Healthcare commissioning- ?Adverse to patient care
Mar 22, 2008 - 2:31:53 AM

The government’s new healthcare commissioning policy for England has not only jeopardised the future of many hospitals but has also led to considerable frustration and disappointment among patients, argue senior doctors in this week’s BMJ.

Under the new policy, primary care trusts or general practitioners directly commission specialised services and the trusts pay for the treatment of their patients in hospitals. The aim of such commissioning is to save huge sums of money by using hospital services as sparingly as possible.

But Rahij Anwar and colleagues believe that weaknesses in the referral system mean that their patients are not receiving appropriate care.

The worst affected patients, they explain, are those who have more than one condition at the same time because to primary care trusts these are very “expensive” patients, and therefore some of their problems might be “downplayed” to be managed in the community, and referrals to specialists are filtered.

Constant reminders to comply with trusts’ policy in relation to clinic times and referrals also mean that patients are often sent back to their GPs if they have a new problem for which a referral has not yet been made.

The crux of the matter is that these patients could well have received better care had they been treated in the traditional system, where there were no “time bound appointments,” “designated payment pots,” and “referral politics,” they argue.

Patients should be given sufficient time and opportunity to discuss their problems properly, so that the problems may be dealt with concurrently, not consecutively, they say. Hospital specialists should also be allowed to generate a fresh “episode of treatment” if a patient develops a condition related to the same specialty while he or she is waiting for an appointment.

This will not only significantly lessen the workload of general practitioners but would also help to reduce waiting times, paperwork, and inconvenience to patients.

Although we all are expected to use the meagre resources of the NHS wisely in these difficult times, we should not forget that our foremost duty is to safeguard the interests of our patients, they write.

We should continue to question all policies that adversely affect the care of patients, and we believe that “one way healthcare commissioning” is one such policy.

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