I'm also sure that "economies of scale" is one of the the principal
factors in the cycle of NHS reorganisation:
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These small organisations are inefficient. If we merge them we can make
economies of scale. ^
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This large organisation is not locally sensitive. We need a layer of
smaller organisations beneath to offer local flexibility.
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I have presented it as a circle but it's actually a spiral of small
organisations being formed, merged and then finding new small
organisations being formed under their umbrella.
I have watched this happen with the various configurations of health
authorities/PCTs over the last couple of decades, and our local PBC
clusters went through the whole cycle within a couple of years recently.
It's just about time for the local clusters to start spawning
sub-groups again.
On 17/07/2008 01:38, Adrian Midgley wrote:
> I've become accustomed to hearing a pair of stories in close proximity:-
>
> - - THere are economies of scale, everything must be done by bigger
> organisations and teh small must be amalgamated to make the big;
>
> - - {it} can be done cheaper in general practice than hospital ... setting
> a lower fee.
>
> I am not sure that I believe the first, but if it is true, payments to
> GPs for the additional benefit the patient receives from proximity
> should be larger than to hospitals or Trusts, for whatever value of {it}
> one picks.
--
Regards,
Stephen
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