Levelling the playing field

Dr Rant has been reliably informed that a certain PCT not far from Oxford has been up to some rather mischevous work. To set the scene, Oxford has an excellent Orthopaedic specialist centre in the form of the Nuffield Orthopaedic Centre which has some of the best surgeons around and an outstanding record of clinical care. However as part of HMG's reform program an Independent Sector Treatment Centre was set up in Banbury, about twenty miles north of Oxford. The PCT, probably due to pushing from the government, signed up to a long contract with this ISTC that paid large amounts of money up front for a quota of work that has not been completed; a familiar tale for an ISTC, burning money again.

At a recent PCT Practice Based Commisioning (PBC) meeting it was made clear that certain rather large and unfair incentives were being offered to whoever was willing to refer patients to the ISTC. The cost of all referrals and treatments at the ISTC will not be charged to the GP practice's budget, in an attempt to boost the trade of the flagging treatment centre. Patients would also be reimbursed all their travel expenses for making their way to the ISTC. Other policies were also brought through at this meeting which look to waste even more tax payer's cash on anti-obesity schemes with a zero evidence base of their efficacy.

This example perfectly demonstrates just how much damage the government's poorly thought out reform program is causing. The Nuffield is a brilliant tertiary referral centre that has been struggling financially of late; largely thanks to a Payment By Results (PBR) system that does not reward the units that do the trickier more complicated work, work that is in fact too hard for other units to even consider undertaking. The government's fisherprice payment system rewards easy work and gives no incentive towards doing good work; this means that a hip replacement that lasts only three weeks because it was wrongly positioned makes as much money as one that lasts for twenty years.

The PCT's actions are yet another kick in the balls for excellence in the NHS, and show that in reality this rigged internal market is acting as a catalyst for needlessly burning tax payer's money. Money is not only burnt running the highly inefficient PCT bureaucracy, but it is also burnt bribing GP practices to send patients to the flagging treatment centre. Even if the Capio treatment centre was able to provide as good a standard of treatment as the NHS' Nuffield, this would be an incredibly wasteful scheme. However when you hear that local medical staff refer to the Banbury treatment centre as 'Crapio', one soon realises why the patients flock to the Nuffield.