"Does the NHS have money to burn on bureaucracy?"

About: Nottinghamshire County Teaching PCT

(as the patient),

When my wife's rheumatoid arthritis went into good remission, the consultant said "No need to continue with these regular check-ups; instead telephone my secretary to make an appointment if you have any worries."

When a year later she had a worry and telephoned, she was told "the system has changed. You now have to do it through your GP."

That involved a visit to the GP (a waste of his and her time) and a letter to the hospital (another waste of time and money). Then a letter from Principia setting up an appointment (expensive and time-consuming) and yet another letter from the clinic confirming the appointment (more time, energy and money wasted).

What benefits are there from such a cumbersome system? Does the NHS have money to burn on this kind of bureaucracy?

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Response from Helen Limb, Patient and Public Involvement Manager, NHS Rushcliffe Clinical Commissioning Group

Thank you for taking the time to post an opinion about your recent experience.

Wherever possible we do use direct access pathways however for the majority of specialties the system is designed so that when patients are not seen for a period of time in hospital it is a requirement for the patient to be re-referred by their GP.

It is important that we know what is being referred into hospital so that we can manage the budget and validate the activity we are charged for. It also helps us plan future services to meet changes in demand. There are also national targets around waiting times and unless patients are referred via their GP using the national Choose and Book system we are unable to ensure patients receive treatment within the treatment time parameters.

Principia’s Clinical Assessment Service (CAS), we feel adds value to the patient experience, the CAS staff are able to advise patients on a range of hospital that are available for treatment and availability of appointments. For some specialties we have commissioned services in the community the CAS are able to offer these services to patients.

I agree it is frustrating that we have to send out a confirmation letter in the full knowledge that the hospital will also do this, but this system was put in place after some patients failed to attend their appointments as they hadn’t received confirmation from the hospital, this is often due to short waiting times not allowing sufficient turn around for the administration team at the hospital.

We are continually reviewing our systems and are looking in to how we may use text messaging and email to reduce costs in the future.

Once again thank you for your feedback.

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Update posted by stockl (the patient)

In this reply I feel Principia has used a lots of words but has failed to demonstrate that the kind of bureaucracy I described in my letter can be justified.

The priority in the situation I described was the saving of money, time and energy, all of which the NHS has in short supply. But, it seems to me, that Principia’s priority is clearly is different. They seem to be in the business of claiming that long-winded and time-consuming and expensive paperwork is justified.

Response from Helen Limb, Patient and Public Involvement Manager, NHS Rushcliffe Clinical Commissioning Group

I am sorry you feel our response was ‘wordy’. Some processes sound long-winded and time-consuming, however, as all of the funding comes from the NHS and we do need to confirm it has been spent on the right patients, as different parts of the country gets different amounts depending on their populations. I agree that having multiple letters of confirmation can look very bureaucratic, however, these letters do reduce the amount of appointments which are not attended and therefore cut down on the overall waste. 7% of patients do not attend booked appointments, which we realise looks like we are over contacting the 93% who do. NHS Nottinghamshire County are holding sessions across the county called ‘The Big Healthy Debate’ which are aimed at members of the community about the big changes facing the local NHS. The Big Healthy Debate has two main objectives: • To educate local people about why the NHS is evolving, so that they understand the political and financial context for changes that may happen; and • To encourage people to help the transition by using the NHS more appropriately, and taking greater responsibility for their own health. The session in Rushcliffe is on: Tuesday 26th October 10.30 am – 12.30 pm at Rushcliffe Arena, Rugby Road, West Bridgford, NG2 7HY For further details on the Big Healthy Debate, and to play our interactive game ‘Play Your NHS Right’ please visit www.bighealthydebate.nhs.uk
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