There is nothing new in the challenges facing our NHS.
It has been recognised, possibly for more than 20 years, that the increasing demand on the service in addition to significant
demographic changes with an ageing population and almost
a daily increase in new technologies that can improve
diagnosis and treatment puts immense strain on the NHS,
and is beginning to test its very viability.
A baby born today is now expected to live about five hours
longer than a baby born yesterday. If a female, the baby could
There is nothing new in the challenges facing our NHS.
It has been recognised, possibly for more than 20 years, that the increasing demand on the service in addition to significant
demographic changes with an ageing population and almost
a daily increase in new technologies that can improve
diagnosis and treatment puts immense strain on the NHS,
and is beginning to test its very viability.
A baby born today is now expected to live about five hours
longer than a baby born yesterday. If a female, the baby could
expect to live to 2111. There is nothing new in the challenges facing our NHS.
It has been recognised, possibly for more than 20 years, that the increasing demand on the service in addition to significant
demographic changes with an ageing population and almost
a daily increase in new technologies that can improve
diagnosis and treatment puts immense strain on the NHS,
and is beginning to test its very viability.
A baby born today is now expected to live about five hours
longer than a baby born yesterday. If a female, the baby could
expect to live to 2111.
Anthropologists and evolutionary review estimate that the
human, free from disease, could possibly live to be 120 years
old in future. As our society has an ever-increasing number of
elderly citizens we have not seen a concomitant improvement
in general health with longer life. Care of the elderly will be
an ever-increasing challenge in the future.
The current and immediate focus to meet this challenge
has been described by the Department of Health (DH)
programme, Quality, Innovation, Productivity and Prevention
(QIPP).
Launched in 2009, this recognises an inextricable link
between quality, innovation, productivity and prevention
of disease. The NHS has not always recognised that quality
can and often should be improved without increasing costs
and indeed a highly productive service should also always
demonstrate an improvement in quality.
Productivity is best served by the prevention of disease
and the only way to link these three aspects of QIPP together
is to have an innovative and entrepreneurial outlook into
changing care pathways and improving care.
The QIPP programme describes ways to enable people
with long-term conditions to be cared for in their community
or at home. It aims to support new ways of meeting the
increasing demand for urgent care, to improve self-care,
end-of-life care, give the right care and extend preventative medical care. There are 12 national workstreams in total.
In the short term, the quality and productivity challenge
for the three-year spending review from 1 April 2011 is that
between 15 -20% of current NHS spend needs to be more
efficiently used, released from where it is currently deployed
and focused on the above challenges.
In a public service that consumes £100bn of taxpayers'
money each year, this equates to an efficiency gain of a
minimum of £5bn, year on year up to 2014.
So what does this mean in real terms, at practice level,
for new GP commissioners? Well for the 50 million citizens
of England, this means an improvement in the deployment
of NHS resource usage by a minimum of 40p per citizen in
England for every day that general practice is currently open
(say approximately 250 days per year).
Therefore an average general practice looking after 6,000
patients could be expected to do something remarkable on
a week-to-week basis that drives an efficiency gain of almost
£2,500 from their commissioning budget every day that they
are open, and this to be redeployed in meeting the new
demands on the NHS.
While QIPP, as an acronym, is sometimes perceived by
clinicians as civil service jargon and still does not mean much
to many in everyday clinical practice, the principals laid out
in the QIPP program to maintain our NHS free at the point
of access and not based on the ability of a citizen to pay for
their healthcare, it is a vital programme in the immediate and
medium term.
For general practice, it does mean reviewing prescribing
and referral practice on a day-to-day basis. For GP
commissioning consortia this involves a review of unwarranted
variation between NHS resource usage and health outcomes.
In practice it will mean repatriating a significant amount
of low-tech, low-complex work from hospitals back into the
community. It will be a challenge to consider how to manage
the ever-increasing demand on urgent care services. It
will mean detailed consideration of prevention of hospital
admissions, readmissions and reducing length of stay in
hospital beds.
In the early days of the NHS internal market, GPs worked
in an environment which required cost effectiveness. Most
recently we have focused on the quality agenda for the NHS.
The future, however, is about increasing value for the taxpayer,
which is an equation that recognises that value equals quality
divided by cost and that clinical decision-making will have to
be aligned with NHS resource deployment.
As Stephen Dorrell, Chair of the Health Select Committee,
recently said: "It is unacceptable for a GP to make a referral
or sign a prescription and not realise they are spending
taxpayers money".
National Clinical
Commissioning
Network Lead
Department of Health
