Transcript Heading for new professionalism? Experiences in the NHS

Ruth McDonald
[email protected]
Acknowledgements
 SDO, Department of Health, Commonwealth Fund
 Sudeh Cheraghi-Sohi, Martin Tickle, Martin Roland,
Tim Doran, Stephen Campbell, Steve Harrison, Darren
Ashcroft, Caroline Sanders, Russell Mannion, Keith
Milsom.
Methods
What do we mean by
professional?
‘New’ professionalism?
 Dynamic context
 Changes to incentive structures
 Aligning payment to policy goals
 GP contract & Practice-based Commissioning
(PBC)2004
 Pharmacy contract 2005
 Dental contract 2006
 Policy goals multiple, complex and competing
GP contract
 Self-employed contractors (partnerships)
 Quality and outcomes framework (QOF)
 Contract with practice
 End to OOH
 Software to facilitate delivery
 Negotiated, ballot, own data
 New money, MPIG
Impact?
 Self surveillance
 Surveillance by others (including non doctors)
 Hierarchy
Impact?
 Critical of other practices
 Improvements in other practices
 Acceptance of public accountability
PBC
 GPs act as commissioners
 Elites & rank & file
 New strata
 Surveillance of self & by others
Pharmacy Professional status
• Business vs. public interest
• Control over the substance of work
• ‘Incomplete professionals’ (Denzin & Mettlin 1968)
• Subordinate to medicine
• Increasingly ‘corporate’
• Divisions/ fragmentation
Professional status
 Conflict with business concerns overstated
 Knowledge imbues drug with social significance
 Pharmacists respond to disorder, ‘providing tools for
the sick person to respond to the question “What is
happening to me? What do the disordered senses of
my body mean?”’ (Dingwall and Wilson 1995: 122).
Pharmacy contract
 Contractors
 61% multiples (>5 pharmacies)
 Essential (dispensing)
 Enhanced (smoking cessation, minor ailments)
 Advanced
MURs
 Consultation room
 £28 per MUR
 Max 400 per annum
 Copy to GP & patient
MUR volumes
Professional status
 Targets for MURs
 Tick box MURs
 Home delivery of medicines
 Delegation to other staff
 Competitive market
Dental contract
 End to open ended funding
 End to patient registration
 UDAs
 Band 1 - Diagnosis, treatment planning and
maintenance 1 UDA
 Band 2 – Treatment (e.g. fillings, root canal treatment,
extractions) 3 UDAs
 Band 3 - Complex treatment that includes a lab
element (e.g. bridges, crowns) 12 UDAs
2000 2500 3000 3500
No of
0
extractions vs. year
1993
1997
2001
Year ending March
2009
Treatment band analysis
1100 1300
Clinical dataset
2005
700
900
Our findings are consistent with economic theory that suggests that
500
No of
0
root-fillings vs. year
1993
1997
2001
Year ending March
Clinical dataset
2005
Treatment band analysis
2009
Summary
 a contribution to high levels of attainment of quality
targets and a reduction, over time, in the variation in
care quality related to deprivation in general medical
practice
 increasing volumes of incentivised activities in
community pharmacy
 a shift towards dental treatments which pay more,
relative to effort expended
Many thanks