One of the problems with the New NHS that has attracted relatively little notice is something with the Orwellian name of the “Quality Premium”. Like the Ministry of Plenty that controls the ration books, or the Ministry of Information that works hard to keep government activities secret, the Quality Premium has very little to do with quality and nothing to do with premium.
First they deduct money from the allocations to GP practices, then they say that you can have some of it back ‘if’. And it is in the ‘if’ that lies the secret of this tool of management. In his initial spin Andrew Lansley would have had you believe that this money would be earned back if the practices delivered a high quality medical service to its patients; but it was always obvious that the government lacks the tools to measure real quality and it would be just too tempting to use it to help manage local funding problems.
In the British Medical Journal last week we got a clue as to how the system would really work. There is a plan to set a target for reducing admissions to hospital. Draft Guidance from the NHS Commissioning Board suggests that a quarter of these incentive payments would depend on commissioning organisations achieving a reduction or no change in admissions for certain specified conditions.
Children with asthma, diabetes or epilepsy could be the first to suffer.
The conditions being suggested are heart failure, angina and hypertension in adults and asthma, diabetes and epilepsy in children.
So you can picture the scene. It is February. Your child with asthma is struggling for breath so you take him to the doctor. In the normal course of events your doctor would send the child to hospital. But we are getting close to the end of the financial year, the commissioning group has already hit their maximum number of allowed admissions for asthma. What does the doctor do? If he admits your child then the practice loses money. If the practice loses money he may have to sack the asthma nurse.
Perhaps you think that my headline is rather sensational. Maybe a better headline would be:
How they intend to penalise the conscientious GP and hit the needy patients.
Because one likely outcome is that good GPs will continue to be good GPs, but they will effectively be fined for being good GPs. And it goes beyond that because patients in less wealthy parts of the country will suffer more than the better off. In wealthy areas a GP who is about to ‘hit the buffers’ of his maximum permitted admissions may take some of the pressure off the service by referring patients privately. In the poor areas no-one will be able to afford to go privately, so they will suffer the full financial penalty of this iniquitous system.
This is, alas only one of the many unfair and damaging aspects of the changes to the NHS set in motion by the 2012 Health and Social Care Act. But none of this is a surprise to those of us who examined Andrew Lansley’s proposals.
I warned those in government and others about this very issue. I even wrote here about it.
So the question now is what are you going to do about it?
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