Postcode rationing in prescribing must be eliminated, Professor Sir Michael Rawlins (chairman, National Institute for Clinical Excellence) said on February 28 delivering the 17th Wallace Hemingway memorial lecture at Bradford university.
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Sir Michael Rawlins: the least said about the NHS internal market the better |
In North America the main health care providers, health maintenance organisations (HMOs), provided clinicians, nurses and pharmacists with mandatory management protocols. Deviations from the protocols could only be made with HMO approval.
"This is not a way in which most of us would wish to work," Sir Michael said.
Market forces had also been tried in an attempt to improve quality, with little effect. Introducing an external market in the United States had not led to better quality of health care in comparison with the UK. And as for the internal market, that had been introduced to the NHS and Sir Michael felt that "the least said about that the better".
Virtually every developed country in the world was struggling to find a solution to the problem of quality in health care, he said. However, simply removing health care professionals who were poor performers, while obviously important, would do little to improve the overall quality of health care. Given the fact that the majority of professionals were somewhere between poor performers and exemplars he saw the real challenge as ensuring that the average moved up.