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Archway
Development & Consulting Ltd
54
High Street
Bovingon
Herts HP3 0HJ
Tel 01442 817217
Fax 01442 879647
email
here
Registred in England
Company No 3326461
Registered
Office
C21 Herbal Gardens
9 Herbal Hill
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Consultant Provider Agency 1995-1999
| Consultant Provider Agency: The First NHS Diagnostic and Treatment Centre |
Outpatient Office |
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| This provided NHS outpatient services, based on clinical
governance principles, before the term was invented. We used protocol
and reciprocol contracts to help both the primary care team, and
consultant (specialist) follow patient management guidelines. There is
still a place for this service. |
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- Cheaper than NHS Trust Service
- Developed new Concepts
- Was developing a software system to go on the NHSnet.
- Protocol contracts
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Proforma/Clinical Guideline Contracting for Secondary Care Services.
This is a service that could still benefit NHS Trusts and Primary Care Trusts.
The Consultant Provider Agency ran for three years, and became the
largest private provider in North East London to the NHS. It ceased
trading with the end of Fundholding.
Many of the idea we had were simply ahead of their time. Nowadays we
would have been called a Diagnosis and Treatment Centre. We were
developing systems for e-booking, and involving developing chronic
disease management systems to avoid hospital attendances. The service
and our development programme depended on fundholding so we closed with
fundholding in 1999.
We still have the experience and the concepts. We still hope to restart
the service with NHS Trusts. We still have a team in place.
Below describes how the service was funded until April 1999, during the
Fundholding (Internal Market) era, and how the money went round:
Prices (cost per case) were cheaper (half or a third) than local NHS providers.
We covered all major specialties, including cardiology, psychiatry, general surgery and performed minor operations.
The GP made a referral, sending a patient to the CPA clinic (perhaps via a trust contract), appointments were within two weeks.
The CPA had its own indemnity insurance and the work undertaken by the
consultants come under their own Defence Union Indemnity rather than
The Crown.
It is important that these referrals are not made to a standard
outpatient service, since this is NOT what the Agency provided. We are
developing a patient and disease management, and appointment
administration service.
CPA was a provider, in a modern clinic, but was not a hospital. The GPs
had to 'work the patients up' and provide more test results than some
GPs would normally provide. After an appointment with one of the CPA
NHS consultants, the CPA billed the GP's fund, (sometimes Health
Authority). The GP paid for the service though fundholding, in effect
wrote a cheque, in the form of Fund Schedule 9, to the G.P. fund's
bankers who were the Health Authority, which paid the invoice to the
CPA.
The CPA then paid the Consultant and expenses (such as patient
transport) and also paid the GP for doing the secondary care work,
according to proforma, before and after the referral.
CPA concept gave a unique position of being able to pay the consultant
and the GP for the management of patients. The gives a firm lever on
clinical governance, before that term was invented. The payment system
meant that we could put in place an audit system and insist on the use
of the proforma and protocols as well as testing the workability of
clinical guidelines. The follow up rate with such referrals was very
low, at 1.2 : on follow-up to each new referral (The NHS average has
remained at 3:1 since 1949). This saving in attendances would be
funding the service.
CPA system bought more NHS time of consultants, leaving consultants
less time for non-nhs patients. No private (non-nhs) patients were seen
at our centres.
All inpatient treatments that were required (say for an operation) came
back to the consultants' NHS Trusts such that patients joined shared
NHS waiting lists.
The referral process could be reduced to little more than logging the
patients onto a care management system rather than making a physical
appointment. We were developing the software (referral engine) to
manage the CPA service. The CPA model would then handle the
administration of the patient management, which may or may not require
the patient to attend a centre or hospital at all (e.g. for Chronic
Diseases, such as COAD, or management of specific conditions like
suspicious skin lesions biopsied in practice).
After only 18 months, we were up and running with a service and have
demonstrated that it worked. We had invested large sums in IT so we
could put the referral engine and booking system, on the NHS Net.
The CPA ceased trading because of the new environment of following the
demise of the internal market and fundholding. Also NHS Executive
Letters (ELs) went at the time which almost forbade NHS Trusts working
with the private sector. Politically, at the time, the CPA service was
a problem, as we offered quicker or cheaper services, and that was not
thought to be equitable. The 'Executive Letters' at the time also
imposed a common waiting time policy and all but forbade contracts with
the private sector.
Investment by the CPA until 1999:
Capital investment had been completed, providing equipped consulting
rooms, secretariats, I.T, and minor operations rooms. This service was
up and running with two referral centres. Further investment was made
for services at other centres.
We invested with CASPE Consulting and Research Limited at The Kings
Fund to develop a project to go to the Region, Health Authorities and
Trusts. This project was to test the workability of guidelines and
protocols using the CPA to provide the reciprocal contracts and
outpatient management service then concentrated on developing the
proforma from existing authenticated guidelines.
We invested large sums in writing a Java-based programme that will use
a browser interface that booked (e-booking) patients into a clinics,
monitored the proforma and handled the invoices. The CPA and its sister
company, The Fundholders' Support Agency had all the equipment in place
to provide an Intranet with ISDN connections with its users. With
little investment it could provide store and forward telemedicine.
Now it would use the NHS Net.
Enquiries to
Dr Gerard Bulger here
What followed CPA is here:
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Clincal Governance Contracting
- Lower Follow up rate
- Audit system for G.P. services
- Consultant input into Primary Care
- A Service before its time
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We subscribe to the
HONcode principles