The latest issue of ‘Pulse’ magazine reports that NHS hospitals have cut acute beds by 10% in just three years “as managers pile pressure on GPs to manage complex cases in the community”. The figures have been released in response to a Parliamentary question.
Minister Ben Bradshaw said that the decrease in beds was the result of “dealing with patients more efficiently” and more people being treated in primary care. However, despite promises from the Department of Health “there has been no accompanying shift in funding from secondary to primary care”.National Audit Office figures show that the value of healthcare services commissioned by PCT’s has risen by 11% since 2005 for secondary care but by only 6% for primary care.
In contrast with Bradshaw, the Chair of Camden and Islington LMC accused PCT’s of cutting costs and leaving GPs to pick up the pieces. “It’s a rolling door. Every single day GPs have to see patient who have been hurtled out of hospital too quickly. Every single Friday the local hospital is on an emergency beds system and we are fighting to get our patients accepted. We are under pressure continually to manage patients at home”.
Dr Jonathan Fielden, chair of the BMA consultants’ committee, said funding cuts meant specialists were relying on already stretched GPs to pick up the slack.
“While we have hospitals with this limited capacity – as we saw this winter – we will have more delays in getting patients in and we will be much more reliant on our GP colleagues to look after patients a bit longer and take them that little bit earlier,” he said.
Pulse reported in October last year there had been a rise in emergency readmissions as hospitals sought to decrease bed-days and follow-up appointments and shift work to GPs. Figures showed a 12% leap in emergency readmissions over the first three quarters of 2007.
GP’s have been offered financial incentives to cut referral rates of patients to hospitals. Pulse reported: “Take GPs in Torbay, where the PCT is offering practices payments of around £8,000 per thousand patients, if they meet its targets to reduce spiralling hospital activity. Practices can earn maximum points if they achieve an 8% reduction in GP referrals, bring down the number of emergency bed days by 4% and pull off a 10% reduction in admissions for a huge array of acute and chronic conditions, ranging from COPD, heart failure and diabetes complications via dental problems through to influenza and ENT infection. The coup de grace though is the unfortunately worded section which offers GPs top points for ‘increasing the proportion of all deaths that occur at home by 4%’.”
When the NHS is more and more being operated on a commercial basis, with the obligation to break even every year, then it is no surprise that trusts are cutting costs, and that includes bed numbers.
Martin Wicks 