ruth mcdonald [email protected]. acknowledgements sdo, department of health,...
TRANSCRIPT
Ruth [email protected]
AcknowledgementsSDO, 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 contextChanges to incentive structuresAligning payment to policy goals GP contract & Practice-based
Commissioning (PBC)2004Pharmacy contract 2005Dental contract 2006Policy goals multiple, complex and competing
GP contractSelf-employed contractors (partnerships)Quality and outcomes framework (QOF)Contract with practiceEnd to OOHSoftware to facilitate deliveryNegotiated, ballot, own dataNew money, MPIG
Impact?Self surveillanceSurveillance by others (including non
doctors)Hierarchy
Impact?Critical of other practicesImprovements in other practicesAcceptance of public accountability
PBC GPs act as commissionersElites & rank & fileNew strataSurveillance 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 statusConflict with business concerns overstatedKnowledge imbues drug with social
significancePharmacists 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 contractContractors61% multiples (>5 pharmacies)Essential (dispensing)Enhanced (smoking cessation, minor
ailments)Advanced
MURs
Consultation room£28 per MUR Max 400 per annumCopy to GP & patient
MUR volumes
Professional statusTargets for MURsTick box MURsHome delivery of medicinesDelegation to other staffCompetitive market
Dental contractEnd to open ended fundingEnd to patient registrationUDAsBand 1 - Diagnosis, treatment planning and
maintenance 1 UDABand 2 – Treatment (e.g. fillings, root canal
treatment, extractions) 3 UDAsBand 3 - Complex treatment that includes a
lab element (e.g. bridges, crowns) 12 UDAs
05
00
700
900
110
01
30
0In
terv
entio
ns in
tho
usa
nd
s
1993 1997 2001 2005 2009Year ending March
Clinical dataset Treatment band analysis
02
00
0250
0300
0350
0
Inte
rve
ntio
ns in
tho
usa
nd
s
1993 1997 2001 2005 2009Year ending March
Clinical dataset Treatment band analysis
Our findings are consistent with economic theory that suggests that
No of
extractions vs. year
No of root-fillings vs. year
Summarya 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