Specialist physician productivity: An effective measure for NHS

Abstract: The founding principles of the NHS England, NHS Scotland, NHS Wales and the affiliated Health and Social Care in Northern Ireland were the provision of comprehensive, universal healthcare which is free at the point of delivery without based on the ability to pay.  The NHS systems are 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services. About 10% of GDP is spent on health and most is spent in the public sector. The 2008/9 budget roughly equates to a contribution of £1,980 per person in the UK. The 2018/2018 NHS England budget was about £ 114.6 Billion.

Fundamentally, productivity represents the level of output produced for a given level of inputs. Some scholars define productivity as the effective output or quality output produced by the allocated amount of inputs. Theoretically, the productivity could be enhanced by the reducing the wastes, maximizing the output of the existing inputs, reducing the inputs for the current level of output or improving the output of given level of inputs. However, healthcare productivity is assessed in various terms as physician productivity, healthcare institution productivity and health system productivity. 

Physician productivity is the level of healthcare output produced by the physicians for a given level of inputs such as staff, infrastructure, medical equipment and infrastructure. This basic definition implies that the validity of a productivity assessment will depend on the corresponding validity of one’s specification and measurement of all relevant inputs and output(s). Conceptually, physician “productivity” is the result of a physician’s labor. It is a measure of the physician’s work or output.

Physician productivity measured in different health systems depends on the objective of the measurement. For example, in United States Medicare health system physician productivity is measured to remunerate the physicians while NHS implements various performance targets and indicators to improve the financial efficiency of the Trust hospitals hence enhanced productivity. In NHS Trust hospitals, the physicians are being paid a fixed salary with variable component for on-call and emergency services provided. On the other hand, they must follow the standards and guidelines provided by the NHS England, National Institute for Health and Care Excellence (NICE), Care Quality Commission and other relevant organizations.  Some of these targets include referral to treatment target (RTT), a maximum four-hour wait in A&E from arrival to admission, transfer or discharge, Ambulance response times, New cancer waiting time standard and waiting time standards for mental health services. Therefore, the physicians employed in the Trust hospitals have a limited capacity to cater the services as they are bound to provide services according to the set standards.

It is seen that various treatment targets have been set by the NHS organizations in order to cover the financial target and improving the Trust hospital productivity. But this managerial decision should be considered in a broad perspective as the ultimate objective should be to improve the productivity of the NHS. Some management decisions implemented January 2011 has shown that the decision taken in-favour of increasing hospital income by altering the “new to follow-up ratio” has resulted in reducing the health outcome of the patients while increasing the burden on the NHS health system. Some studies have shown that improving number of patients seen (efficiency) could hinder the quality of care and measuring   productivity without regard to quality or value is a risky foundation for wise policy.  The NHS faces major hurdles and is engaged in innovations such as foundation trusts; the new, performance-based contract for general practitioners; a massive investment in information technology; and some dabbling in health care imported from offshore organizations. These innovations are far more consequential than changes in the type of productivity reported by the Office of National Statistics (ONS), and they need to be carefully managed, treated as social experiments, adjusted as time passes, and assessed objectively. Their proper assessment requires that policy makers rely not on simple, potentially misleading metrics of numerical throughput but rather seek answers to the tougher and far more important question of value for money. The people of the UK should be not asking, “How many events for the pound?” but rather, “How much health for the pound?”.

Therefore, the NHS organizations should carefully apply the physician productivity concept in the hospitals as it could lead to the negative productivity in wider sense even though it shows that it would improve the performance of the Trust hospitals.

Keywords: Physician Productivity, Patient Satisfaction, Staff Satisfaction, New to Follow-up Ratio.

Title: Specialist physician productivity: An effective measure for NHS

Author: Somaratne CJK, Fernando DJS

International Journal of Recent Research in Commerce Economics and Management (IJRRCEM)

ISSN 2349-7807

Vol. 9, Issue 2, April 2022 - June 2022

Page No: 110-115

Paper Publications 

Website: www.paperpublications.org

Published Date: 14-June-2022

DOI: https://doi.org/10.5281/zenodo.6641356

Paper Download Link (Source)

https://www.paperpublications.org/upload/book/Specialist%20physician%20productivity-14062022-2.pdf