GPs given go ahead to buy care for patients
http://www.100md.com
《英国医生杂志》
General practitioners (GPs) in England have been given the go ahead to commission health services for their patients from April next year in a bid by the Department of Health to provide patients with better care.
Announcing the scheme this week, health minister John Hutton said that practice based commissioning was part of the package of measures aimed at empowering GPs to improve the quality of patient care outlined in the NHS Improvement Plan published in June.
Mr Hutton insisted that the scheme differed from GP fundholding, which Labour abolished in 1998. He said that it built on the best aspects of the former scheme while leaving out the worst.
Unlike fundholding the new scheme was open to all general practitioners and practices and offered no financial incentive to doctors themselves, he said. In addition, the introduction of the national tariff for procedures in secondary care ensured there would be no opportunity for "local haggling" among hospitals for commissions by offering "bargain basement" services as has happened in the past.
"We want to secure the maximum involvement of clinicians at a local level to shape the NHS," said Mr Hutton. "This is something that GPs have been saying they want to have. It will help them define and engineer their local NHS so that there are better, more convenient services for their patients."
Commissioning would allow GPs to decide which services they wanted to purchase from secondary care and which they wanted to provide themselves. For example, they may decide that some hospital follow up appointments can be done just as well in their surgeries, perhaps by a nurse rather than a doctor, and that most referrals for x rays are unnecessary and can be dispensed with. Provided there is an evidence base to back up commissioning decisions, GPs will be allowed to do as they see fit, said David Colin-Thome, a GP in Lancashire and national director of primary care.
Practices who opt for commissioning will be given an indicative budget based on what they spent in 2003-4 with an appropriate increase.
They will be able to use up to 50% of any savings they make to develop patients?services, for example by buying physiotherapy sessions or extra hours of a practice nurse抯 time. Any overspends will be met by the primary care trust for up to three years. If a practice fails to balance its budgets for three years it could lose its right to commission unless exceptional circumstances can be proved.
Commenting on the government抯 paper on practice based commissioning Hamish Meldrum, chairman of the BMA抯 General Practitioner Committee (GPC), said, "These are interesting and potentially very far reaching proposals and the GPC will wish to consider them carefully before making a detailed response. We welcome the fact that there will be a right for all practices to have an indicative budget and that primary care trusts must work with practices to help them develop procedures for implementing this.
"There are concerns about the absence of clear national guidelines and because of this we will want to issue detailed guidance to practices and local medical committees as to how they should take this initiative forward."(London Zosia Kmietowicz)
Announcing the scheme this week, health minister John Hutton said that practice based commissioning was part of the package of measures aimed at empowering GPs to improve the quality of patient care outlined in the NHS Improvement Plan published in June.
Mr Hutton insisted that the scheme differed from GP fundholding, which Labour abolished in 1998. He said that it built on the best aspects of the former scheme while leaving out the worst.
Unlike fundholding the new scheme was open to all general practitioners and practices and offered no financial incentive to doctors themselves, he said. In addition, the introduction of the national tariff for procedures in secondary care ensured there would be no opportunity for "local haggling" among hospitals for commissions by offering "bargain basement" services as has happened in the past.
"We want to secure the maximum involvement of clinicians at a local level to shape the NHS," said Mr Hutton. "This is something that GPs have been saying they want to have. It will help them define and engineer their local NHS so that there are better, more convenient services for their patients."
Commissioning would allow GPs to decide which services they wanted to purchase from secondary care and which they wanted to provide themselves. For example, they may decide that some hospital follow up appointments can be done just as well in their surgeries, perhaps by a nurse rather than a doctor, and that most referrals for x rays are unnecessary and can be dispensed with. Provided there is an evidence base to back up commissioning decisions, GPs will be allowed to do as they see fit, said David Colin-Thome, a GP in Lancashire and national director of primary care.
Practices who opt for commissioning will be given an indicative budget based on what they spent in 2003-4 with an appropriate increase.
They will be able to use up to 50% of any savings they make to develop patients?services, for example by buying physiotherapy sessions or extra hours of a practice nurse抯 time. Any overspends will be met by the primary care trust for up to three years. If a practice fails to balance its budgets for three years it could lose its right to commission unless exceptional circumstances can be proved.
Commenting on the government抯 paper on practice based commissioning Hamish Meldrum, chairman of the BMA抯 General Practitioner Committee (GPC), said, "These are interesting and potentially very far reaching proposals and the GPC will wish to consider them carefully before making a detailed response. We welcome the fact that there will be a right for all practices to have an indicative budget and that primary care trusts must work with practices to help them develop procedures for implementing this.
"There are concerns about the absence of clear national guidelines and because of this we will want to issue detailed guidance to practices and local medical committees as to how they should take this initiative forward."(London Zosia Kmietowicz)