Obamacare means nurses taking the place of doctors

Health care reform that focuses on fixing health insurance without dealing with the chronic and growing shortage of primary care physicians is likely to encounter “Massachusetts style growing pains” unless nurse practitioners are fully involved in health care reform, according to University of Miami President and former Secretary of the U.S. Department of Health and Human Services (HHS) Secretary Donna E. Shalala, Pennsylvania Governor Edward G. Rendell, and other experts brought together today by the American Academy of Nursing (AAN) and its “Raise the Voice” (RTV) campaign.

Shalala, Rendell and the others agreed that “Nurse-Managed Health Centers” – an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations – will be a vital ingredient in any plan to increase the capacity of the nation’s health care delivery system. The good news is that these nurse practitioner-led facilities are a “solution in plain sight” that already has been tested in Pennsylvania and 40 other states. Today, there already are over 250 Nurse-Managed Health Centers across the U.S. providing assistance to millions of Americans. It is estimated that these existing health centers could be expanded to reach over 20 million Americans, a significant number of the estimated 46 million Americans without health care insurance.

Experts have expressed great concern about the nation’s supply of primary care physicians, and their ability to meet the needs of patients throughout the United States. The current downturn in the number of primary care physicians is likely to increase during the next 20 years, resulting in a shortage of as many as 44,000 physicians in the fields of general internal medicine and family medicine by the year 2025. Advocates of nurse-led care point out that while the current acute physician shortage is only projected to worsen in the coming years, the number of advanced practice nurses will rise significantly.

The implications for health care reform of the doctor shortage could be staggering. In Massachusetts, for example, passage of a universal insurance plan has overwhelmed the system’s existing supply of primary care physicians. As of 2008, only 52 percent of internists in Massachusetts are accepting new patients. In the face of acute primary care physician shortages and steady reductions in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of a universally insured nation.

University of Miami President Donna E. Shalala, former Secretary of the U.S. Department of Health and Human Services (HHS) and Chair of the Advisory Committee of the Robert Wood Johnson Foundation funded “Raise the Voice” campaign of the American Academy of Nursing, said: “While increasing access to health insurance will help improve access to health care, our nation’s health care crisis cannot be solved by insurance alone. Enhanced nurse practitioner involvement in primary care has the potential to dramatically increase access to health care, improve care for patients with chronic diseases, and improve the efficiency of the health care system, all by maximizing the use of our existing health care resources. One option – Nurse-Managed Heath Centers need additional federal funding. Just as important, nurses need a seat at the table when true reform is being debated.”

Pennsylvania Governor Edward G. Rendell said: “The ‘Prescription for Pennsylvania’ experience, which two years ago focused on implementing innovative, non-physician models of heath care in the state has been nothing short of a major success. Our chronic care and patient centered medical home model, provides high quality health care to tens of thousands of patients that otherwise would find it difficult to access and pay for these services. By next month, we expect 400 primary care practitioners to be involved in four learning collaboratives, transforming chronic care for more than 750,000 patients. Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising heath care costs and ensure greater access to heath care.”

National Nursing Centers Consortium Executive Director Tine Hansen-Turton said: “Our nation’s 250 Nurse-Managed Health Centers are community-based, non-profit health centers that are staffed and run by advanced practice nurses (primarily nurse practitioners). They represent an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations. These health centers are positioned to significantly expand the capacity of our nation’s overburdened health care delivery system in a cost-effective and affordable way, but their true potential remains untapped. These centers can provide the foundation for real health care reform that will work, serving tens of millions of additional families across the United States.”

Independence Foundation President Susan E. Sherman noted: “Philadelphia may be the future vision of health care reform in the United States. Because we believe in the model’s potential, the Independence Foundation has invested millions of dollars in 12 Nurse-Managed Health Centers that provide primary care, health promotion, and disease prevention services. These Nurse-Managed Health Centers help clients manage current health problems, detect potential health problems, and reduce the risk of future health problems. We are proud of our support of this innovative model of care, but our support is not enough to sustain these centers. We need federal funding to bolster private sector support.”

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NHS spent £350m on management consultants

They could have hired a lot of doctors and nurses for that

The NHS paid £350 million to management consultants in England last year, according to figures released today. The Royal College of Nursing said that the spending — the equivalent of 330 fully staffed 28-bed medical wards, 9,160 experienced staff nurses or 267,647 bed days in an intensive babycare unit — was "utterly shocking”.

About £273 million of the money was not related to patient care, said Peter Carter, the RCN chief executive, who obtained the figures through freedom of information legislation. The bulk of the money was spent on increasing competition in the health service and supporting bids for foundation status by NHS trusts, he added. “These figures are utterly shocking when you consider the difference that this money could have made to patients,” Dr Carter said.

“A very significant sum of money is clearly being spent on setting up competition in the NHS and pursuing foundation status, rather than being invested in patient care. You only have to look at what happened at the Mid Staffordshire NHS Foundation Trust to see the consequences of this.” A report earlier this year into up to 1,200 deaths in Mid Staffordshire criticised the trust board for being more interested in attaining foundation status than caring for patients.

The RCN believes that the total spent on management consultants in 2008/09 may be higher, as more than 40 per cent of the NHS organisations which it contacted did not provide details of their spending.

Reducing the amount spent on management consultants could deliver 11 per cent of the £2.3 billion savings demanded from the Department of Health in last month's Budget, Dr Carter said. “Before the Department of Health and local health trusts look at cutting frontline services, training budgets or new facilities, they need to look very carefully at the money spent on external advice and what value is added to the patient experience,” he said.

“When some individual management consultants are getting more than £1,000 a day to advise on finance, we must surely be able to afford improvements to the quality of patient care. “Savings in this area could contribute a huge proportion of the savings to be made by the Department of Health, without jeopardising patient care."

According to the the RCN, 39 per cent of the money spent on management consultants was allocated to market testing designed to help providers and commissioners identify the most profitable options in the NHS market. Twenty-three per cent was used to support applications for foundation status, 13 per cent to achieve “provider separation”, and 12 per cent to buy advice on the Private Finance Initiative.

The Department of Health said: “Individual NHS organisations decide how best to invest their resources to ensure local people get the best possible care and services. We expect organisations to consider value for money and patients’ interests in all aspects of their expenditure. “All spending and investment is subject to independent audit — £350 million equates to less than half a per cent of total NHS expenditure for the last financial year.”

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