Introduction: Increasing numbers of patients are being treated outside traditional NHS hospitals as part of GSup (General supplemental funding) projects and other initiatives to reduce waiting lists. Concerns regarding these arrangements include case mix at NHS hospitals, quality of clinical care and patient satisfaction.

Null Hypothesis: There is no difference between overall patient satisfaction following treatment within the NHS, as part of GSup or as an independent private patient.

Methods: Patients undergoing total hip arthroplasty by a single consultant were contacted 6 to 18 months postop. 3 groups were formed; those treated in the local NHS hospital, patients treated as part of GSup and private patients independently financed.

A previously validated patient satisfaction questionnaire was completed by each patient. This investigates satisfaction with admission, environment, healthcare professionals, treatment, leaving hospital and overall care. Fisher exact test used to compare groups for significant differences in responses, significance was assumed at p< 0.05 level.

Results: 144 of 202 patients responded. Though generally high overall levels of satisfaction were reported, areas of concern were identified, particularly regarding cleanliness of hospital, the availability of nursing staff, maintenance of patient confidentiality and communication with patients. In all cases the GSup patients reported significantly higher levels of satisfaction compared with the NHS patients. 12% of NHS patients felt their overall care fell below “very good” compared with 0% of the GSup patients (p< 0.05).

Discussion: Significant differences are identified between NHS and GSup patient satisfaction regarding hospital environment, healthcare professionals and overall standards of care. There were few differences between GSup and private patients treated in the same environment but where they did occur they were universally more positive for the GSup patients.

Conclusions: Concerns that GSup patients may be less satisfied with their care appear unfounded; in general they were better satisfied than NHS patients.

The purpose of this study is to evaluate the effectiveness of current surgical management of pelvic acetabular fractures providing insight into the outcomes of fractures treated operatively using validated scoring systems.

20 Patients were surgically treated over a 2 year period at the Hudders field Royal Infirmary Hospital, United Kingdom. All were operated on by a single surgeon following pelvic and acetabular fractures. The first part of the study consisted of a review of the clinical records and x-rays done by 2 different observers. All the pelvic fractures were classified according to the Young-Burgess classification, and acetabular injuries according to the Letournels classification. The notes were assessed for probability of survival on admission and ‘ISS scoring’. The clinical records were reviewed for post operative complications, a protocol for follow up management, involvement of HDU, and any relevant re-admissions. The second portion of the retrospective study consisted of patient reviews at the clinic, the minimum being 6 months post operatively. Recent x-rays were reviewed for bone healing, heterotrophic ossification and avascular necrosis. The patients wound healing was assessed. Clinical results were recorded using the Oxford Hip score and the SF-36.

The results were analysed whilst ISS scoring varied from 8–32 with most of the patients. All patients had a good reduction and fracture healing. Complications noted were wound infection in 5%, and heterotrophic ossification in 5%. There were no nerve palsys, no DVT or pulmonary embolus, and no patients had avascular necrosis of the femoral head. Most patients had returned to near normal activities, with low pain scores. The Oxford Hip score ranged between 12–25, and the SF-36 score between 80 & 100.

The authors concluded that patients with complex acetabular fractures can be managed effectively in a district hospital set up. Osteoarthrosis of the hip can be avoided if an anatomical reduction is achieved.