Dear Alex,
I have to admit that I do enjoy reading and watching your postings.
thank you for them.
In some ways I feel the only safe way to pay GP's is the ancient
Chinese way that you pay the GP when you are well and they pay you
when you are sick.
Simple!
This then becomes a night mare. Who defines the parameters for
sickness and health and their relative values and costs to Doctor
and patient. If you as a GP get a lot of renal unit or severe
Life threatening but not fatal diseases you go out of business. If
you act like Shipman or the Vet you make still more money by
squaring the mortality curve . A long happy life and a short terminal
illness.
I wish there was an easier compromise.
Sad to say channel 4 are quite correct. GP's are setting up
commissioning companies right across the country. They are
incentivised by the profit motive. They are also incentivised by the
greater good for greater numbers argument the total amount of money in
the system is limited therefore cheaper secondary care [laying off
your bets and risks] could be seen as an advantage.
In the real NHS the system is totally tainted. Government wants to
drive down costs. PCT's suddenly become regulators and arbiters of
illness in other people that they do not understand beyond any
public health epidemiological level. GP's are becoming increasingly
target driven and profit orientated. There is a distribution of all
these attributes in each of the systems above. Sometimes the
combination becomes philanthropic sometimes the combination becomes
greedy and money orientated.
I dont know the answers but I hope I have demonstrated some knowledge
of the way the system behaves under stressful conditions.
I hope the scenario below will allow Nicholas Jones to discuss his
illness and treatment with his GP and secondary care provider.
However Should Nicholas be in the medical arena at all? Perhaps
social care and poverty relief would offer him more options than
medicine. Should Nicholas be paid £10,000 per year for his terrible
skin disease as compensation for the hassles he has from the genetic
and environmental lottery we all live in?
I still have not solved the conundrum of very expensive health care
such as growth hormone therapy. Are you better off short but paid
£20,000 per year for 5 years or would you do better to invest your
money with the drug companies for a better future?
Thanks for keeping me thinking in a grey world
Philip
On Tuesday, September 4, 2007, at 02:30 pm, Alex Scott-Samuel wrote:
> Are GPs exploiting NHS markets?
>
> Watch the report at
> www.channel4.com/news/society/health
>
> By: James Blake, Channel 4 News
>
> Doctors may be boosting their income by outsourcing treatments to
> companies they have a stake in.
>
> Their salaries are already at an all-time high. But now there's
> concern that some GPs could be further boosting their income by taking
> advantage of the health service's internal market.
>
> Under the NHS's new "practice-based commissioning" scheme, treatments
> can be outsourced to private companies which doctors are allowed to
> recommend to patients.
>
> But as Channel 4 News has discovered, in Liverpool more than 70 GPs
> have a financial stake in one of those companies. It has led to
> accusations of a conflict of interest and calls for the rules
> regulating the award of contracts to be tightened.
>
> The unit had to apply to provide healthcare to the city for the first
> time - and lost. Now most patients will be referred to two private
> companies - and that'll have a big impact on the funding for the
> hospital.
>
> Yet many GPs will personally make money from the contracts. Channel 4
> News has learnt that 73 local doctors are shareholders of one private
> company that won.
>
> Nicholas Jones, a dermatology patient with severe psoriasis, will now
> be treated at the private clinic. Yet he questions whether he can
> trust any GP with a financial stake in his care.
>
> He says: "I would get the impression that clinical decisions are being
> driven by financial incentives. So if these companies want to make
> more money, its in their interests to refer less patients to the
> consultants.
>
> "And that way they save more money which is more profits for
> shareholders. And for GPs who have their own interests. So I'm very
> frightened and very horrified."
>
> 'I would get the impression that clinical decisions are being
> driven by financial incentives.'
> Nicholas Jones, dermatology patient
>
> The hosptial can't compete with the two companies on cost. They charge
> the Primary Care Trust (PCT) £90 for each new patient - £25 pound less
> than the specialist unit here.
>
> "The sum of money they'll receive under payment by results applies to
> the NHS as well as the private sector. Yes they are paid for each
> individual patient that is seen as is the NHS. The price they'll be
> receiving from the PCT is less than NHS hospitals."
>
> In Liverpool the private companies and the hospital had to apply to an
> official consortium of 19 local GPs - that works under the direction
> of the PCT.
>
> But was the process fair? And did the hospital have a chance? The
> woman who monitors the process on behalf of patients was surprised by
> the revelations.
>
> She said: "There certainly is a conflict of interest. If you walked
> down town and asked people is that a conflict of interest they would
> say yes.
>
> "It's a conflict of interest for the GP because they should tell the
> patient about the financial interest. It's a conflict of interest for
> the patient because how are they to decide what is the best service
> for them."
>
> 'The procurement method for the service is a matter for the
> Primary Care Trust and we are satisfied that the highest standards of
> probity have been followed.'
> Our Care's statement
>
> The private company, Our Care, is based above a GP practice in
> Liverpool. One of the GP directors accepted he is in the Commissioning
> Consortium - but denied having a personal involvement in awarding the
> contracts. The company refused to do any interviews but issued this
> statement.
>
> "The procurement method for the service is a matter for the Primary
> Care Trust and we are satisfied that the highest standards of probity
> have been followed. As a matter of course we do not comment on
> individual contracts."
>
> There is an independent scrutiny committee at the City Council, which
> examines the new services and will make an assessment after 6 months.
> The chairman says he trusts the PCT - that there is no conflict of
> interest here. But he was not personally told the GPs linked to Our
> Care were in the consortium.
>
> The government has rules to protect patients - the process must be
> transparent and GPs offering a service must exclude themselves from
> the group making a decision about a service.
>
> But health think tank the Kings Fund says that's not enough and argues
> conflict of interest is inherent in the policy.
>
>
Dr Philip Dawson
Dolphins Practice
Nightingale PCC
HAYWARDS HEATH
RH16 4BN
Tel 01444 414767
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