Saturday, 5 March 2011

Top tips from a money saving GP expert.


We thought we might have a laugh and introduce a series of ideas on how the NHS could save loads of money for very little effort and perhaps as a side effect, in contrast to central Party diktats, improve patient care. Here is our first (possibly of a few?) GP money saving expert top tips.

When we were junior grunts the diagnosis of angina was clinical. This meant talking to patients and examining them without ticking any boxes and coming up with a differential diagnosis or list of things that you thought as a professional, rather than a Party tick boxer, the patient might be suffering from.

In the case of angina, classically described as central crushing chest pain occurring on exertion radiating into the neck and down the left arm causing the sufferer to slow or cease exertion and the pain resolves with rest, all one needed to try was a trial of a few pence worth of a drug to see if this eased the symptoms. If it worked the diagnosis was likely and then other more expensive drugs could be added to control the symptoms.

With advances in pharmacology the control of symptoms by drugs was added to by the use of preventative drugs like aspirins and statins. All good old fashion general practice and clinical medicine – simple, cheap and safe.

For more difficult cases, or where the diagnosis was not clear cut, then referral to a general physician or a cardiologist might be required who then might order an exercise ECG or stress test or proceed to more invasive tests if bypass surgery was considered. However most cases could be managed cheaply in general practice.

Such medicine was not considered good enough by the Party who via the QOF (Quality and Outcomes Framework) introduced the “quality” angina framework which if you wish to you can read it here.

So now instead of simple cheap GP management between 40-90% of patients are now expected to be referred to a hospital. Not the minority who used to be referred there but the majority will have to be referred in order to maximize GP income and tick the QOF boxes to show how "good" a doctor you are.

So now for every patient with angina either £ 93 of exercise ECG or £ 215 to see a cardiologist (click 2 Outpatient attendances) will be incurred to ensure that the GP is Party compliant and gets paid. And that is in addition to what was done previously.

If you look here you can see some figures for how many people in the UK have angina. So if you round up the figure to 2 million the costs of treating angina have gone up from a few pounds in general practice per patient to a few hundred pounds per patient if you follow the Party approved protocol.

Our former leaders felt that this cheap and cheerful approach which helped patients was not worthy of those who had not had the misfortune of ever working in medicine and so these wise idiots overnight increased the need for unnecessary investigation of the majority of those with angina by introducing centralized QOF control of medical practice. Even the Party’s tame GP attack muppet does not approve.

This is akin to looking in a field and saying there is a four legged animal with a white fleece, a black face, that chews grass and emits baah sounds and this looks like a sheep. It is indeed likely to be a sheep and does not require further investigation unless you suspect that the 3 foot long creature might be a blue whale in disguise as a sheep in which case far more expensive tests than the mark one eyeball might be required for example DNA analysis to determine if your case of angina was in fact a case of blue whale in sheep’s clothing. Such DNA testing is now required for all sheep by the Party to exclude the odd blue whale out there.

Medical training in the NHS has generally tried to minimize over investigation in order to get a result but Za Nu Labour’s QOF has probably increased over investigation with no discernable benefit in terms of “outcome” but as long as targets and tick boxes are met we know that “quality” care has been given.

Clinical medicine is ever changing and what might be de rigueur today could be heresy tomorrow. Ticking QOF boxes restricts clinical freedom and imposition of centrally dictated “outcomes” and economic control will severely restrict medical advancement and compromise patient care. For if in order to get paid the doctor has to tick the box as opposed to give a patient a better treatment than QOF allows this will clearly compromise patient care as QOF takes time to change.

Praise be to the Party for dictating how we should waste money. This is the sort of thing that GP consortia should be tackling but they can only do this if they come up with some NICE ideas that are Monitored and approved by the Board and its ultimate controller.

So we must now be looking forward to a new GP led free from central control NHS and money saving ideas like this will be so simple to do, won’t they?

1 comment:

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