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Report criticises NHS reforms

12 June 2008

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Reforms aimed at increasing the number of NHS patients treated in the community have failed to achieve all that was promised, according to a heavyweight study.

The joint Audit and Health Commission report found that only 11% of PCTs were making use of the Choose and Book system for booking appointments despite a 90% usage goal having been set.

Another 31% were underperforming against this target while 58% had outright failed to meet it.

Such evidence suggests “that the challenge of persuading GPs to adopt the new system has been greater than anticipated”.

One of the key goals of the reforms has been to move care out of hospitals and into the community. But the report said this did not appear to be happening on the “scale that was envisaged”, with the numbers of staff in primary care increasing at a slower rate than in hospitals.

The study also called for better collection of data on performance and activity in primary care.

The government stated that, by 2004, consultants who had previously only worked in hospitals would be providing four million outpatient appointments in the community.

However, no data has been collected to measure this, a situation that needs to be “urgently” addressed, the study said. The report also found that patients did not have enough information to comfortably decide where they wish to be treated.

The government’s reforms, which included changes to how GPs commission services and how hospitals are paid for the work they do, are thought to have cost in the region of £1bn since 2004/05.

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“We try because of the DES but it is so often ‘down’ and is invariably time consuming. Our patients tell us they prefer the old system” – Jean Kennett, Isle of Wight