograph scheme was given the green light.

The story so far

Dr Peter Weaving is a GP in north Cumbria and locality lead for Cumbria PCT. As former chair of a large PBC consortium he can see many sides of a PBC argument. This month he has to explain to the LMC why a bid for an ultrasound scanner was turned down while a similar-looking scheme for an echocardiograph kit was approved…

My phone rang in surgery as Mrs Jones was leaving with her prescription for slightly more ACE-inhibitor than she arrived on.

A No number was calling me. That was not good. Unknown number, as it's also known, depending on the network, was usually someone from the LMC office.

‘Peter, No number here. We've had a meeting today; some disappointment has been expressed at your decision to turn down the ultrasound scanner bid. There's a call for a vote of no confidence in your ability to run the locality.'

The locality board had received a business case from a local practice to provide a diagnostic ultrasound service and asked the locality to buy the kit. The local DGH service had improved with routine referrals seen in six weeks and we were getting no flak about ultrasound waits, so it was not top of our must-do list. We would support them on an any willing provider basis but were not keen to pump-prime the proposal with locality funding.

This decision followed the cold reality that there was going to be no FUR (Freed Up Resources) coat for the practices from PBC activity to ward off the impending financial winter. They had made massive savings of millions on their prescribing budget but a DH edict on pharmaceutical services had top-sliced almost the same number of millions, leaving the practices with an insultingly small pay-out.

I sighed to myself and wondered how best to explain to No number and the practices he represented why the locality board had decided not to fund the diagnostic ultrasound service but was keen to fund kit for an echo-cardiography service.

The bids would sound similar but the latter was going to be part of a whole community cardiology service provided by different practices. Initially focusing on diagnostics around arrhythmias and 24-hour BP monitoring it was to expand to include a one-stop breathlessness assessment service with echo-cardiography, spirometry and near-patient testing for BNP. The driver for its prompt provision was analysis of our activity data that showed cardiology outpatient referrals and emergency admissions for breathlessness were high on our list of where the money goes.

Even more exciting, and unusual, transferring this activity to community settings had the full support of the local cardiologists. They were keen for us to take on the bread-and-butter cardiology so they could concentrate on more complex cases. The door then opens on the innovative step of an expanded DGH cardiology department taking on primary angioplasty for the management of all patients presenting with acute coronary syndromes. This, for a rural area with no in-county cardiac surgery, is extraordinary. It is, of course, not a popular decision with our regional tertiary centre that is keen to take our patients.

Meanwhile, the LMC rep is waiting for my reply. ‘I am confident...' I begin.

The PBC Diaries

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