(extract taken from my article in Osteopathy Today November 2012 issue)
I am fortunate to attend many health events around the country and meet many manual therapists from different disciplines. I remain surprised by the lethargy, lack of knowledge and engagement to the new NHS reforms. In this blog, I will highlight the main points of the Reforms bill and discuss what effect it may have on the private sector in particular.
It is easy to dismiss the new Health and Social care reforms as yet another attempt by a government to tackle the long standing problems of inefficiency, long waiting lists, poor accessibility and lack of patient choice within the NHS. However the radical reforms passed in Westminster this March are about to impact on all of us.
The economic burden of neck and back pain has placed MSK services high on the list of priorities. The Any Qualified Provider agenda offers parity, recognition and opportunity to physiotherapists, osteopaths, chiropractor and podiatrists. Clinical Commissioning Groups (the purchasers of MSK services) will map out the health needs of their region and a mix of NHS, private and independent providers will be encouraged to deliver new, innovative services to the local health market.
Under Any Qualified Provider, providers will compete for MSK contracts on quality and patient satisfaction, not just on price. With a choice of provider it is expected that this will drive-up quality, reduce costs and enable innovation. Commissioners control both contracts and prices and will challenge providers to deliver services of the highest quality but with less money. These contacts will be monitored for cost effectiveness and quality of service using predetermined patient recorded outcome measures (PROMs) and patient recorded experience measures (PREMs). N3 connection to the NHS Choose and Book system will eventually be required so that GPs can directly book an appointments for their patient from a list of registered AQP providers in their region.
The Health Act has been passed and a new health market will emerge. Service providers and Private Practice owners need to gain an informed opinion before deciding whether to be part of it or not. Ignoring the process is risky as it’s unlikely there will be a second chance to participate once contracts have been finalised.
Here is my response to common questions about how AQP will effect the private provider..:
I’m a private provider and we’ve always managed well without a NHS contract….so why should I be concerned ?
Anyone involved as a local provider should consider how the market would look if the NHS mirrored the private sector. Free parking, early access to therapy, evening and weekend appointments, performance monitoring and a ‘can do’ culture of genuinely meeting the needs and expectations of the patient. In other words a service that looks like yours. The service might be at an NHS outpatient facility or equally at one of your competitors clinics. Would patients still pay to see you if they can access a similar service for ‘free’ ?
I’m a private provider and maintain a great relationship with my local GP practice and I’ve held a GP contract for many years… why should I be concerned ?
Providing a great service by your local GP practice puts you in a strong position, but you will still need to apply for AQP recognition…even then that may not be enough, CCGs will be receiving expressions of interest from large organisations who have the track record, scalability, expertise and financial stability to deliver MSK services across the entire care pathway.
In both of the scenarios above the most likely outcome is that you could experience a contraction in patient numbers in the private sector and/or become a subcontractor to a prime provider accepting their payment structure, terms, conditions and delivery standards without any guarantee of referral numbers.
So what should I do ?
Engage, engage, engage. Find out how the AQP process is shaping up in your area. Attend local CCG meetings. Join or build a local provider network using social media such as Linkedin. Try and gain a unified voice for local providers so that you can engage more effectively with large providers. Think about your current service, do you use PREMs and PROMs, do you effectively deliver exercises or still draw stick man diagrams ? Do you adhere to Care Quality Commission standards and provide patient information leaflets ? Look at your surroundings… do they comply with the Disability Discrimination Act, does it look like a facility that the NHS would choose…if you work from home have you thought about locating to alternative facilities. Accept that key decision makers will have preferences between the manual therapies and consider whether combining disciplines with a physiotherapist and/or chiropractor would provide a more attractive multidisciplinary service.
Despite all the uncertainty of AQP it should be remembered that local providers play a key role in the care pathway. Large providers will need high quality, effective and efficient services locally. Success in the new health world will be determined by the willingness to engage in the process.