Reforming the consultant contract again?
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《英国医生杂志》
EDITOR—It is a paradox that, if NHS consultants eradicate waiting lists, they might experience less success in the private sector.1 The new contract will not eradicate private practice, and often NHS acute trusts cannot provide bespoke care but crisis management. Patients pay extra for fast, client oriented care with a consultant of their choice.
One major cause of this situation is the need to reduce waiting lists while catering for acutely ill patients who are not on waiting lists and commonly have no choice about treatment. Urgent and elective patients are trying to access the same health resources in acute trusts, and with the current emphasis this may disadvantage urgent cases waiting for treatment.
Acute trusts should make their primary mission the care of urgently ill patients, and financial flows should reflect this mission. Elective work should be done through elective units. Training opportunities may be best in ill patients, not on elective cases that go well. Later, senior trainees could also train in elective units, paired with a trainer.
An alternative new consultant contract would offer an Australian style working week, with three days a week delivering care to urgent patients in a network of public hospitals. NHS acute trusts could offer eight programmed activities for three days a week, with two programmed activities for training and continuing professional development. Two days a week would then be available for elective care, at 63-75% of BUPA rates, in accredited independent institutions. NHS pensions could be supplemented from this income, by choice.
Any patient would have the right to treatment for urgent or elective conditions through any hospital, free at the point of delivery. Unlimited fee for service risks unnecessary procedures and escalating costs. Time limited fee for service, with time for care of urgent cases and supporting activities and teaching, is a good compromise. In this model, consultants will not be obliged to put the emphasis on patients who have waited a long time when sick patients languish elsewhere awaiting their attention.
Adam P Fitzpatrick, consultant cardiologist
Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9WL adam.fitzpatrick@cmmc.nhs.uk
References
Maynard A, Bloor K Reforming the consultant contract again? BMJ 204;329: 929-30. (23 October.)
One major cause of this situation is the need to reduce waiting lists while catering for acutely ill patients who are not on waiting lists and commonly have no choice about treatment. Urgent and elective patients are trying to access the same health resources in acute trusts, and with the current emphasis this may disadvantage urgent cases waiting for treatment.
Acute trusts should make their primary mission the care of urgently ill patients, and financial flows should reflect this mission. Elective work should be done through elective units. Training opportunities may be best in ill patients, not on elective cases that go well. Later, senior trainees could also train in elective units, paired with a trainer.
An alternative new consultant contract would offer an Australian style working week, with three days a week delivering care to urgent patients in a network of public hospitals. NHS acute trusts could offer eight programmed activities for three days a week, with two programmed activities for training and continuing professional development. Two days a week would then be available for elective care, at 63-75% of BUPA rates, in accredited independent institutions. NHS pensions could be supplemented from this income, by choice.
Any patient would have the right to treatment for urgent or elective conditions through any hospital, free at the point of delivery. Unlimited fee for service risks unnecessary procedures and escalating costs. Time limited fee for service, with time for care of urgent cases and supporting activities and teaching, is a good compromise. In this model, consultants will not be obliged to put the emphasis on patients who have waited a long time when sick patients languish elsewhere awaiting their attention.
Adam P Fitzpatrick, consultant cardiologist
Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9WL adam.fitzpatrick@cmmc.nhs.uk
References
Maynard A, Bloor K Reforming the consultant contract again? BMJ 204;329: 929-30. (23 October.)