I recently attended the CSPs ‘Survival Guide for Clinical Leaders and Managers’ seminar at Bedford Row, London. The physiotherapy delegates, mainly from the NHS, received a stark message…. in order to survive the NHS reforms against Any Qualified Providers (including osteopaths and chiropractors) from the private sector they must provide leaner, more accessible services which encompass all aspects of the NHS programme for Quality, Innovation, Productivity and Prevention (QIPP).
Musculoskeletal services were highlighted in particular as these are high on the government’s agenda for improvement and are first up for Clinical Commissioning Group tenders. The importance of selling your service to CCGs and backing up your pitch with clinical outcomes using the unimaginatively named EQ-5D-5L clinical instrument was also underlined.
For me, it is hard to see how NHS outpatient departments will successfully compete. The private sector is used to providing services that are accessible to patient needs, operates with clinical associates and contractors and can quickly ‘right size’ its staffing levels to necessary demand. Waiting lists at local private clinics are usually a matter of hours not weeks. Private companies will be slicker in their presentation and market their services to best effect. That said, there is a ray of hope for NHS outpatient departments. They are currently well integrated with existing care pathways (trauma and orthopaedics, rheumatology) and already have strong relationships with their local GP’s. They often share the same technology such as ‘Choose and Book’ systems and can readily access patient notes and / or services such as radiology for MRI/X-ray. If they have been providing anything better than a reasonable service, CCG’s may opt to align themselves with their known provider (read as ‘better the devil you know’) but insist on quality improvements over time.
The key priorities for NHS musculoskeletal services are accessibility and the provision of innovative services. Patients want services that are convenient for them, rather than the self serving family friendly policies that operate for the NHS staff who serve them. Survival will mean NHS outpatient doors opening for evening and weekend appointments. This could result in shorter waiting lists and perhaps decreased DNA rates. Innovation must infiltrate services actively, organically and swiftly. So often the CSP reports enthusiastically on an improved MSK service only to find, when delving deeper in to the story, that this has been enforced by a PCT or as a response to closure / cutbacks. Read for example ‘Physios win fight for services ‘( http://www.csp.org.uk/frontline/article/physios-win-fight-services) and discover that this victory was achieved by addressing inefficiencies that should have been picked up through simple clinical audit.
Over the next few weeks I will be putting together a survey for the CSP East of England region’s team to compare how the NHS compares to the private sector in terms of accessibility of service (earliest and latest appointments, weekend appointments), waiting lists for the first appointment, DNA rates, length of appointment times etc…). If you work in that region expect my call in March !
In my next blog, I will be reporting on why NHS workers holding on to their agreed contractual working conditions may turn into a pyrrhic victory. … and in Our Virtual Clinic’s the Physio Direct service is about to become even more effective.
To all AQPs, I wish you a Happy New Year, and for the sake of the patient, let the best services win !