One more sign that we may miss the expertise of PCTs
While the NHS accelerates towards an uncertain future, primary care trusts are braking hard on activity.
True, their ability to control emergency admissions appears limited, but the exclusive analysis carried out for HSJ by CHKS shows that where they have greater control, their performance is impressive.
In the three years from 2007-08 to 2009-10, overall outpatient referrals rose 33 per cent, with GP referrals up 25 per cent and consultant to consultant referrals higher by an astonishing 53 per cent.
With the financial writing on the wall, the need to slow the growth in referrals became an imperative. The result? Pro-rata figures suggest overall outpatient referrals will increase just 1.5 per cent in this financial year, with consultant referrals actually declining by 5 per cent.
It is worth asking, of course, why referrals were allowed to grow in such an unfettered way in the first place. Was the increase in volume entirely justified by the 18 week target? But it is clear that primary care trusts can manage demand when required.
Last August, HSJ ventured the unfashionable opinion that the final round of world class commissioning scores suggested many PCTs were beginning to master their brief. The performance on outpatient referrals strengthens that view.
The National Quality Board declared this week that PCTs should prepare “legacy documents” to ensure effective knowledge transfer to commissioning consortia. The secret to effective demand management will form a key element of this handover.
Leaving these positive messages about PCT success will also help staff avoid the strong temptation to follow the example of former Treasury secretary Liam Byrne, who left a note to his successor saying: “I’m afraid to tell you there is no money. Kind regards and good luck!”
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Readers' comments (4)
Stephen Kell | 24-Mar-2011 7:13 am
We have worked in partnership with the PCT and have reduced referrals by almost 10% without referral management systems. Agree there has been a change in engagement since the reforms.
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Anonymous | 26-Mar-2011 9:51 am
Typical narrow minded managerial perspective. What happened to quality? Early referral to cancer specialists? Who cares - thats so much more difficult to measure.
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mike batt | 29-Mar-2011 8:01 am
"Their performance is impressive"?
I will tip my hat to commissioners, when they re-design a whole health system, so that people continue to receive the care they need, but more efficiently. Where this has happened in local health econmies; it has been providers doing it.
Just telling off highly trained professional clinicians for referring patients is just lowest common denominator management.
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Anonymous | 29-Mar-2011 9:34 am
Mike Batt, I don't know who you are or where you work, but you really ought to lay off the vinegar at breakfast! There are many health economies where commissioners and providers are working together to redesign health systems, but even you must acknowledge that this sort of work takes time - and generally performed a few chunk at a time as well.
As for just "telling off highly trained clinicians"? Well sometimes those highly trained clinicians just swamp plastic surgery departments with referrals for minor skin lesions and suchlike that have no business going anywhere near secondary care. But it is also likely the containment in referrals (as it is in my area) is down to the provision of alternative services outside secondary care which have been secured by commissioners and GPs working together.
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