Primary care productivity reforms must focus on cost effective policy options
Health economist Professor Alan Maynard is warning policy makers seeking to improve primary care productivity that reforms must be developed with care and a focus on evidence of the cost effectiveness of competing policy options.
Posted: 21 June 2012
Writing in the Journal of the Royal Society of Medicine, Maynard advises policy makers to ignore the rhetoric of politicians and the superficial analysis of consulting firms, describing the arguments used by the authors of the 2010 McKinsey report into NHS productivity as simplistic and offering no robust evidence to support their assertions.
Maynard says that the regular ‘re-disorganisations’ of NHS structures over the last 30 years have largely marginalised the reform of primary care provision by focusing attention on the development of commissioning and improving the performance of hospitals. “The failure of NHS reforms to focus thoroughly on the role of primary care as a rationer of access to health care and as a provider means that practice variations and fundamental issues about the efficient delivery of primary care have been side-lined. Policy makers must seek to improve primary care productivity with a programme of radical change inherent in the NHS reform documentation.”
Changing clinical practice will, Maynard says, involve improved comparative activity analysis, complementing activity data with outcome measurement, competitive tendering and changes in skill mix with increased employment of nurses. Funding constraints mean enhanced financial incentives to alter GP behaviour cannot be afforded. Instead there will be more focus on policies that create threats to income and reputational incentives that rely on peer pressure and professional pride to motivate change and improve patient care.
Maynard says: “Radical attempts to reform the provision of primary care should be expected as the NHS Commissioning Board (NCB) pursues improved productivity throughout the NHS in order to achieve the saving and recycling of £20 billion over four years. Defining targets and improving incentives will be the focus of the NCB as it uses the Clinical Commissioning Groups to enforce its will locally.”