Most primary care trusts will have to “raise their game” if they are to survive changes in the system for paying doctors, says the author of a report from the Audit Commission.
The message comes as primary care trusts move towards a “payment by results” system—paying doctors for work done according to a set tariff, taking into account regional variations in cost and complexity of individual cases.
The report attacked primary care trusts over their “inadequate” financial management capabilities, adding that some NHS bodies would “struggle to meet these new challenges.”
Emma Knowles, the author of Achieving First-Class Financial Management in the NHS , said, “The situation is okay, for now, but it’s time for NHS trusts to get their house in order. They have to make sure staff know their responsibilities and their accountability. Finance departments don’t always have control over how most of the money is spent—this is normally down to the clinicians and management.
“Payment by results will be the biggest change in how the system works. Trusts with extra expenses, like a lot of sick patients or new buildings, will have to have a look at how other trusts manage. Financial management is weak in some primary care trusts. A lot of them don’t have staff with the necessary skills.”
Andy McKeon, the Audit Commission’s managing director of health, said that the payment by results system would bring news risks and complications.
“For trusts, there will be a premium on knowing their costs and there will be an increased need for risk planning and management.
“At the moment, data are not always accurate. Case diagnoses are not being entered into computer systems because there is no incentive. In future, if a trust doesn’t have a case diagnosis, they can’t charge for it.”
An earlier report published by the Audit Commission this March showed that 41% of doctors surveyed who were involved in the validation of clinical coding agreed with the statement, “The information on the trust’s IT systems is often inaccurate.” The report also found that in 62% of trusts, IT managers said that no clinical staff attended data quality meetings.
Calling on doctors to have a greater financial awareness and involvement, Mr McKeon added: “In general, the non-executives on boards of primary care trusts and NHS trusts need to get a grip on financial management.”
The report states that “NHS bodies need to act now to improve their financial management arrangements.” It looks at financial management in the NHS, and at the improvements that NHS bodies may need to make to survive under the new payment by results system and the move towards patients having more choice in their health care.
Nigel Edwards, director of policy at the NHS Confederation, told the BMJ : “PCTs have a management problem. This is down to a lack of people with the right finance skills. A public perception of the NHS is that it’s full of managers, but in reality we are extremely short of managers. One way of improving this situation is by sharing resources, including finance directors.”
The report is at www.audit-commission.gov.uk/