Doctors Power, Neither Waxing nor Waning: The changing
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Transcript Doctors Power, Neither Waxing nor Waning: The changing
Doctors Power
Neither Waxing nor Waning:
The changing power of the
omnipresent group
EHMA Annual Conference, Athens, June 2008
M. HEMADRI
MBBS (Madras) FRCS (Edinburgh) MBA (Leicester)
In this presentation…..
Using
Porters 5 forces tool
An analysis of NHS consultants powers
Reveal doctors’ omnipresence in
healthcare
Doctors’ and change: dealing & controlling
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Porters Five Forces
Wikipedia image
Five Forces Analysis assumes that there are five important forces that determine
competitive power in a situation
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Impact of NHS Consultants on
Porter’s Five Forces
Threat of New Entry
High Cost
Tough Regulation
Specialist knowledge
Supplier Power
NHS
Private hospitals
Private clinics
Intensity of Rivalry
Number of players
Quality
Patient loyalty
Threat of substitution
Medical tourism
Telemedicine
Alternative medicine
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Buyer Power
Patients
Private hospitals
Commissioning
Supplier Power
NHS
major supplier
Private hospitals minor supplier
Private individuals very minor supplier
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Supplier Power
What is supplied?
Access pathways
Consultations
Tests
Drugs
Surgery
Follow up
Who really decides?
Single-visit, one-stop,
two-stop, direct to test etc
Five major PPIs
Dozen different hernia
meshes
Frequency, need, type
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Buyer Power
Who
is the real
buyer?
Patient?
Commissioners?
Private Hospitals
Insurance
companies
Patients?
Self pay patient
Waiting list patient
Insurance patient
Cost restraining
buyer power?
Private Hospitals
Buy work
NHS CONSULTANTS
Recommend the hospital for private patients
Go to private hospital for NHS w/l patients
Power to bar
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Barriers to new entry
Cost
Regulations
Limited
specialist manpower
Legal
Impossibility
of introducing radically new
models
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Doctors dealing with reduced barriers
EU
EWTD - Bane
Calman
MMC
PMETB
Non EU recruitment
Government
Driven
changes
INCREASED NUMBERS
Dilution Efforts?
Narrow subspecialisation
EWTD – Boon
New activity
Registration Vs Job
Consultant
Driven
Changes
Consultant inputs
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Balancing Efforts?
Threat of substitutes
THE CHALLENGE
THE RESOLUTION
Physicians assistants
Anaesthesia practitioners
Surgical practitioners
Sonographers
Nurse led clinics
Remote diagnostics
Technology
Patient empowerment
Medical Tourism
Alternative Medicine
Non independent
environment, parallel
service, very limited role,
very limited numbers
Pathology reporting
Radiology reporting
Ethics & Emotion
BMAS
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Intensity of rivalry: LOW
Specialisation
Regional
Cross ‘ownership’ of NHS & private patients
Chambers, cartels, group practice
Dominant NHS
Strong, vocal, respected Trade Union
Strong vocal respected national specialty
associations/Royal Colleges
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Is it that a problem?
Uniformity
Less
of a commercial agenda
Reputation for standards
The
strong NHS shadow on private care
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WHY?
Expertise
Scarcity
Image
Other
What
is in a name? (Employer, employee
or consultant)
Where does the loyalty rest?
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Trainer – Boss Dualism
MBA
IT
Pilots
Army
Engineering
Finance
Teacher/Trainer – Boss - Colleague
Synchronism
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Plan – Execute Dualism
Board – Managers – Workers
MOD – Generals - Soldiers
Plan – Execute Synchronism
NHS
Consultants
Pilots
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Inferences
Doctors
powers are not waxing or waning
Due to their omnipresence in the healthcare
The healthcare industry has changed, doctors
powers within healthcare have changed
Doctors ability to control the changes and the
changed environment remains largely intact
New and innovative management paradigms
may be needed to deal with such unique
groups
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THANK YOU