David:
"Yes, but "- Gary has posed a theoretical question, deliberately adopting an extreme set of conditions to emphasise his point
Whatever your views on the financial minutiae, Gary's principle remains valid, and highlights the inherent conflict of interest for all Clinical Scientists between demand management and departmental 'profit' (oops - perhaps 'income maximisation' would be less contentious?) in a 'silo structure' (within secondary care as well as between secondary and primary care). In EQA we face a similar with fee-paying participants who appear to be providing a service which is not fit for purpose
Today's Dail;y Telegraph promised 5 pledges on the NHS from Cameron, one of which seemed to relate to "integration of health services", but on closer reading this seemed to relate not to any integration of primary & secondary care (as in Scotland, Wales & Ulster, but not England) but simply to the patient not having to repeat her history to every new doctor ((or health professional?) she encountered - how this is compatible with the government's apparent failure to support the electronic health record was not exactly clear . . .
Do our august Professional Societies have a policy view on this fundamental dilemma? [and also on how GP commissioning will inevitably not only engender but also increase 'postcode lotteries' in healthcare?]
David
Consultant Clinical Scientist
Birmingham Quality (UK NEQAS for Clinical Chemistry)
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Cowley, David [[log in to unmask]]
Sent: 06 June 2011 19:50
To: [log in to unmask]
Subject: FW: Whose saving would it be?
Dear Gary,
I wish we could operate with 90% profit margins down here!
Best wishes David
David Cowley
Brisbane.
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Gary Mascall
Sent: Tuesday, 7 June 2011 2:46 AM
To: [log in to unmask]
Subject: Whose saving would it be?
Looking at the following scenario, how would you apportion the saving?
Laboratory and GP's identify 2 high volume tests with limited clinical value for majority of primary care patients.
Laboratory does a modelling exercise, and identifies only around 20% of tests are required, and if the un-needed 80% were stopped, would save the laboratory in the region of £50,000 on reagents. Hence a true Pathology saving.
However, income from these tests would have brought in £500,000 in payments from primary care.
So, an apparent Pathology saving would end up reducing the Parent Organisation's income by £450,000. Pathology not now such a "good boy", but told now to make an additional £450,000 CIP saving to make up the shortfall in Trust income.
Or, should Pathology and Primary Care be congratulated for jointly coming up with a strategy for saving £550,000, which if the model was followed across UK, could release at least £10,000,000 into the health economy either as a saving, or to be redistributed for other worthwhile medical/surgical interventions?
Nowhere in any of the current round of QIPP have I seen anything which relates to this scenario, it is all about withdrawing costs out of Pathology, and would be interested in other people's thoughts.
Gary Mascall
Consultant in Clinical Biochemistry
worcestershire Acute Hospitals NHS Trust.
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