On-call neurosurgery: can this continue as a free service?

Abstract

Since 2005, Acute National Health Service (NHS) Trusts have been funded using a system called Payment by Results. This provides a national or regionally set tariff per patient treated, according to a health resource group code. Health resource group codes vary according to diagnosis or procedures carried out and patient co-morbidities. This only funds trusts admitting patients rather than those advising remotely, as neurosurgical centres do for the majority of emergency referrals. Numbers of referrals and emergency admissions to our unit were analysed for the last 4 years in addition to consultant and secretarial time devoted to these cases. This demonstrated an increase in the number of referrals and time spent advising. For the trust hosting the neurosurgical department, this represents a funding deficit for services offered. In our region, this has been remedied by charging neighbouring trusts a fee for emergency neurosurgical referral advice. However, this is difficult to administrate and would be better served as a service-level agreement with our commissioners. Only when this has been achieved, can neurosurgical centres provide a comprehensive consultant-led emergency service without it being to the detriment of the host trust.

Key words:

• Costs
• cost-analysis
• neurosurgery
• referral pattern

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Note

1.Payment by Results: Preparing for 2005, Department of Health, 2003.

2. NHS reference costs 2009-2010, Department of Health, 2011.

3. Payment by Results Guidance for 2011-2012, Department of Health, 2011.

4. Equity and Excellence: Liberating the NHS, Department of Health, 2010.