Specialist Health Services within the New NHS



Problems have long been associated with the provision of specialist health services, including securing equity in access, ensuring adequate provision and the financial viability of providers, developing new services and avoiding unnecessary service duplication. However, the introduction of the internal market within the NHS has raised additional concerns. Providers of specialist services are experiencing problems in contracting with multiple purchasers, and purchasers have been faced with unpredictable high-cost extra-contractual referrals (ECRs). The change towards capitation funding is moving funds away from districts with specialist providers and the reorganisation of health services within London and other major cities threatens the very existence of some hospitals providing specialist services (Tomlinson, 1992; Thompson, 1993). Reports by specialist committees have highlighted actual and potential problems for specialist services within the new contracting environment and have drawn attention to the need for appropriate contractual arrangements (CSAG, 1993; BPA, 1993).


Specialist Service Tertiary Referral Specialist Provider Specialist Health Service Multiple Purchaser 
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  1. BPA (1993) The Care of Critically Ill Children, Report of a Multidisciplinary Working Party (London: British Paediatric Association).Google Scholar
  2. Chamberlain, M.A., and A. Tennant (1991) ‘Health Service Reforms and Access to Specialist Services’, British Journal of Rheumatology, 30, 322–4.CrossRefGoogle Scholar
  3. Challah, S., A.J. Wing, R. Bauer, R.W. Morris and S.A. Schroeder (1984) ‘Negative selection of patients for dialysis and transplantation in the United Kingdom’, British Medical Journal, 288, 1119–22.CrossRefGoogle Scholar
  4. CS AG (1993) Access to and Availability of Specialist Services, Clinical Standards Advisory Service (London: HMSO).Google Scholar
  5. Dalziel, M., and C. Garrett (1987) ‘Intraregional variation in treatment of end stage renal failure’, British Medical Journal, 294, 1382–3.CrossRefGoogle Scholar
  6. DoH (1989a) Working for Patients, White Paper CM555 (London: HMSO).Google Scholar
  7. DoH (1989b) Funding and Contracts for Hospital Services, Working for Patients Working Paper 2 (London: HMSO).Google Scholar
  8. DoH (1989c) Contracts for Health Services: Operational Principles issued under EL(89)MB/169 (Department of Health).Google Scholar
  9. DoH (1990a) Contracts for Health Services: Operating Contracts, issued under EL(90)MB/24 (Department of Health).Google Scholar
  10. DoH (1990b) Contracting for Tertiary Referrals, EL(90)194 (Department of Health).Google Scholar
  11. DoH (1990c) Charging for Extra-Contractual Referrals, FDL(90)7 (Department of Health).Google Scholar
  12. DoH (1992a) Guidance on Extra Contractual Referrals, issued under EL(92)60 (Department of Health).Google Scholar
  13. DoH (1992b) Tertiary Referrals, EL(92)97 (Leeds: Department of Health).Google Scholar
  14. DoH (1992c) Review of Contracting — guidance for the 1993–94 contracting cycle, (Leeds: Department of Health).Google Scholar
  15. DoH (1993a) Guidance on Operation of Notification Arrangements for Tertiary Extra-contractual Referrals, HSG(93)8 (Leeds: Department of Health).Google Scholar
  16. DoH (1993b) Progress towards Weighted Capitation, FDL(93)20 (Leeds: Department of Health).Google Scholar
  17. DoH (1993c) Contracting for Specialised Services, EL(93)98 (Leeds: Department of Health).Google Scholar
  18. DoH (1993d) Managing the New NHS (London: Department of Health).Google Scholar
  19. Donaldson, L.J. (1992) ‘Maintaining excellence: the preservation and development of specialised services’, British Medical Journal, 305, 1280–4.CrossRefGoogle Scholar
  20. Duley, J.A. (1993) ‘No charge for unique service’, British Medical Journal, 306, 1543.Google Scholar
  21. Forsythe, M. (1993) ‘Commissioning specialist services’, British Medical Journal, 306, 872–3.Google Scholar
  22. Goldberg, D. and G. Jackson (1992) ‘Interface between primary care and specialist mental health care’, British Journal of General Practice, 42, 267–9.Google Scholar
  23. Heinemann, A.W., G.M. Yarkony, E.J. Roth, L. Lovell, B. Hamilton, K. Ginsberg, J.T. Brown and P.R. Meyer (1989) ‘Functional outcome following spinal cord injury’, Archives of Neurology, 46, 1098–102.CrossRefGoogle Scholar
  24. Lewis, P. (1993) ‘Cash crisis puts babies’ lives at risk’, The Observer, 29 August 1993.Google Scholar
  25. Mihili, C. (1993) ‘Doctors “fail to refer cancer patients to specialist centres“’, The Guardian 1 December 1993.Google Scholar
  26. Moore, W. (1992) ‘Health chiefs fear crisis over neonatal ECR bills’, Health Service Journal, 102, 4.Google Scholar
  27. Mullen, P.M. (1986) ‘Funding of Supra-Authority Services’, Public Money, 6, 55–8.Google Scholar
  28. NHSME (1993a) Good Practice and Innovation in Contracting (Leeds: NHS Management Executive).Google Scholar
  29. NHSME (1993b) Contracting for Specialised ServicesA Practical Guide, issued under EL(93)98 (Leeds: NHS Management Executive).Google Scholar
  30. SRSAG (1992) Annual Report for the period ending 31 March 1992 (London: Supra Regional Services Advisory Group).Google Scholar
  31. Thompson, M. (1993) Review of the Research and Development Taking Place in the London Postgraduate Special Health Authorities, A Report by the Review Advisory Committee (London: HMSO).Google Scholar
  32. Tomlinson, B. (1992) Report of the Inquiry into London’s Health Service, Medical Education and Research (London: HMSO).Google Scholar
  33. Williams, A. (1990) ‘Ethics, Clinical Freedom and the Doctors’ Role’, in A.J. Culyer, A. Maynard and J.W. Posnett (eds), Competition in Health Care: Reforming the NHS (London: Macmillan).Google Scholar

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© Penelope Mullen 1997

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