A recent paper in the journal Thorax by Amaia Calderón-Larrañaga annd colleagues examined the association between hospital admissions for chronic obstructive pulmonary diseases (COPD) and population and primary health care factors. Hospital admission rates for COPD are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence. The study examined admission rates in 8,064 general practices in 152 English PCTs. Admission rates for COPD were strongly associated with population deprivation and smoking prevalence, whereas healthcare factors such as influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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