Managing chronic diseases: Funding follow-up is key to long term specialist care

doi:10.1136/bmj.330.7497.964

BMJ 2005;330:964 (23 April), doi:10.1136/bmj.330.7497.964

Letter

Managing chronic diseases

Funding follow-up is key to long term specialist care

EDITOR—Gask says that consultants do not manage most patientswith chronic diseases even though they should have a key role.¹She argues that the current NHS organisational structure islargely to blame.

The current service level agreement means that primary caretrusts pay hospitals for referrals of new patients and per procedure.No fee has been set for follow-up, and fees for new patientsare not varied, to take into account the chronic nature of acondition.

To preserve current levels of service, hospital clinics haveto maintain an active discharge policy to stop clinics becomingoverwhelmed with long term, non-funded follow-ups.

This can reduce job satisfaction in and patient satisfactionwith hospital care. New funding arrangements will need to tacklethis problem for secondary as well as primary care to achievea better service for patients with chronic diseases.

Jon Norman, pain fellow

South Manchester University Hospitals Trust, Manchester M23 9LT j.norman{at}smuht.nwest.nhs.uk

Competing interests: None declared.