Intended for healthcare professionals


Improving productivity in the NHS

BMJ 2010; 341 doi: (Published 27 July 2010) Cite this as: BMJ 2010;341:c3965
  1. Albert G Mulley, chief
  1. 1General Medicine Division, Massachusetts General Hospital, Boston, MA 02114
  1. amulley{at}

    Reducing practice variation through better decision making is key

    Since 2008, economic prospects for virtually all countries have worsened. In England, the economic crisis came after a decade of investment in the NHS that nearly doubled public expenditure for improving infrastructure and capacity to deliver services. That spending trajectory is on a collision course with the new pressures on public spending; estimates of the shortfall in NHS funding by 2014 approach £20bn (€24bn, $30bn), roughly 20% of the current budget.1

    In a report published today by the King’s Fund, Appleby and colleagues refine the deficit projections and note some mitigating factors, such as a commitment from the new coalition government to real term increases in NHS funding.2 Nonetheless, they estimate that productivity will need to improve by 3-4% each year until at least 2014 to avoid reductions in service that could threaten the quality of care. The report concludes that productivity could be improved by focusing on clinical decision making in order to reduce variation in clinical practice.

    Appleby and colleagues are not alone in targeting such variation to achieve better delivery of health services. During the heated American debate on healthcare reform, President Barack Obama cited an evocative story about the ethical and economic implications of practice variation and declared, “This is the …

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