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Monday 21st May 2018

The price of keeping patients out of hospital

23rd October 2008

Michael White, writing in the Health Service Journal, explores the issue reported in the media concerning GPs being given money to prevent hospital referrals.


Reports in The Sunday Telegraph and The Times have shown that GPs are being paid - £59 per patient - to not refer their patients to hospital and to give them treatment "within the primary care system instead".

There is clearly something to talk about here - but what is the real topic for debate? A few days before, the government's health minister Ben Bradshaw was hounded by Conservative spokesman Andrew Lansley about the Department of Health's "Martini strategy" on primary care.

Mr Lansley mentioned a quote by Professor Barbara Starfield of Johns Hopkins University in the US, saying: "Primary care deals with most health problems for most people most of the time."

"There is lots of evidence that a good relationship with a freely chosen primary care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs."

Mr Lansley went on to say that the government is forcing an atomisation of primary care because of polyclinics and removal of power from family doctors. He added that this took away the "good relationship" which was so important between a patient and their GP.

This provides an answer to the article in The Telegraph - namely that it costs less and is "better" for patients to make sure they do not go to hospital.

The most important question is "should GPs be paid" to keep patients from going into hospital?

The debate in the Commons did not look into the issue of incentives for doctors during the debate - they were too busy arguing about the latest performance statistics for hospital trusts published by the Healthcare Commission.

Alan Johnson praised the statistics publicly, but he was criticised over superbug issues and the fact that a mere 31% of patients are able to visit their doctor within 48 hours (it was 80% in 2007).

The government blame the new figures on the commission's "new method of data collection".

While there may be problems within the healthcare system it is logical to think that the whole structure has not fallen apart since last year.

The government has also announced "capital spending projects" to counteract the recession. However while some projects could be fast tracked, it is probable that "times ahead are going to be tight".


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