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Commissioning
Abstract Submissions - Survey category

Dear Editor
Re: Commissioning - one head of the hydra (May 2009)

Objectives like "highest quality at lowest cost" are surely virtually meaningless. The devil is as always in the detail.

In my area of specialisation, substance misuse, commissioning, led by the recently formulated special health authority the NTA, has reached a nadir, but can in no way be said to have achieved anything like "High quality". What you do get is lowest common denominator services, run on a shoestring by third sector organisations, with poor staff, little commitment to task where the job - as seen by commissioners - is to measure performance against some arbitrary quality standard which actually tries to synthesise a needs led delivery model, but where recognisable quality falls through the punched holes of the quality manuals.....

Any bottom-up innovations and best practice developed are usually killed at birth. If perchance it survives inception, the attempt to measure, write up and replicate so deforms the initiative as to make it practically undeliverable.

Howard Coulson
Floating Support Worker
Guinness Care and Support, Havant

Dear Howard

Neither I as an individual nor the BGS as an organisation are apologists/propagandists for "world class commissioning". The era of big strategies and NSFs and targets from the centre with additional earmarked funding is coming to an end and so there is a presumption from government that the key to better services is the use of better local strategic needs assessment and planning and prioritisation. Hopefully the metrics commissioners use to monitor provider performance will be ones which meaningfully reflect the patient experience and are not merely a box ticking exercise. Also, hopefully there will be some realisation that getting the care right for, say patients with dementia, multiple long term conditions or falls, could provide gains not only for older people themselves but also for the whole system by avoiding unnecessary or too-late hospitalisation, long-term care etc. As with any other health service reform it will inevitably have unforeseen consequences, both good and bad. And of course in reality, there is finite resource for health and social care (likely to get tighter still in 2011) so there will always be prioritisation/rationing, either overt or covert by commissioners. There is plenty of evidence that older patients with common, debilitating but "unglamourous" conditions have generally had a raw deal even though they account for over 60% of hospital bed days and 60-70% of health and social care spend. Getting their care right is the key to the whole system and looking after them well is not necessarily more expensive than looking after them badly. it could be argued that for a long time much less commonplace problems, generally affecting younger patients supported by powerful advocacy groups have had a disproportionate share of investment.

David Oliver

Dear David

Re Abstract submissions to BGS Scientific Meetings - New Clinical Effectiveness Survey Category (BGS News May 2009, page 13)

I cannot help thinking that no wonder so many abstracts are getting rejected. Within the allowable 230 words there are so many requirements to fulfil before you even begin to describe the results, interpretations and conclusions! Abstracts for conferences are abstracts and no more than that, they are not posters in their own right. It is most unusual even in abstracts for published papers to discuss response rates, bias, evidence base, pilot studies etc. If this is a requirement then submitters need more words to play with.

I also think a false distinction is being drawn between surveys and audits that really is not necessary. Surveys (whether of databases, providers, patients or carers) often have internal and external standards, while audits are often conducted by surveys of databases – in fact almost always in primary care these days.

Of course the BGS should set whatever standards it sees fit but I can’t help wondering if setting the bar so proscriptively high has something to do with the lower numbers attending and may result in the Society missing valuable pieces of practically relevant work that might appeal to a wider range of healthcare professionals?

Just a suggestion!

Jon Bayly

Dr Danielle Harari (Chair, CPEC) responds:

Thanks for your helpful comments. Regarding clinical effectiveness abstract guidance, when abstracts under this category were first introduced a few years ago, there was a strong steer from both the new CPEC and A&R committee to set standards guiding authors on what is acceptable for a national meeting and for potential abstract publication in A&A. Initially submissions were invited as audit, guideline development or systematic review, but criteria have since grown organically in response to the broader scope of abstracts being submitted. 'New Practice Development' (a popular subcategory with AHPs) was introduced, and now the Survey subcategory. The reason for the detailed guidance on what makes a good survey (and really, we do not expect every one to meet them all!) is that we are still getting quite a number of small scale local surveys of the type that would be appropriate for, say, a departmental practice review meeting, but not for a national meeting. With clinical audit, we have observed that by firmly sticking to guidance of including practice change strategy and re-audit cycles, the messages from abstract submissions have grown in strength and generalisability. Finally, you are not the only one to have highlighted the length and detail of the many pages of instructions for abstract submission...these will be edited down for next deadline.

BGS Newsletter, July 2009
Issue 22 ISSN 1748-6343 22