English treatment centres are treating less complex patients than hospitalsBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4540 (Published 02 November 2009) Cite this as: BMJ 2009;339:b4540
All rapid responses
These findings come as no surprise. The community dermatology service
in which I work was designed to allow easier cases to be managed in the
community where this was appropriate, largely as it was perceived as a
waste of scarce resources for patients with simple conditions such as
'entry level' common rashes and seborrhoeic warts to be refered to
hospital and consume scarce consultant time. The service (*) was set up
co-operatively (initially NHS, later 'privatised' by a GP led consortium)
with input from acute trust, PCT, GP and patient representatives and is
considered to have worked well.
However, where profit alone (rather than local resource matching and
need) is the motive for setting up alternative/competing services, it
seems likely enough that cherry picking of the easy work may take place.
The possible negative consequences of this on training and funding should
have been thought through more carefully before ideologically based market
reforms and competition were imposed on the health service.
This is not, to use a cliche, rocket science. A simple case costs
less to treat. A more complex case costs more to treat. A non-NHS provider
which is mainly motivated by profit will seek to take on as many easier
cases at a profit as possible and avoid the complex cases, just as a for-
profit insurer will seek to sell insurance to as many fit people as
possible and charge more to or reject clients who represent poor risks.
Like most of my colleagues, I am not opposed to private sector
involvement in principle, but as we have seen with the banking industry,
the profit motive alone is no guarantee of best value for money.
(*) Solent Medical Services
works in a private sector NHS friendly community dermatology service
Competing interests: No competing interests