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Optimising Consultant Productivity
- Tom J W Lee, A Deepak Dwarakanath (20 September 2007)
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The same Wanless?
- Nadeem E Moghal (25 September 2007)
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It's more productivity we need not more spending
- stephen black (26 September 2007)
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Tom J W Lee, SpR Gastroenterology University Hospital of North Tees, Stockton upon Tees, TS19 8PE, A Deepak Dwarakanath
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In the light of the Wanless report [1], there is an ever increasing pressure on consultants to increase productivity and provide a rapid and responsive service; it is important that every effort is made to optimise efficiency and consultant diagnostic time. We have adopted a system in outpatient clinics whereby the patient’s appointment letter asks them to bring a list of medications, past medical and family history. At clinic, this routine but vital demographic and historical data is collected by a trained outpatient nurse prior to the consultation with a doctor. Thus maximising the time available for the doctor to make diagnostic and management decisions. This makes optimal use of the resources and skills available. If the doctor saves 5 minutes per patient, this may amount to 30-45 minutes per clinic in which more patients can be seen. Time is such a valuable commodity in this era of payment by results and consultant contracts that small changes, such as the one described above, can have a significant impact on the quality of a framed consultation and the quantity of patients seen. 1. Wanless D, Appleby J, Harrison A, Patel D. Our future health secured? London: King's Fund, 2007. www.kingsfund.org.uk/publications/kings_fund_publications/our_future.html. Competing interests: None declared |
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Nadeem E Moghal, Consultant Paediatric Nephrologist and Head of Department Newcastle upon Tyne Hospitals NHS Foundation Trust
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Appreciating we can't all keep a track of all that is written, I was interested to have the following snipets from the Guardian Newspaper forwarded to my inbox. “Northern Rock: Derek Wanless, chairman of the bank's risk committee, whose job was to alert the board to potential credit, interest rate and liquidity risks ……….” “Natwest: Derek Wanless, 59, worked at NatWest for his entire career, working his way up to chief executive. He was jettisoned, however, in 1999 after a series of management mistakes culminating in a failed merger attempt with Legal & General. He joined the Northern Rock board in 2000” It is presumably all about context? Competing interests: None declared |
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stephen black, management consultant london sw1w 9sr
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Chris Ham seems to accept the proposition that we might need to spend more on the NHS to meet future demands. But this is based on the overly pessimistic belief that there is nothing that can be done about productivity (or, as Wanless might prefer "efficiency"--a more narrow concept). Herein is the single biggest weakness of all of the Wanless reports about the NHS: no bottom up analysis of how efficient the system could be. Top down analysis of history leaves anyone pessimistic about the potential to improve efficiency as the story is pretty depressing. And the BMA makes the impossibility of improving productivity in hospitals an axiom of its opposition to reform. But bottom-up analysis tells a completely different story. Big improvements in productivity (by big I mean 50%-100% not the handfuls of percent of Wanless) are possible. Those of us who look at how things are organised in hospitals know this well. But so do the Medics who care: see John Petri's article in this journal (BMJ 2007;335:210-211 (28 July), doi:10.1136/bmj.39282.619641.4E) or the book "Better: a surgeon's notes on performance" by the American surgeon Atul Gawande. When you know that big improvements in efficiency are possible, the conclusions should be different. The big question should be "what stops potential efficiency gains being achieved?" The answer--and the keystone of much recent health reform--is incentives. Much of the old NHS was riddled with perverse incentives that, if anything, rewarded the less efficient (John Petri nearly doubled surgical prodictivity and found his rewards to be a pat on the back, indifference from colleagues and a loss of his private patient income). The key reforms of Patient Choice and provider competition go some way to creating the right incentives for those in charge of provision. Chris Ham is, however, skeptical about the key reforms possibly because he too has not grapsed the scale of improvement that ought to be possible in efficiency. But the long term effect of the reform programme on incentives is the best hope for the future of the NHS. The biggest threat is probably the schizophrenic approach of Government to implementing reform. Competing interests: management consultant working in UK health |
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