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Frustrated change

Why is it so difficult to decomission services that we know don't work, asks GP and PCT boss Dr Paul Zollinger-Read.

So we now know that injections for subacromial shoulder pain have no long-term benefit ... or did we know this already? Also I see form this week's BMJ that we're using too much imaging (well to be precise the US are).

So what's my beef? Well the small sum of £100m. That's the gap I will have in the PCTs finances after three years if we carry on doing what we do and we get, as expected flat cash. Let's dispense with the management cost argument; our costs are one of the lowest in our region, so we're not going to plug much of the £100m that way

The NHS will be much better protected that other public services, but it is still going to be very very challenging. However, out of every challenge comes opportunity, and the time and the focus to do the things we haven't been able to do before. And yes that's where you all come in.

Last week I talked about GP clusters, now we get to the 'so what are they going to do bit'. My view is that we have frustrated change; indeed we have talked when what we needed to do was execute. At the end of the day, what counts is execution, execution, execution (no names mentioned).

Looking at what we can do more effectively in a different setting is a good start. In my patch, dermatology activity is rising 5% pa and there's something in here about BCCs but not all. In one part of the county we have an extremely effective community model and we now need to duplicate this all over the county.

But we also need to look at the variability we see in referral rates. We have been round the houses on this and my take is slightly different. By all means look at the top end (also look at the low end as there may be quality issues), but the biggest focus needs to be shifting the mean.

This all comes back to more effective pathways than the default acute checkbook. Have any of you looked at decision support tools? I'm starting to and they look fairly good to me, but more on this later.

Finally back to the start. If we know something doesn't work, why do we have the devil's own job in stopping it? Let's see how I go on with decommissiong steroid injections for subacromila shoulder pain.

Dr Paul Zollinger-Read is a GP and chief executive of NHS Cambridgeshire

Paul Zollinger-Read


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