Moving 15% of procedures to private sector will wreck NHS
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《英国医生杂志》
Plans by the government to improve the NHS by moving a major proportion of treatment to the private sector and to pay by results will wreck the NHS, a BMA conference heard.
London would be ripe for being turned into a marketplace for health care, with its "high presence of private and commercial health care and a high density of providers able to make the most of opportunities," said Dr Chaand Nagpaul, a member of the BMA抯 General Practitioners Committee.
He was speaking at a seminar last week organised by the BMA抯 London Regional Medical Council on the implications for London of the NHS improvement plan. Dr Nagpaul said it was the duty of the BMA to highlight the dangers of the proposals.
He added that they would "really put an end to the sort of NHS that we have all been part of ?We need a strategy and we need to be one step ahead."
Published in June, the plan (BMJ 2004;329:14) anticipates that by 2006 the independent sector will carry out up to 15% of procedures each year for NHS patients, paid for by the NHS. By 2008, patients will have the right to choose from any provider.
The plan is underpinned by the new system of standardised payments, known as "payment by results" (BMJ 2004;328:969-70). Under this system primary care trusts must pay providers at a predetermined national rate for each patient抯 completed stay in hospital or service received. Already under way in the first wave of foundation trusts, payment by results is due for full implementation next April.
Dr Nagpaul argued that payment by results would fragment care. He said the incentive under the system for secondary care to maximise its income "makes a mockery of integrated care pathways and joined up working."
Professor Allyson Pollock, of the health policy unit at University College London, said planning bodies were no longer able to allocate resources on the basis of need. She said it was important that BMA members understood "the way in which the financial flows and the system of pricing is going to work against the universal healthcare system."
She added: "Why is it problematic if ?7m of elective care in London goes into the private sector? Hospitals are barely breaking even now, and most are running significant financial deficits ?if you move money out you are also losing money for IT and other services." The private sector had the ability to "cherry pick" more routine cases, leaving very expensive treatments behind in the NHS and "undermining the core function of the NHS, which is risk pooling," she added.
Even small movements of patients out of NHS trusts and foundation trusts would push hospitals into greater financial crisis, she argued. She said foundation trusts were already struggling to find patients because of the government抯 policy of facilitating independent treatment centres on long term, guaranteed contracts.
The BMA is to host a conference and internet forum on the NHS improvement plan on 30 November. The speakers will include Professor Pollock and the chief executive of United Health Europe, Dr Richard Smith.
Details on the conference are at www.bma.org.uk and the improvement plan is at www.publications.doh.gov.uk/nhsplan/index.htm
?br>(London Ann McGauran)
London would be ripe for being turned into a marketplace for health care, with its "high presence of private and commercial health care and a high density of providers able to make the most of opportunities," said Dr Chaand Nagpaul, a member of the BMA抯 General Practitioners Committee.
He was speaking at a seminar last week organised by the BMA抯 London Regional Medical Council on the implications for London of the NHS improvement plan. Dr Nagpaul said it was the duty of the BMA to highlight the dangers of the proposals.
He added that they would "really put an end to the sort of NHS that we have all been part of ?We need a strategy and we need to be one step ahead."
Published in June, the plan (BMJ 2004;329:14) anticipates that by 2006 the independent sector will carry out up to 15% of procedures each year for NHS patients, paid for by the NHS. By 2008, patients will have the right to choose from any provider.
The plan is underpinned by the new system of standardised payments, known as "payment by results" (BMJ 2004;328:969-70). Under this system primary care trusts must pay providers at a predetermined national rate for each patient抯 completed stay in hospital or service received. Already under way in the first wave of foundation trusts, payment by results is due for full implementation next April.
Dr Nagpaul argued that payment by results would fragment care. He said the incentive under the system for secondary care to maximise its income "makes a mockery of integrated care pathways and joined up working."
Professor Allyson Pollock, of the health policy unit at University College London, said planning bodies were no longer able to allocate resources on the basis of need. She said it was important that BMA members understood "the way in which the financial flows and the system of pricing is going to work against the universal healthcare system."
She added: "Why is it problematic if ?7m of elective care in London goes into the private sector? Hospitals are barely breaking even now, and most are running significant financial deficits ?if you move money out you are also losing money for IT and other services." The private sector had the ability to "cherry pick" more routine cases, leaving very expensive treatments behind in the NHS and "undermining the core function of the NHS, which is risk pooling," she added.
Even small movements of patients out of NHS trusts and foundation trusts would push hospitals into greater financial crisis, she argued. She said foundation trusts were already struggling to find patients because of the government抯 policy of facilitating independent treatment centres on long term, guaranteed contracts.
The BMA is to host a conference and internet forum on the NHS improvement plan on 30 November. The speakers will include Professor Pollock and the chief executive of United Health Europe, Dr Richard Smith.
Details on the conference are at www.bma.org.uk and the improvement plan is at www.publications.doh.gov.uk/nhsplan/index.htm
?br>(London Ann McGauran)