Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Serious threat to private practice?
- Dinesh Verma, Los Angeles, California 91007, USA (26 September 2003)
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Much Ado About 'Do and Go' ...
- Joseph .C. Obi (27 September 2003)
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Re: Much Ado About 'Do and Go' ...
- Gordon N Gillespie (2 April 2004)
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Analysis of oranges and lemons? Productivity in Treatment Centres.
- Mr Simon P Kelly, FRCOphth (8 January 2005)
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Dinesh Verma, Associate Professor of Ophthalmology Doheny Eye Institute, DEI-3611, Los Angeles, California 91007, USA
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I agree with John Elston's comments that the awarding of waiting list contracts to a private company is a "serious threat" but I totally disagree with his further implications. It is not a serious threat to NHS but a serious threat to the private practices of NHS consultants that thrived because of their long NHS waiting lists. By giving these contracts the government has confirmed it's commitment to reducing the waiting times for NHS patients notwithstanding the lack of support from NHS consultants. While I sympathize with the NHS consultants who are asking for a better pay scale for the services they provide, I cannot condone the hypocrisy of those who exploit the system to their personal benefit. It is high time that these consultants decide if they wish to serve their NHS patients or come clean and sit in their chambers to provide services to their private patients. With the awarding of these contracts they can say goodbye to "best of both worlds" scenario that they have enjoyed for so long. Competing interests: Author has resigned from NHS and is available for contract work by private companies |
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Joseph .C. Obi, Chief Consultant WellnessClinics.co.uk
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Very many thanks for your recent 'Call-To-Arms'. Your noble comments are 'exceedingly well taken'...and will be duly placed in the 'appropriate file'; for 'future administrative reference'. Now...Let's all get back to the major business of the day: URGENTLY BRINGING DOWN TOTALLY UNACCEPTABLE NHS HOSPITAL WAITING LISTS...IN A SAFE , SPEEDY, EQUITABLE, ACCESSIBLE , CONSISTENT AND COST-EFFECTIVE MANNER. Comprenez-Vous ? Very soon, the European Commission will hopefully ratify long overdue legislation, which will generally allow Doctors who are registered in any EU country to fully practise in another EU country for roughly 120 days per year...without any additional registration formalities. What this simply means is that (for approximately 120 days) any 'GMC- Registered Doctor' could gleefully waltz into Luxembourg to earn 'Oodles of Euros' for a few months...and literally 'Do and Go'; without the 'GMC equivalent' in that exceedingly rich country ever even knowing he was there in the very first place. The very same proposed scenario would also obtain with other European Doctors wanting to work in the UK. Ecoutez Bien... This 'standardization' will therefore almost certainly be seen as an exceedingly welcome move by the European Commission; as it will thankfully go a very long way in levelling the 'therapeutic playing field' ; and also gradually improve fundamental access to high quality healthcare facilites throughout the whole EU sub-region. Most of the doctors who will staff these new Diagnostic and Teatment Centres (DTC's) in the UK will be sourced from the millions of European Doctors who care to excercise this pending '120 Day Licensing Waiver'...and as such there will literally be no 'extra strain' on the NHS whatsoever. End Result: More EU Doctors + Better Foreign Management = Shorter UK Waiting Lists. D'Accord...? The very same licensing waivers will also apply to EU Nurses ... Physiotherapists ... Pharmacists ... OT's ... etc Mais...Je Crois... The only problem here is that a few 'alarmingly greedy' and 'outrageously xenophobic' organizations within the UK ...together with their 'highly impeccable poodles'; are putting their own weird 'financial and socio-political gains' before basic patient satisfaction. If a foreign company has commercially developed a fantastic 'Do and Go' network of DTC's...which is staffed through a perfectly legal 'Do and Go' policy from the headquarters of the EU; then perhaps it's now time for any self-centred harbingers of 'DTC hatred' to daintily 'Do and Go' too. Competing interests: Dr Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants. |
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Gordon N Gillespie, SpR Trauma & Orthopaedics Royal Gwent Hospital NP20 2UB
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Sirs, While I agree that the current state of the NHS waiting lists is utterly unacceptable, I would wish to provide an alternative view on DTCs and their impact on the NHS from an orthopaedic standpoint. Firstly removing the majority of straightforward primary arthroplasty cases from the NHS waiting lists will inevitably skew the outcomes of the surgery for surgeons within the NHS by virtue of the increased proportion of complex cases within their workload. From a trainee's perspective, with the diminishing hours available for our training with the EWTD and the new proposals in Modernising Medical Careers, causing further loss of "training cases" such as straightforward primary arthroplasty would have a disastrous impact on our training. Thirdly, in an environment where we are increasingly accountable for the long-term results of our operations, a centre where transient surgeons who will not be responsible for follow-up on a long-term basis of these operations is potentially opening a very litigious can of worms. In my view, the funding earmarked for such centres should be placed in providing better NHS facilities and in adequately training our own surgeons to have a long-term solution to the waiting-list situation rather than a "quick-fix" which will further take resources away from where they are needed Competing interests: None declared |
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Mr Simon P Kelly, FRCOphth, Consultant Ophthalmic Surgeon. Bolton Hospitals NHS Trust. BL4 OJR
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Dear Sir or Madam. Aspects of a recent UK Department of Health (DH) publication on Treatment Centres might benefit from critical analysis. (Ref 1) In considering surgical productivity of Independent Sector Treatment Centres (ISTCs), utilising overseas visiting ophthalmic teams in mobile facilities, section 28-29 states 'In 2002-03, the National Health Service (NHS) in England carried out more than 270,000 cataract removals in 141 different providers. This equates to about five cataract removals per provider per day, which contrasts with the 39 cataract removals per day in the mobile cataract units'. (Ref 1) This calculation may be iniquitous as ophthalmologists in NHS Trusts do a lot more besides cataract operations. In calculating cataract ‘productivity’ it appears that the DH divides the 270,000 annual cataract operations by the 141 hospital Trusts and then again by 365, yielding 5, as the operation numbers per Trust per day. However as NHS Trusts are not staffed to carry out elective cataract surgery 365 days per year this methodology is erroneous. The Secretary of State for Health Dr John Reid may have bemused matters further on the BBC Radio 4 Today broadcast on January 7th 2005 by suggesting that surgeons in NHS Trusts were only doing 5 operations per day while surgeons in the mobile units perform 39 operations per day. (REF 2) The wisdom of performing 39 operations per day (ie 1 cataract procedure every 12 minutes given an 8 hour working day, without breaks) merits reflection, if indeed accurate. The accepted target for cataract surgery is approximately 2 cases per hour for non- teaching patients. (REF 3) More time and care is needed for training and or for complex cases. Patient safety must remain paramount. Many NHS ophthalmology units have already modernised and streamlined their practices. (REF 3, 4) The Royal College of Ophthalmologists have responded to this recent DH publication (REF 5). This debate will continue as UK health policy makers favour continued expansion of the ISTC programme (REF 1) whereas many clinicians argue that local hospitals should be adequately funded to allow them to provide local services safely based on clinical priority. (REF 2,5) REFERENCES 1 Department of Health Treatment Centres: Delivering Faster, Quality Care and Choice for NHS Patients. London 2005. http://www.dh.gov.uk/assetRoot/04/10/05/24/04100524.pdf 2 Interviews with Dr Paul Miller, British Medical Association and the Rt Hon Dr John Reid, Secretary of State for Health, BBC Radio 4 Today programme. 7th Jan 2005. http://news.bbc.co.uk/1/hi/health/4153067.stm 3 Department of Health. Action on cataracts – Good Practice Guidance. NHS Executive. Feb 2000. http://www.dh.gov.uk/assetRoot/04/01/45/14/04014514.pdf 4 Royal College of Ophthalmologists. Cataract surgery guidelines 2004. London 2004 http://www.rcophth.ac.uk/scientific/docs/cataract04.pdf 5 Royal College of Ophthalmologists. Response to the Department of Health's press release and publication on Treatment Centres London. 7th January 2005 http://www.rcophth.ac.uk/about/press.html Competing interests: Member of Council, the Royal College of Ophthalmologists and also Clinical Speciality Advisor, the National Patient Safety Agency. These views are my own. |
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