Patient care: access
In the fifth of seven BMJ articles on the modernising of the NHS, Healthcare Consultant Mark Murray, looks at delays in access to care and argues that improving access involves determining the demand and applying resources to match it or reduce it.
He suggests a number of principles towards managing demand and gaining capacity - such as clearing system backlogs, reducing the number of queues and predicting future demand - and highlights organisations that have successfully improved access by adopting these approaches. For instance, a primary care group in Alaska significantly reduced patient waiting times by adding extra work with current staff for six weeks to clear their backlogs, ensuring that patients saw their own doctors and enabling doctors to do more with each visit, thereby reducing the demand for care.
By modifying these principles, specialist services can also reduce demand, adds Murray. For example, partnering with their referring primary care groups to clearly define areas of responsibility for care or ensuring that specialists perform only the work that makes them unique in any system, can help reduce waiting times and improve overall clinical care.
Murray argues that these concepts are commonplace in other industries, yet "such thinking is long overdue in health care." He advocates a fundamental system redesign, concluding that "if we don't like the results we have to change the system - basically and radically."
Contact :
Mark Murray, healthcare consultant, 2209 Capitol Avenue, Sacramento, CA 95816, USA Email: murraytant@email.msn.com