Re: Multimorbidity and the inverse care law in primary care
As a GP who has served for 20 years in a population amongst the 5% most deprived in the country, I can confirm that the analysis of this editorial matches exactly with experience on the ground. My professional life could be characterised as the systematic rationing of my time with the persistent feeling that I am regularly (out of necessity) short-changing my patients of professional input.
Unfortunately the current obsession of CCGs with cost (CCG meetings are almost entirely dominated by ways of invoking less secondary care for our patients or by (politically) important matters such as NHS Health Checks which are tangential to our population's actual needs) is already depriving practices with more deprived populations of resources because the differential multimorbidity that exists between practices, which is exaggerated by the choice agenda, is ignored in budget setting. The practices in my CCG cluster who lose out on prescribing incentive schemes are the ones with higher multimorbidity. After years of prescribing reviews, we have now arrived at a point where to be 'good' and stay in budget may require deliberate under-treatment compared with other practices.
Ironically the practices under the most pressure are likely to be the ones the NHS can learn efficient prescribing from but as their 'poor' performance obscures this they are also the most likely to be deemed in need of 'help'.
We urgently need a system of resource allocation for both primary and secondary care budgets that accounts for multimorbidity at the practice level. This should be based on practice derived data (as secondary care derived data necessarily discriminates against the practices who are good at keeping these patients out of secondary care!) GP records are surely good enough to support this as most practices have been claiming payment on the QoF for years on the basis that their records are electronically summarised. The tools for doing this, such as the John Hopkins ACG System, already exist. This approach also solves the problem of nursing home costs that Patrick Holmes refers to.
The Liberal Democrat element of the coalition could do everyone a favour by resisting the retrogressive moves to base funding solely on age.
Competing interests:
No competing interests
30 July 2012
David J Shepherd
GP Trainer and Senior Clinical Research Fellow LNR CLAHRC
Rapid Response:
Re: Multimorbidity and the inverse care law in primary care
As a GP who has served for 20 years in a population amongst the 5% most deprived in the country, I can confirm that the analysis of this editorial matches exactly with experience on the ground. My professional life could be characterised as the systematic rationing of my time with the persistent feeling that I am regularly (out of necessity) short-changing my patients of professional input.
Unfortunately the current obsession of CCGs with cost (CCG meetings are almost entirely dominated by ways of invoking less secondary care for our patients or by (politically) important matters such as NHS Health Checks which are tangential to our population's actual needs) is already depriving practices with more deprived populations of resources because the differential multimorbidity that exists between practices, which is exaggerated by the choice agenda, is ignored in budget setting. The practices in my CCG cluster who lose out on prescribing incentive schemes are the ones with higher multimorbidity. After years of prescribing reviews, we have now arrived at a point where to be 'good' and stay in budget may require deliberate under-treatment compared with other practices.
Ironically the practices under the most pressure are likely to be the ones the NHS can learn efficient prescribing from but as their 'poor' performance obscures this they are also the most likely to be deemed in need of 'help'.
We urgently need a system of resource allocation for both primary and secondary care budgets that accounts for multimorbidity at the practice level. This should be based on practice derived data (as secondary care derived data necessarily discriminates against the practices who are good at keeping these patients out of secondary care!) GP records are surely good enough to support this as most practices have been claiming payment on the QoF for years on the basis that their records are electronically summarised. The tools for doing this, such as the John Hopkins ACG System, already exist. This approach also solves the problem of nursing home costs that Patrick Holmes refers to.
The Liberal Democrat element of the coalition could do everyone a favour by resisting the retrogressive moves to base funding solely on age.
Competing interests: No competing interests