1. THE NEW NHS ARCHITECTURE
A new adventure by Lewis Carroll

2. DH
SHA SHA SHA
PCT PCT Commissioning
GPs

3. NOW - PAYMENT BY RESULTS = ACTIVITY
ce
ch oi
Same price everywhere = tariff
Compete on quality
Increasing throughput = more income

4. NOW - PRACTICE-BASED COMMISSIONING
Commissioning
PCT
Savings to be
invested in
NHS care
These could be private
providers

5. EFFECTIVE
COMPETITION?
WASTE OF
ENERGY?

6. Private Companies
PCTs
LA
DH
Commissioning
Inexperienced
Unkeen
Busy
GPs Excited

7. ANY WILLING PROVIDER
NHS
PATHWAY 3RD SECTOR
CONSO
RTIUM
PRIVATE SECTOR
CHOICE
REFERRAL DIAG TREAT

8. AN INCENTIVE TO OFFER LESS. A CONFLICT OF INTERESTS
consortium
£
------------------------------------------------------------------------------------------------
Consortium
Quality
premium
Paid back to consortium

9. AN INCENTIVE TO OFFER LESS. A CONFLICT OF INTERESTS.
AN OPPORTUNITY TO MAKE MONEY
£
consortium
Company owned by
consortium
Paid back to consortium

11. RISKS TO PATIENTS
• The cuts to the rest of the system
• The effective cuts to the NHS
– 40% management cuts now
• Longer waits
• Disintegration
• Reduced services
• Top-ups
• GP conflicts of interest