NHS pressures – future trends

British Medical Association

BMA warns that unless urgent action is taken, millions more patients will be waiting for longer than 4-hours for treatment in A&E, and there will be dramatic rises in number of people waiting on trolleys for treatment, or at home for non-emergency elective procedures.

Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

Hospital-Community Partnerships To Build A Culture Of Health

This compendium features detailed descriptions of hospital-community partnerships from across the United States that have made substantial improvement addressing priority health needs in their communities | American Hospital Association

Image source: AHA

These hospitals and communities vary in location, service type, type of partners and degree of partnership. All participated in Learning in Collaborative Communities, led by the Health Research & Educational Trust and supported by the Robert Wood Foundation.

Priority needs that the featured hospital-community partnerships are addressing include:

  • Chronic disease management
  • Health care access
  • Mental and behavioral health
  • Obesity
  • Preventive health practices
  • Social determinants of health
  • Substance use disorders
  • Violence

Partnerships are important because individuals and organizations share valuable insights, tools and resources. Lessons learned from successful partnerships motivate other partnerships to implement effective strategies in their organizations. The case studies in the compendium describe effective partnerships and programs to create a Culture of Health, their impact and lessons learned.

Read the full report here

The NHS must embrace digital services or risk being left behind

Online services are challenging our model of primary care – the NHS must find a way to incorporate new approaches into the mainstream |story via The Guardian


Writing in today’s Guardian, Richard Vize discusses how Online services are challenging our primary care model. People unable to take half a day off work for a few minutes’ consultation are using digital technologies in large numbers. The article goes on to claim GPs in clinics need to respond, with consultations conducted remotely if that is the patient’s choice.

The author suggests that the whole principle of list-based general practice will be called into question as healthcare is increasingly accessed via smartphones. Thousands of doctors are already working for online services; the NHS needs to find a way to incorporate this approach into the mainstream of care. The article concludes arguing that soon the first channel for delivering primary care will be digital, not clinics. The NHS needs to embrace this or be left behind by the private sector.

Full story at The Guardian

Improving quality of care through partnerships and collaboration

Partnerships for improvement: ingredients for success | The Health Foundation


The idea of partnerships and collaboration across organisational boundaries is at the heart of NHS reforms in England. This briefing from the Health Foundation looks at what makes successful partnerships between providers at an organisational level, providing a snapshot of some of the key ingredients needed for successful partnerships.

The report looks at a range of current organisational partnerships focusing on five different partnering arrangements. It also includes interviews with national leaders, and draws learning to help inform and guide policymakers and providers.

The report finds that partnering does have potential benefits, but these are not easy or quick to achieve. To have a meaningful impact on the quality of care, the right form of partnering needs to be used in the right context and it needs to be accompanied by the right set of enabling factors – as described by the report.

Full briefing: Partnerships for improvement: ingredients for success

Related: Health Foundation blog: Is together always better? How good are NHS organisations and the wider system at achieving the potential benefits of partnering?