Efficiency, the NHS's panacea

Why is the NHS so hopelessly overspent? The accountant's answer is that the NHS is very labour-intensive, it has a huge workforce and many of its workers have recently received large pay rises.

This is all very true, and very appropriate, too, because for far too long the NHS paid its staff peanuts. So how can it save money? The secret is to enable staff to work more efficiently.

It is here that hospitals, many of which are badly overspent, need to look at general practice. Primary care is without doubt the most cost-effective part of the NHS, largely because any unnecessary expenditure hits the GP's pocket directly. We have a vested interest in delivering healthcare efficiently so we work with only the numbers of staff we need.

Practices usually have just one manager, giving effective management input while minimising its cost. And we are computerised, more so than hospitals, whose IT is hopelessly outdated.

When practices go paperless, they soon discover how few staff they need.

Working paperlessly reduces the time and effort spent delivering notes to the clinician's desk and filing them again afterwards. There's no such thing as a lost record, and lab results are available within seconds.

Imagine the savings that hospitals would achieve if they too went fully paperless. No longer would there be hordes of filing clerks or time wasted in locating the records when a patient has been discharged from inpatient care, only to be re-admitted as an emergency to a different ward two days later.

Clinicians in outpatients wouldn't wait for notes. Casualty officers would have a vastly easier job when obtaining a history from forgetful, incoherent or seriously ill patents, and tests would no longer need repeating because the results had been lost.

Records and X-rays 'in transit' are by definition useless. The savings from paperless working are potentially enormous, not just in the cost of handling, storing and transporting patient records, but in the ease and speed of their acquisition and the more efficient use of precious medical and nursing time.

For far too long hospitals have been the dinosaurs of an efficient health service, packed with high-tech medical equipment, yet with unbelievably low-tech support. For the NHS to function cost-effectively this must change, and change quickly.

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