Hi David,
In the case I illustrated, what is being asked is for Primary Care to "cherry pick" out a single test from a group of tests.
So, if the group of tests initially contained 5 investigations, they only want to pay for/receive 4 from now on.
Therefore, we still receive exactly the same number of requests/samples, hence little opportunity to reduce staff costs, but hits the bottom line.
Regarding the first point, yes 90% does appear to be a large mark up, but in the simplistic way the NHS has looked at costing Pathology services, with a single discipline "tariff", you have to accept that there will be low cost to laboratory tests which will subsidise other high cost tests, i.e. Immunoassays.
Many years ago, with the first round of GP fundholding, I worked with others to look at a banding structure to charge for work done. Initially there was a request handling charge, and on top of this you added in the cost of tests in band 1, band 2 etc.
This way, you loaded every request, whether for 1 or 20 tests with a handling charge to cover pre/post analytical elements, then added in test costs. Thus a single glucose was a lower charge than a request with 20 tests.
Unfortunately, although being initially welcomed by then Chief Executive and finance director, when they saw that it did not just equate to a simple, "one price for all", they opted to use an "average" request cost for everything, much in the same way as the tariff. Reason? To complicated for finance department to handle!!
Strangely enough they were supported here by Medical director and GP representatives, who did not want colleagues to be penalised for their high use/cost of Pathology tests.
Yes, unfortunately Pathology in the UK still is not able to run as a business, for the simple reason that our users, here GP's and consultants, baulk at the thought of actually being scrutinised for the use they make of the service, and what resources they actually use. Until then, whatever we do is merely windowdressing, even with QIPP I'm afraid.
This is certainly NOT demand management, more demand manipulation. Indeed one area I have approached users on is the ever increasing requesting of CRP. I can't understand why it is being requested 50% of requests, but trying to get meaningful discussion as to how to tackle this is impossible. So if anyone has managed to put the cork back into this bottle then I'd be very interested to hear how it was achieved.
Gary Mascall
Consultant in Clinical Biochemistry
Worcestershire Acute Hospitals NHS Trust
Tel: 01562 823424 extn 56100
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Cowley, David
Sent: 06 June 2011 23:38
To: [log in to unmask]
Subject: Re: Whose saving would it be? - reductio ad absurdum . . .
Hi David,
Yes, but what he has not said is that he could presumably retrench $450,000 per annum of staff and return the cash to the taxpayer or perhaps redeploy them so that they were doing something useful.
Best wishes David
David Cowley
Brisbane
-----Original Message-----
From: David Bullock [mailto:[log in to unmask]]
Sent: Tuesday, 7 June 2011 6:50 AM
To: [log in to unmask]
Cc: Cowley, David; Gary Mascall
Subject: RE: Whose saving would it be? - reductio ad absurdum . . .
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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