Clinical responses to the downturn

14 / 12 / 2010

This joint publication brings together practical recommendations from focus groups with seven specialty medical societies and royal colleges, each of which were asked to suggest ways that clinicians in their own specialties can release NHS resources while maintaining or enhancing quality.

Seven medical specialties address how they can help tackle the NHS financial challenge.

The NHS faces the most prolonged period of financial constraint in its history. In the next four years it needs to find £15-£20 billion of savings at the same time as tackling underlying increase in the costs and demand for healthcare, and managing one of the biggest reorganisations in its history.

This report examines how to release NHS resources across the seven specialties of:

  • neurosurgery
  • geriatrics
  • vascular services
  • pathology
  • orthopaedics
  • neonatology 
  • dermatology

The answers tackle issues with referrals, discharge, follow-up, procedures of low or questionable value, workforce profiles, commissioning, waste, and productivity, among others.

The recommendations will be of use to local commissioners and providers, clinical leaders, policy makers and anyone else seeking to address the most serious period of financial constraint in the history of the NHS.

Download the full report or individual chapters below

Individual report chapters
The British Society of Neurological Surgeons recommendations cover:
Pre-admission clinics
Emergency admissions
Single-use items
Reduction of changeover time in theatres
Other areas of variation in practice
System-wide issues.

Read the neurosurgery chapter.
The British Geriatrics Society recommendations cover:
Geriatrician-led admissions
Geriatric assessment
Advance care planning
Medicines management
Recognition and treatment of delirium
Virtual clinics and telephone consultations
Frequency and expense of litigation
Efficient working practices
Best practice.

Read the geriatrics chapter.

Vascular services
The Vascular Society recommendations cover:
Structure of vascular services nationally
Consultant-delivered care
Discharge planning
Demand management
Outcome-based standards
Procedures of low or questionable value
Theatre overruns

Read the vascular services chapter.

The Royal College of Pathologists recommendations cover:
Intelligent requesting
Workforce profiles and training
Efficiency and productivity
Openness on performance
New developments and molecular testing
Intelligent commissioning
Information technology and disintermediation
Clinical leadership in pathology
Who should do what.

Read the pathology chapter.

The British Orthopaedics Association and the British Orthopaedic Directors Society recommendations cover:
Discharge planning and length of stay
Unnecessary referral
Procedures of questionable value
In-theatre efficiency
System-wide issues.

Read the orthopaedics chapter.
The British Association of Perinatal Medicine recommendations cover:
Non-rational variation in practice
Stronger networks
Demand management
’24 weeks and below’ position
Use of SHOs/junior doctors
Systemic issues.

Read the neonatology chapter.
The British Association of Dermatologists recommendations cover:
Demand management
Technology to triage referrals
Reducing non-attenders
Telephone and non face-to-face consultations
Generic substitution for prescribing
Reducing unnecessary consultations
Other initiatives
Other system-wide issues.

Read the dermatology chapter.

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