Shifting the focus upstream. Are thinking and doing going the same way. A Thought experiment

Jim Mcmannus has already blogged in this space. 

Here’s another spin of the dice – in a slightly different direction.

The intention of many plans is to shift ££ upstream towards a proactive and preventive model, often predicated on greater emphasis toward social care and primary care.

Of course this is good, you’d expect me to say this

Often the ambition comes with pictures. Here’s a picture from a plan I’m familiar with.

Its probably ambitious!  



What about current spending. This pic is taken from CCG Accounts (my rubbish graph)

We  spend £85m on primary care contract.

(Of note, we spend more on drugs in primary care than doctors. One might question whether this balance might be shifted if we truly want to achieve more value.)
Here is a little thought experiment…..Using the data from the Hobbs paper in the Lancet

Hobbs et al Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14 –
And specifically Table 1 –

Which gives crude consulation rates

51,013 consults per 10,000 person years
 So for sheffield – assuming that Hobbs holds in sheffield (obviously big assumption) there are 600,000 people (Im keeping the maths simple)

So 60 * 51,013 consults in a year 3,060m primary care appointments

Or £27 per contact



I’ve two questions 

1. How many individual contacts are there for the £480m we spend in the hospital system

2. what’s the trend in investment in primary care as a share of the total, looking back over the accounts. This is the acid test of whether we are putting our money where our mouth has been over the last 15 years or so.
Lastly, as picked up by Mark Gamsu over the weeekend, a GrantThorntonUK analysis of 200 #NHS orgs annual reports focus moves away from prevention 
Subtle, but there nonetheless. 

Yes times are tough and there are immediate pressures that must be addressed.
I’ve no doubt the analysis can be improved 

I’ve no doubt the reality is harder to nail than just a bit of data

Of course it’s difficult. There are here and now demands to meet, and not enough resources for those. Also the world works in short term financial and electoral cycles. However, if that was always the prevailing issue it’s worth reflecting that we wouldn’t now have a park system, or a drain system. So maybe a bit more long term investment mentality needed??

Our aspirations remain great. Without some rather difficult changes they remain in danger of being that – aspiration.


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