The McKinsey report sets out a range of advice to enable NHS organisations to achieve suggested savings.

  • Reduce the tariff to enable strategic health authorities and primary care trusts to push through efficiency savings
  • PCTs renegotiate GP and provider arm contracts to drive down costs
  • Decrease range of productivity among GPs. The least productive GPs have only 77 appointments per week, while the average is 126. If the worst improved, the same number of patients could be seen with 3,500 fewer GPs, saving the NHS almost £400m a year.
  • Stop or reduce elective procedures that are ineffective (eg tonsillectomy), cosmetic (eg tattoo removal), have a narrow margin between risk and benefit (eg knee joint surgery) or where other interventions should be tried first (eg hysterectomy for non cancerous heavy menstrual bleeding)
  • Reduce routine referrals to outpatient appointments
  • Reduce variability in outpatient referrals
  • Increase nurses’ patient facing time. For example the number of district nurses could be reduced by 15 per cent if the average number of visits increased from 5.6 to 6.6 per day.
  • Review how much of their time nurses spend with patients. Of the 25 minutes per hour acute and general ward nurses spend with patients, only 15 minutes is spent on “physical care” as opposed to “psychosocial care”.
  • Increase clinical productivity. The least productive 10 per cent of doctors and nurses see a fifth of the patients seen by the most productive 10 per cent.
  • Increase the rate of patients treated as day cases. In some specialties, such as gynaecology and breast surgery, the rate could be increased by 40 per cent.
  • Reduce the variation in prescribing by PCTs. The amount they spend on prescribing per weighted head of population ranges from £85 to £192. If they all moved closer to the average - £151 - they could save £600m a year.
  • Reduce spending on supplies by £1.9bn. For example, GP supplies could be 15 per cent cheaper if they used national procurement contracts and the NHS Purchasing and Supply Agency. In some areas of procurement, eg, microfilming and waste, the NHS is paying more than 40 per cent over the odds.
  • Don’t waste NHS space. Spare land and buildings can be sold to make £8.3bn and underused space should be put out of use to save £400m on heating and maintenance. Hot desk more. Cut the square metre to bed ratio.