Outcomes AND activity based commissioning

Outcomes based commissioning is the way your healthcare will be funded tomorrow. It makes a lot of sense. Get all the medical staff together and pay them only is what they do makes a difference. That way, they can work out between them whose input is most valuable and when.

In truth, most health outcomes depend very little on medical science. Whether you take amoxicillin for your cough or simvastatin for your raised cholesterol isn’t going to make much difference compared to your 20 a day smoking habit and your household income.

So if we’re going to integrate, let’s amalgamate all budgets with the potential to benefit health. You’ll have a hard time finding a budget that does not. Let’s get all that money together and find the best way to help people live healthily for longer.

However, within that system, let us pay people for the work that they do. In particular, pay GPs for each consultation they undertake,

That way, if I as a GP spend time advising someone on their housing needs, I will be paid for my time. However, it is likely that it would be more cost effective for them to speak to their housing officer, and so the integrated system should do all it can to ensure that people in need of housing advice reach their housing officer first.

Similarly, someone understandably distressed after the breakdown of their long term relationship, might be encouraged to contact the psychological treatment service, Relate or perhaps a faith leader.

Even those with an problem likely to resolve without medical intervention, such as a viral illness, might be encouraged to take advice from a trusted family member or friend - or even the internet - and accept the small risk that the first diagnosis they receive might not with hindsight be 100% accurate. Within the context of either honesty or finite resources, this is in any case the only possible conclusion.

GPs might be nervous that their role be usurped by others. They need not. There is no shortage of dire medical need.

GPs might respond by requiring more consultation time for each condition. With modern IT, the solution to this is simple: cap funding to that appropriate for the anticipated consultation time for each new diagnosis.

In summary, outcome-based commissioning has the potential to drive integration only if components within each system are paid for their activity. Why base a person's livelihood on outcomes beyond their control?