The right sort of patient – by Andy Kliman


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Are you the right sort of patient? You may think you are; you take your meds, you do some exercise and you try to steer clear of chocolate and fancy deserts as much as possible, but this might not be enough. You might well be the wrong sort of patient.

The NHS is changing and Health Minister Andrew Lansley is introducing a new way of doing things. Our GPs are banding together into groups called ‘consortia’ in order to spend large chunks of NHS money – £80 billion of it. Fair play to them they are spending it on us, but that is also where the dilemma comes in.

The way the money works in the NHS is that hospitals charge for the care they provide, and they can make a lot as some hospitals take over £1bn a year. This money, our tax money, is paid out by Primary Care Trusts (PCTs) whose job it is to keep the amount spent as low as possible. So the hospital wants to get us in and the PCT wants to keep us out. Well now the PCTs are being scrapped and GPs will be doing their jobs – or rather the people GPs employ will do their jobs.

So GPs are looking to keep us out of hospital, which is a good thing and hopefully leads to better primary care and better support in the community for people with long-term conditions such as Diabetes. The problem comes because GPs will be responsible for the amount that is spent on hospital treatment and, let’s face it, as hard as we try diabetics do tend to spend too much time in hospital which makes us a higher risk to the balance sheet.

GP consortia will not be allowed to go into debt, if they do the Department of Health can take them over and sack all the managers employed by the consortia. So to protect their jobs managers will want to make sure they have more of the ‘right kind of patients’ and less of the ‘wrong kind of patients’. GP practices in areas with high levels of diabetes or smoking related diseases are going to be at a disadvantage.

Diabetics may well be the ‘wrong sort of patients’ when it comes to cost but the NHS reforms could have a very positive benefit in putting our care at the top of GPs agendas. They will want to keep us out of hospital for their own budget’s sake and avoid emergency hospital admissions for heart or other problems.

Conversely we may find some unscrupulous consortia trying hard to keep certain GP practices out of their generally low-risk groups because that practice has too many patients with long term conditions. Mr Lansley needs to be very wary these self-defining consortia spread the risk of having diabetic patients or we might end up with a situation where many diabetics are locked in to poor performing consortia that aren’t able to provide the care we need. Already we have seen how variable diabetes care is and these reforms may well exacerbate it.

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Hi Brian, I was talking only about England and that’s a fair point to make – I made an assumption that people knew something of the background to these changes and the devolved political system in the UK – but I guess you can never be too clear.

Thanks

Andy

Andy,
Are you referring to NHS England or does this information apply equally to the devolved NHS Services in Wales, Ireland and Scotland? I believe the current planned changes to the NHS apply only to England.

Should this be the case Andy, we must always be careful not to give the wrong impression. An example of bad reporting is the BBC news web site where they state (today 15 Feb 2011 0900) that the ‘NHS if failing on care to elderly’ When the article is clicked on to expand, it turns out it applies only to England!