BMJ  2008;336:1088 (17 May), doi:10.1136/bmj.39577.668993.3A

Letters

NHS commissioning

Current system has lost touch with reality of patient care

The first 150 words of the full text of this article appear below.

Ham’s dissection of the problems of NHS commissioning is welcome to me as it shows I am not the lone voice crying in the wilderness that I feared I was.1 2

The current system of commissioning has lost touch with the reality of patient care. Commissioners have become obsessed with saving money and have started playing games to achieve this. Secondary care services are (largely) paid for through the payment by results (PbR) tariff, but increasingly we are seeing attempts to commission cheaper services by finding ways around paying tariff rates. In my own area, a consultant service in rheumatology has been established in a general practice, so not subject to PbR. It costs less than half the PbR tariff rate, which I, as an acute trust employee, cannot match.

Can my own service go off tariff? Actually it seems that it can—by establishing clinics that call themselves something else (for . . . [Full text of this article]

Andrew N Bamji, consultant rheumatologist

1 Queen Mary’s Hospital, Sidcup, Kent DA14 6LT

bamji@btinternet.com


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