Martin Roland Comments from the UK on 2012 Commonwealth Fund Survey “It’s good ……but ….” twitter.com/cchsr

Electronic medical record usage High rates of utilisation (97%), highest for ‘multi- functional’ use – e.g. most GPs will now get lab results downloaded to the EMR the same day …. but …. Continued problems of integration with specialist care Major problems of integration with social care

Waiting to see a specialist UK has finally got on top of this – 28% now report barriers – equal to US and bettered only by Netherlands and Switzerland Evidence that targets (especially associated with penalties) can work …. but ….. Guaranteed two week wait for suspected cancer has not resulted in earlier presentation of cancer to specialists

Access to primary care We are now ‘average’ for patients being able to get a same or next day appointment … but …. Our improvement in this (which had a financial incentive) was at the expense of patients being able to book ahead Patients also find it harder to see their own doctor Example of an unintended consequence of an incentivised performance indicator

Nurse case managers for serious chronic conditions We are now no. 1 (78%) …. but …. Little evidence that case managers have reduced unplanned hospital admission, and some evidence that they may have led to increased admissions Much easier to improve quality than to reduce cost

Feedback on clinical quality We are now no. 1 for clinical outcomes (84%) and patient satisfaction (84%) …. but …. financial incentives are not a magic bullet. They may have some effect combined with other quality improvement initiatives but may have unintended consequences little impact of feeding back patient satisfaction scores (including making scores publicly available)

Conclusions In the UK, we are doing “OK” …. but ….. there’s a long way to go the government continues to invest in primary care England is giving 70% of the hospital/specialist budget to consortia of GPs which will do something ….. but we don’t know what ……. twitter.com/cchsr