Perverse incentives in the underfunded NHS

The “postcode lottery” for access to spirometry reported by Howard reflects a wider vicious circle in the NHS.1 We undertook spirometry in our general practice, unfunded, as part of good quality care, until the requirements for certification prevented us from providing it. An intervention to raise standards has perversely stopped the care procedure that it was intended to improve. In a primary care setting with restricted funding, best care cannot always be provided. Slightly suboptimal, but safe, service is better than none at all.One response to underfunded suboptimal care in the NHS is to set targets and requirements for compulsory training to improve that quality of care. The local health service provider reaction is to focus on the target to maintain recycled funding and to stop doing procedures when the hurdle for certification and staff time needed is too high. This, in turn, leads to a clamour to ringfence funding…
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