Friday, May 24, 2013

NHS: Internal Market vs Integration!

Dawn anyone?

Laguna Azul, Bocas del Toro©Am Ang Zhang 2013
There is much to commend about the integrated health care that Kaiser Permanente is famous for.
When I was working, I used to know every single GP in my locality and every consultant that worked in our Hospitals. Monday lunch time was when we had our clinical presentations and GPs turned up regularly and it was a good time to know them over drug firm sponsored lunches.
We would often pick up the phone and talk to the referring GPs or they would talk to us about someone they worry about.
No need to get clearance from anyone. Until later that is.
It was not written anywhere about the need to avoid XYZ because of money.
We did what is best and often we would initiate prescriptions and even repeat them if we see the patient for regular follow-ups. More often with adult psychiatrists than with child psychiarists.
But now: we have to let the GPs prescribe as it is going to cost the trust XYZ more otherwise.
How sad!!!
In the MPS Casebook:
Mrs B was a 49-year-old deputy headteacher who, for 18 months, had been increasingly troubled by heavy irregular menstrual bleeding. She was referred to a gynaecologist who carried out a pelvic US and an endomentrial biopsy. In her follow-up appointment with the gynaecologist, Mrs B was told that her investigations had been normal and hormone replacement therapy (HRT) was suggested to regulate her bleeding. The gynaecologist told Mrs B that he would be writing to her GP with his opinion and treatment recommendations.
Mrs B was therefore advised to go and see her GP to get a prescription for HRT in two weeks, which was thought to be sufficient time for the clinic letter to reach the GP. In the meantime, the gynaecologist scribbled down the name of the recommended HRT and gave it to Mrs B.
Unfortunately she was prescribed unopposed oestrogen.
………… Dr T realised that for many months Mrs B had been mistakenly prescribed an unopposed oestrogen and now had heavy bleeding. Dr T apologised to Mrs B and also explained that she needed to be quickly referred back to the gynaecologist for investigation. She was referred urgently and in view of her history of increasingly heavy bleeding and prolonged exposure to an unopposed oestrogen, a hysteroscopy was carried out. This led to a diagnosis of endometrial cancer. Mrs B had a hysterectomy and made a full recovery.
She made a claim against all the doctors involved in her care at the GP practice.
The confusion could have been avoided if the consultant had issued the first prescription. In shared care situations there is a reduction in risk if the initial prescription is commenced by secondary care.          Read the whole story here>>>>>>

This would probably not happen in Kaiser Permanente nor in the good old days of our NHS.
Can someone do something before it is too late! 

From one of their own advisers: Prof Chris Ham
Parliament debate: Public Bill Committee
Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."                             

“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”

NHS-Kaiser Permanente: Integration?

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