Sunday, 23 November 2008

Practice Based Commissioning (PBC) and Practice Based Commissioning (PBC)

Many of NDs’ team have wasted hours over PBC and were heartened to read that the Kings Fund have decided that PBC is not working. We had realized that after a month of meetings but then we are only Drs not the Party who are all knowing and wise in healthcare matters. We therefore present this explanation as to why PBC has failed:

One of our glorious leaders great ideas was to reintroduce the flawed idea of fund holding introduced by the Conservatives a few years ago. This was basically the idea that you give each practice a budget to spend on their patients and hopefully reduce costs. Fund holding didn’t work because it costs loads to administer and hospitals fixed prices. Unlike supermarkets that can reduce costs simply because if you don’t shop there they don’t earn money the NHS is free at the point of purchase.

In other words if the punter don’t pay they don’t care what sh*te they buy = NHS as it is free. Go to a free drinks promotion or where someone pays for the bar and you will see what I mean - needless consumption of things you might not otherwise consume. Look at a suddenly empty shelf in a supermarket and ask why it has suddenly emptied since last time – hint look at the price reduction or 2 for 1 promotion compared with last time. So competition can never work in the NHS as there is no market as punters turn up knowing they can waste professionals time for free but politicians think otherwise as they are intellectuals.
However because of New Labour who, as true socialists believes that the consumer, not the Party, is king we now have PBC as the New Labour answer to health care inequalities but suffers from one fundamental flaw. What is it?

We know it is not fund holding because the Party tell us that it is not and do not give practices money to spend but they have to earn it by saving the Party money. However there is PBC and PBC. What is the difference?

PBC 1 (the 1 will help us at ND who are thick to work out which PBC is PBC) is where the local Politburo wants GPs to do extra work in order to save money by asking them to do the local hospital’s work. So if a GP does a hip replacement at his surgery the PCT will pay him under £20 (under the local Politburo PBC plans) and save the £5305 it would pay the hospital.

This is where the local Politburo “commissions” = PBCs the GP to do the work to save them money. We all know this will work because GPs are spending too much time on the golf course and not enough time banging in hips or doing triple bypasses all of which they learnt to do in their 3 years of what is now called “specialist training”.

The second version of PBC, PBC 2, is the idea where groups of GPs come together and try to improve the services that the Politburo and its’ wise managers have designed for their patients. Now this in theory might be a good idea as GPs will know which patients are waiting longer for what procedure as their patients moan on to them (not managers). They also know the good and bad hospital doctors and what needs to be done to improve the current systems. In this case the GPs would “commission” = PBC the service on behalf of the patients and hopefully influence its design.

However this idea has many failures the main one being that it would cost the local Politburos’ to run it as anyone knows that quality costs which is at odds with the core current NHS philosophy that the NHS is “care on the cheap”. It is therefore doomed to failure as the Party will not give money to people who might do things better than the comrade commissar managers who have so successfully run the health service for so long.

PBC 1 = secondary care decommissioning or dump it on the GPs to save costs which is after all the whole point of PBC.

PBC 2 could mean GPs in touch with what their patients’ need being able to purchase and even improve things for their patients. This however is not allowed as the Party and its managers know best and have done so for years. So PBC 1 is the only version of PBC that is allowed and so if you look at the force diagram above you can see that PBC is going nowhere fast as doctors and managers are looking at the same problem from different directions.

Confused? So are GPs in Northernshire who have spent hours sitting on their arses listening to fat managers giving presentations from NHS plc Party Central corporate laptops on PBC 1 while asking GPs how they should be saving the NHS money (or doing PBC 2) but not wanting to pay anything to “facilitate the process”.

Here are two examples from one part of the world of Northernshire of PBC 1 at work:

PBC 1 wants to reduce GPs orthopaedic referrals by 25%.

The Party and the local Politburo have increased orthopaedic consultant numbers by 200% as well as purchasing extra, but underused (because it is crap), orthopaedic capacity from the white elephant called ISTC (Independent Sector Treatment Centres) but GP levels are unchanged over 10 years in the one of the most under doctored areas in the country.

So having spent a fortune to increase capacity joined up NHS thinking says lets not use it but increase work for those already under resourced.

Another example is that despite there being “choice” offered where there was none by the Party the local Politburo commissar managers think (oxymoron we thinks there) that too many patients are going to A&E and feel that if GPs have a word with their patients this would stop the flow of (expensive) patients to A&E.

We know that will work don’t we? “I think I am having a heart attack but my GP said I shouldn’t go to A&E as it is too expensive so I will die instead”.

Where do they get the managers to think up this crap from?

PBC another great Party failure going nowhere fast but it will soon be “worldclass commissioning”.

Whatever that is.
Praise be to the Party.

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