Harley Street clinic cheaper for NHS patients.
Faced with a £20m budget deficit in 2007, the Primary Care Trust for Bexley in Kent decided to hand the bulk of the commissioning power to GPs. They now control 70% of the borough’s budget.
With greater control over budgets, GPs in Bexley now offer a better service for patients through specialist clinics such as those in Harley Street. When Peter Aylott aged 67 needed a scan for a heart condition, he expected it would be under his local hospital in Kent, not in a private clinic in London. He said, “We were transported to and from our doorstep to Harley Street, taken into this salubrious place and really treated as if we were a paying patient.”
The Harley Street clinic where Peter Aylott was seen is the first clinic in the country to have a CT scanner that can produce a three-dimensional picture of a patient’s heart with a very low radiation dose.
Dr Chris Harvey, consultant radiologist at the European Scanning Centre is proud of the £1.5m machine. He said, “I think this is the way forward, more GP referrals to specialist centres.”
The costs for Peter’s Harley Street scan was picked up by his local primary care trust in Bexley. However, Peter is not alone in being seen by Harley Street specialist. In the last 8 months, Bexley PCT has sent over 80 patients to the European Scanning Centre for their scans.
The benefits are two-fold, firstly the treatment is less evasive for patients and secondly, each patient sent is saving the NHS money, money that can be used elsewhere. The alternative option for Peter Aylott and patients like him would be to have invasive angiograms at his local NHS hospital in Sidcup, Kent. Having a CT scan is much safer than an angiogram, where one in every 500 patients suffers a heart attack or stroke.
The scan is also cheaper, says Dr Kostas Manis, a GP in Bexley. “The angiogram is £1,300 in the NHS and the private clinic scanner is £900 and we’re negotiating to bring the figure down to £600.”
Dr Manis, who has been instrumental in developing this new scheme has already saved the NHS in Bexley £300,000 in the past eight months.
Talking about his experience at the Harley Street clinic, Peter Aylott said, “You go in for full surgery, they are putting tubes up your leg – there’s always a risk, I’d much sooner have a CT scan, no argument.”
With GPs being given more control over budgets and how it is spent, Dr Manis was convinced there is a better way forward in providing quality patient care, while cutting costs. “The cardiology bill we were receiving from hospitals was astronomical,” he says. Under the community cardiology scheme, which Dr Manis helped to introduce sees patients from GP’s surgeries in Bexley being seen by David Brennand-Roper, a consultant cardiologist from King’s College Hospital, London.
Before this, 95% of patients with cardiovascular problems were referred for tests at the local NHS hospitals. “The PCT was seeing a lot of money spent at hospital on patients who turned out to be remarkably normal.” The solution was longer consultations. Instead of the normal five or 10 minutes consultation, Dr Brennand-Roper sees them for half an hour. “It does seem to work remarkably well and the referral rates have come down to around 10%.”
With schemes like this in operation the GPs get to keep more of the money, but with the big loser being the local Queen Mary’s hospital in Sidcup. Furthermore, with more GPs wanting to refer patients to specialist hospitals and the private sector could pose problems for small district hospitals. “If we see patients in the community there will be problems for hospitals.The difficulty for the hospital in the long term is the shortfall of income,” said David Brennand-Roper.
Dr Manis said, “His experience from Bexley is that the introduction of GP commissioning will mean hospitals and consultants have to radically change. District hospitals have too many managers and too many consultants. GPs are the driving seat and GPs will decide where patients go.”
With changes ahead in the NHS under the government’s proposed reform, more GPs like Dr Manis will be in direct control of how their budget is spent. And with these changes it is GPs and GP locums who are best placed to ensure patients get the best treatment available to them on the open market.
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