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Biomedical subjects

Hugh McLeod

Publications and source records attributed to Hugh McLeod.

6 recordsLinked to original sources
PubMed2003

Booking patients for hospital admissions: evaluation of a pilot programme for day cases.

PROBLEM: NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available. DESIGN: 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate. BACKGROUND AND SETTING: 24 pilot sites in England with relatively short waiting times and some experience of booking appointments. KEY MEASURES FOR IMPROVEMENT: Proportion of patients with booked or "to come in" date during and after pilot programme, proportion not attending for admission, and proportion waiting > or = 6 months. Comparison of pilot sites with non-pilot sites. STRATEGIES FOR CHANGE: National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of 9.9m pounds sterling to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology. EFFECTS OF CHANGE: Proportion of patients with booked or "to come in" date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting > or = 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or "to come in" date than non-pilot sites at end of each period. LESSONS LEARNT: Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors.

Day Care, Medical↗
PubMed2003

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Budgets↗
PubMed2003

Healthcare in Ontario: what has the system learned?

In many ways SARS unmasked some painful truths about our existing system. Throughout the crisis we had to face head-on the unintended outcomes that flow from a healthcare delivery system designed as a series of unconnected silos.

Communication↗
PubMed2002

Hospital bookings. Sticking points.

The proportion of patients with booked appointments for hospital admissions and day-case treatment will have to more than double by 2005 to meet the NHS plan targets. Most patients with a booked appointment liked the system. Implementing a booking system requires considerable commitment from health professionals. The booking targets of the NHS plan will not be achieved without an increase in capacity.

Ambulatory Care↗