Patrick Keady

Comment : can CCGs eclipse PCTs? #1



GP partners are very aware of costs and thank goodness for that.


For all of us that have enticed GP partners to work collaboratively with NHS Providers, we’ve inevitably had to secure money to pay for their hours away from seeing their patients.


And you know, GP partners have a point.  Their focus on costs and the impact of costs on their bottom line, should give GP partners a head start on ensuring that the quality of CCG commissioning is better than PCT commissioning.


One of the advantages of having GP partners leading on Commissioning from April 2013 is that with the exception of dentists optometrists and pharmacists, they are different to virtually all other professionals working in and with the NHS.  Unlike GP partners, people employed in the Department of Health, PCTs and NHS Providers are salaried and it could be contentiously argued that they are less incentivised to know the true costs of providing patient care.


Of course there are reasons for this.  To the outsider there are perverse incentives where for example, PCTs almost exclusively reimburse NHS Providers for procedures performed rather than outcomes achieved and at the same time, those patients that are no longer paying national insurance contributions, bear no responsibility to contribute to the cost of the healthcare services that they receive.


Imagine that a new supermarket opens in your area and that all the residents ask the store manager to enter into an agreement where the store will provide all of the food products that people in your area need for the next four years for a fixed cost of say £1,000 per head per annum.  That sounds unusual and probably appears challenging.  Now think of the NHS.


There seems to be an almost lack of understanding as to how much it costs to deliver patient care.  And much less how these costs compare with health outcomes.  Instead, providers seem to shy away from the costs of treating individual patients with specific medical conditions over the full cycle of their care, in favour of aggregating and analysing costs at the speciality or service level.


It is well known in quality circles that what is measured is managed and in turn that what is managed is more likely to be improved.  Since providers do not understand the costs of treating individual patients, they are unable to link the costs to process improvements and health outcomes.  And inevitably, this stops them from making systematic and sustainable cost reductions.


With GPs at the helm and improvements in cost measurement and the measurement of health outcomes, CCGs will be better placed to influence the National Commissioning Board and introduce reimbursements that reward value, reduce unhelpful incentives, and encourage innovation within all providers that are delivering services to NHS patients.


As CCGs and providers start to understand the total costs of treating patients over their complete cycle of care, CCGs should be better placed to contemplate innovative reimbursement approaches without fear of sacrificing their financial sustainability.  Those Providers that deliver the desired health outcomes faster and more efficiently, with proven simpler treatment models should be rewarded with higher revenues rather than being penalized with lower revenues.


Watch out for part 2 of this article, and in the meantime please add your comments below.  If you would like to receive a fortnightly email of new articles, then please enter your email address at the top right-hand side of this page.


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