Published: 27/06/2002, Volume II2, No. 5811 Page 15

Discussions have started on how much of its 'expertise'Californian health maintenance organisation Kaiser Permanente can share with the NHS.Tash Shifrin finds its senior executive, Dr David Lawrence, optimistic, but could there be a cost?

'I wish they all could be Californian...' sang the Beach Boys. But if the politicians and policy makers of Richmond House and Downing Street are whistling the song at the moment, it will not be Californian girls they have on their minds, but Californian healthcare expertise.

For Kaiser Permanente, the California-based health maintenance organisation, has attracted plenty of interest for its preventive healthcare work, management of chronic conditions and whizzbang IT systems.

Though controversy rages among British medics and health managers about Kaiser's clinical and cost effectiveness, the government is enthusiastic.

Senior executive Dr David Lawrence was in London last week, meeting the likes of NHS chief executive Nigel Crisp, health secretary Alan Milburn, his Conservative predecessor Virginia Bottomley, Tony Blair's health policy adviser Simon Stevens and Department of Health strategy unit director Chris Ham.

The word in government circles is that US groups such as Kaiser are very likely to be used as consultants to improve primary care trust performance. But Dr Lawrence says plans are not so advanced. 'It is a learning week for me, ' he says. 'Where it all leads long term is a matter of speculation. There is no programme that We have worked out of involvement.'

He stresses that what is under discussion are the 'common challenges' facing healthcare around the world and 'areas of overlap' between Kaiser - which both funds healthcare through insurance and provides it - and the NHS.

Fresh from his meeting with Mr Crisp, Dr Lawrence says: 'What We have not talked about, and it would be inappropriate in my view, is [what] some people at the extreme have talked about - us coming in and running a PCT.'

And he adds: 'I would be very leery of doing that. I think the NHS is a rare jewel in the world. Its political realities are unique to Britain.

For an outside organisation to come in and have the hubris to imagine it could understand those issues is ludicrous.'

He is keen, though, to 'talk about real problems on the ground' and says 'to do that you have to get down to the level of a PCT'.

He reiterates: 'We haven't begun to talk about how you actually make that happen - contracts or consulting arrangements - we just haven't had those conversations.'

But what could Kaiser, with its experience of the US system of private health insurance - or for the poor, lack of health insurance - bring to an NHS PCT?

Dr Lawrence points to Kaiser's Care Management Institute, which he describes as a bit like 'a hybrid' of the National Institute for Clinical Excellence and the Modernisation Agency, run by doctors but with a management input.

Its recommendations are put into practice through a network of 'thought leaders' - doctors who carry out this part-time development role alongside their normal practice. This is something Dr Lawrence feels could be shared with PCTs here. But there is more, and this is the bit where it may help to have Silicon Valley nearby.

Dr Lawrence says: 'We are rewriting that CMI information into software.'

The idea is that once CMI has identified 'what the science and evidence suggests in a given illness', this can be translated into decision-support software modules that go into Kaiser's 'clinical information system'.

This system is a three-in-one tool: it is an electronic patient record, it allows continuing communication between different clinicians or healthcare providers.

And it provides the doctor with a decision-support system, following CMI care pathways.

This means that if Patient X with asthma goes to the doctor, entering their name in the system brings up not just that patient's record, but prompts the doctor to ensure the latest recommended intervention for people with asthma is used. If Patient Y has diabetes, the latest information on diabetes control comes through.

You can imagine how this might work with the NHS's national service frameworks... if you can imagine the IT equipment to support it. 'What We are now playing with is what elements of the clinical information system We are going to make available to the patient, ' says Dr Lawrence.

It all sounds pretty smart. But at what cost? Kaiser is not-for-profit, and though it does make a surplus, this can only be used for tightly defined purposes. If a forprofit competitor were looking to buy the system, Dr Lawrence says he would 'rip him off as badly as I could - but the NHS, no way'.

There are, as yet, no concrete proposals about what Kaiser might do in Britain, how it might work, or the cost. And the idea of PCTs becoming more like US health maintenance organisations has sparked fears in some quarters, with defenders of the NHS's universal coverage reluctant to open the door to operators from the US insurance-based system.

But Dr Lawrence has been discussing the possibilities with some big players and his visit looks set to herald plenty more trips between the NHS and sunny California.