Archive for June, 2009

Patients may have legal right to GP access in extended hours

Posted on June 30, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 29 June 2009

Patients could be handed a legal right to access a GP in extended hours, under plans set out by prime minister Gordon Brown. Brown

Building Britain’s Future, published on Monday as Mr Brown sought to outline his vision for the country, sets out plans to give patients a series of legal rights.

The document says: ‘We will give patients enforceable rights to high standards of care, including hospital treatment within 18 weeks, access to a cancer specialist within two weeks and free health-checks on the NHS for people aged 40 to 74.’

But it adds that several other areas could also be made subject to legal rights: ‘At the same time we will look closely at where we can go further to establish new rights, for example to NHS dentistry, to evening and weekend access to GPs, to an individual budget for those with long-term or chronic conditions and whether we can create a right to choose to die at home as further progress is made in implementing the end-of-life care strategy.’

nick.bostock@haymarket.com

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Darzi to switch focus from GPs to consultants

Posted on June 30, 2009. Filed under: GP-led health centres, News stories |

Healthcare Republic | 30 June 2009

Health minister Lord Darzi has signalled that hospital consultants will be the focus of the next phase of his reforms of the NHS. Darzi

Lord Darzi said the 115 new ‘Darzi centres’ opened so far had ‘revolutionised’ GP access but the DoH has no plans to increase the number of practices open from 8am until 8pm and offering walk-in facilities.

It is now up to PCTs to decide if more needs to be done to improve access rather than the DoH, said Lord Darzi.

Under his latest plans, hospital consultants will be made accountable for budgets in an attempt to drive up efficiency in acute trusts.

The health minister has launched a report into the progress made since his review of the NHS, High Quality Care for All, was published a year ago.

‘There are three areas that I felt we can really push more from, for example clinicians in hospitals having control of their budgets.

‘It’s people like me and my colleagues who incur the biggest cost to the health service. How can we be more in control of those budgets but also be accountable for those budgets?’, Lord Darzi asked.

tom.ireland@haymarket.com

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BMA leader calls for end of ‘ludicrous’ NHS market

Posted on June 29, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 29 June 2009

The DoH must put an end to wasteful commercialisation of the NHS to protect resources as public funding cuts loom, the BMA chairman has said. 2B7D89E3-A69D-0589-636D7D4EF3A907F8

Dr Hamish Meldrum told the BMA’s annual representative meeting, which began in Liverpool today, that ministers should not shy away from u-turns on policies that had failed.

He called on the NHS to ditch costly management consultants, drop the use of private finance initiative (PFI) funding, and end the ‘ludicrous, divisive, expensive experiment of the market in healthcare in England’.

He added that NHS leaders should not listen to ‘siren voices’ calling for a shift to social insurance-based funding for UK healthcare.

‘It would seem particularly perverse that, just as it appears that President Obama wants to move away from that discredited system, some in the UK should be arguing that we move further in that direction,’ Dr Meldrum told the conference.

nick.bostock@haymarket.com

Meldrum urges Goverment to end market-led NHS reforms 

Pulse | 29 June 2009 | By Gareth Iacobucci

BMA chair Hamish Meldrum has urged new health secretary Andy Burnham to put a stop to the Government’s controversial market-led reform of the NHS.

Speaking at the BMA’s Annual Representative Meeting in Liverpool, Dr Meldrum appealed to the secretary of state to abandon the Government’s obsession with competition, and called for an end the ‘wasteful bureacracy’ of the market.

He said the looming financial hardship facing the NHS required a total rethink in priorities, and said there had never been a more pertinent time for the Government to review its commercialisation agenda.

Dr Meldrum also attacked the huge sums spent on external management consultants in the health service, as recently revealed by Pulse, and urged all delegates to sign up to the BMA’s anti-commercialisation campaign in solidarity.

‘We must look at how we can use scarce resources more efficiently, where we can cut out waste and unnecessary expense,’ he said. ‘The best advice of all Andy? End the ludicrous, divisive, expensive experiment of the market in healthcare in England.’

‘Never has there been a better time to abandon the wasteful bureaucracy of the market. Never has there been a better time for the various parts of the NHS to cooperate rather than compete.’

Dr Meldrum added: ‘You can cut out the waste and inefficiency of hiring expensive management consultants to try and solve the ills of the NHS. We can tell you what’s wrong with the system and we come a damn sign cheaper than McKinsey’s or KPMG.’

Meldrum’s keynote speech in full

Pulse | 29 June 2009

BMA chair Dr Hamish Meldrum delivered his keynote speech to the BMA’s Annual Representatives’ Meeting this morning. Here is his speech in full.

Welcome to Liverpool.

Last year we were in Edinburgh, the city of my birth. This year it’s Liverpool, the city that, for so many of my generation, provided the iconic musical and cultural background to our formative years.

I was tempted to toss a few Beatles’ song titles into my speech to see how many of them you might recognise but I was worried that the only one that might keep coming up was “Help”!

In any case, this is not a time to be dwelling on nostalgia, since I fear that the NHS and the profession are facing some of the biggest and most serious challenges ever, as we move from a period of sustained growth in resources to one of, at best, stagnation in funding, and at worst, stringency, hardship and even cuts, in our health service.

That, combined with a tainted and hamstrung political system, a devastating loss of public trust and confidence in politicians as a result of their perceived greed and corruption, and a government and a Prime Minister who, rather than leading, simply seem to be clinging onto power, does not make for a happy state of affairs. However, as I hope to point out, even the bleakest times bring with them possible sparks of optimism and opportunity.

But first, I want to pay tribute to all those who have supported me through another challenging year for the BMA – my deputy chairman, Kate, the other chief officers, and colleagues in the various committees of the BMA and, of course, the wonderful staff of the BMA. With them, the job is still difficult, but without them it would be absolutely impossible and I’d ask you to join with me in thanking them warmly for all their hard work and support.

I also want to apologise, in advance, to my colleagues in Scotland, Wales and Northern Ireland, that so much of what I am going to say is particularly focussed on the health service in England. In saying that, I’m not assuming that everything is hunky-dory in the Celtic nations but what I will say is, if you think you’ve got problems, you should see ours!

Before the world financial crisis hit last autumn, the BMA year began with the usual varied collection of issues and problems.

For our junior doctors, the difficulties of MMC and MTAS, though not completely resolved, had been largely replaced by the expressions of unpreparedness, by some, for the impending introduction of the European Working Time Directive. Whilst none of us in the BMA have ever underestimated the challenges and difficulties that the EWTD presents, we had decided early on that one solution which wouldn’t work was simply to stick our heads in the sand and hope that it wouldn’t happen!

Another solution we didn’t believe in was to cross our collective fingers, legs – and any other bits – and hope that, when it did happen, everything would be all right.

The BMA has worked tirelessly to try to ensure that this important piece of health and safety legislation can be implemented, yet, at the same time ensuring that we can protect the quality of junior doctor training and protect the safety and the quality of the care we give to our patients.

That means looking at the length of training, how we train, the apportioning of time between training and service, the selective and controlled use of the individual opt out and of derogation and the planned expansion of consultants in certain key areas.

There can be no excuse for those trusts that have spent the last decade dragging their heels. Our doctors deserve better and our patients must not be let down.

With leadership and cooperation – a theme I will be coming back to later – these problems can be overcome and I commend the work of Andy Thornley and his colleagues for the commitment they’ve given to this difficult task.

For our medical students, along with their ongoing worries about ever-mounting debts, came concerns about potential changes to the selection process into the foundation programme. Furthermore, the economic climate has set back hopes of widening access to medicine, adding new barriers to aspiring doctors wishing to pursue a career in medicine.

For their teachers, the medical academics, we have been dealing with the repeated threats to funding and to contracts as universities and deaneries try to balance their books. Yet I applaud the fact that their commitment to the profession, to their students, and to health care, never wavers.

For SAS doctors, there were the continuing delays and other problems – certainly in some parts of all four countries – about the implementation of their long-awaited “new” contract. For these doctors, who contribute such a vital role to our health service, such recognition is long overdue and the continuing delays are not acceptable.

GPs, having at last received a very modest increase in resources after three years of cuts, were hit by the seriously flawed patient experience survey which changed the basis on which their performance was judged and rewarded.

For their consultant colleagues, it was worries about the future of their hospitals – particularly in London – and that changes to the provision of services were being carried out simply for political or financial reasons rather than for good clinical ones.

Of course, the BMA itself is not immune to the effects of the recession but despite that, we are always trying to improve the services we provide to our members. In addition to looking at the quality of these services, we have continued our policy of increasing support for members in the regions and, if our regional coordinator pilots prove successful, will hope to roll these out during the coming year.

But this needs money, your money, and we can only make these improvements if we look for savings in other areas.

On the professional side, the BMA fought off the insidious Clause 152 of the Coroners and Justice Bill which threatened to derail the good progress that had been made on electronic patient records and confidentiality. Let’s hope that the new Home Secretary will not try to reintroduce that one!

In addition, we have pushed forward our continuing campaigns on a variety of public health issues including smoking, alcohol and climate change.

I know that some of our members wonder why we get involved in matters such as climate change, claiming they are not part of our core business, but if even half of what the experts say about this problem are to be believed, the threat to our health and that of our children and grandchildren could well be greater than HIV, malaria and pandemic flu put together and if that isn’t a reason for getting involved, I don’t know what is.

The BMA will continue to campaign on this issue, both separately and with others – at the same time doing everything we can to put our own house in order and trying to practise what we preach by reducing our own carbon footprint.

I mentioned pandemic flu and I certainly don’t underestimate the potential problems that this is causing and could cause in the future. So far, the preparations we have made and that the BMA has been closely involved in, have worked quite well, though there have been some problem areas usually when local trusts think they can do better by departing from national guidance.

I want to commend all the work that has been done but, particularly, that of Peter Holden in the GPC and Richard Jarvis from our public health committee. There has also been great support from Frank Wells and the Retired Members Forum, who have worked tirelessly to produce a list of our retired doctors who would be ready and willing to help out in an emergency.

As yet, we haven’t seen how well the UK will respond to the effects of a full-blown pandemic, but what I can say and where I can reassure the public, is that, whatever the crisis, you can rely on the doctors of the UK to step up to the mark.

Earlier this year we had the scandal of mid-Staffordshire and also the case of Margaret Haywood, the nurse who was struck off by the Nursing and Midwifery Council for taking part in a whistleblowing, Panorama programme. Now whilst I am not going to comment on the rights and wrongs of an individual case – particularly one which is under appeal – what I will say is this.

Such cases send out completely the wrong message to those health professionals who might want to speak out about unacceptable conditions in their workplace.

They also say a lot about the target-driven culture that has infested the NHS in recent years and that seems to put financial outcomes for trusts above clinical outcomes for patients.

I make this pledge today. The BMA will support any member who, through the proper channels, including the BMA, speaks out about unacceptable standards of care in the NHS. We have already produced guidance for our members and, through askBMA, have a dedicated advice service on whistleblowing. We will not tolerate a substandard service for our patients and we will not tolerate a culture of muzzling or bullying of our staff.

Revalidation is something that will affect all doctors and it’s something which, if properly implemented, can benefit both patients and the profession. The key is in the phrase “if properly implemented”.

We must ensure we have a system that has been tried and tested and is essentially the same in all four countries of the UK.

We must ensure we have a system which is equitable and fair to all doctors, irrespective of their area of practice or type of employment.

We must ensure we have a system that has minimal bureaucracy and doesn’t end up with half the profession chasing round the country revalidating the other half.

Above all, we must ensure we have a system that is properly resourced, both in terms of the individuals who will have to undertake it and the service that will have to implement it.

Let there be no doubt – the BMA supports revalidation for doctors, but not at any price.

I want to return to where I started – the financial and political crisis that is facing our NHS, how it may affect you but, more importantly, what we can do to minimise the impact on the working lives of doctors and the care of our patients.

From the profession’s point of view, there is no doubt that there are going to be those who want to put pressure on our incomes, the medical workforce and our pensions.

Whilst we should be realistic and not expect inflation-busting pay rises and an infinite expansion in medical manpower, I can assure you, that we are not going to allow doctors to be the scapegoats for the failures of the politicians or the bankers.

Last year, when we were an integral part of the conference on the role of the doctor, it was clear just how important and, indeed, how unique the role of the doctor is, the distinctive contribution we make to the delivery of health care and how crucial we are to the NHS. Whatever the problem is, cutting back on doctors is not the answer.

On a wider level, the profession is ready to work with whichever governments are in power, to look at the hard choices, to make the tough decisions but on the basis of evidence, fairness, equity and trust, not just as apologists for another round of failed policies.

And there will be hard choices.

But first, we need to do everything possible to protect the healthcare budget and not concede that swingeing cuts are either inevitable or necessary. But I know, and I think you know, that the days of plenty are over and that, above all we need to be honest with ourselves and, even more so, with the public about what the likely funding is going to be for healthcare over the next few years and to debate, with them, the difficult choices that will have to be made.

For too long they have been promised, as The Guardian journalist Polly Toynbee observed recently, “Scandinavian-style public services on US-level tax rates”.

But that doesn’t mean that we change the basis on which our NHS is funded.

We must resist the siren voices who claim that, by moving to an insurance-based system of funding, we will make the NHS either better or fairer. There is little evidence that such systems reduce demand; they are certainly more expensive to operate and it cannot be argued that they are fairer than raising money from general taxation.

However a health service is provided, one way or another, the public pays. In a system of social solidarity, which is one of the founding principles underpinning our NHS, taxation based on the ability to pay must be the fairest, the simplest and the best answer.

The epitome of insurance-based medicine is the US. It would seem particularly perverse that, just as it appears that President Obama wants to move away from that discredited system, some in the UK should be arguing that we move further in that direction.

Already some of Obama’s critics – on both sides of the Atlantic – are lining up to protect their commercial interests and trying to convince him that he should not try to change the US healthcare system. With exorbitant medical bills being the biggest cause of bankruptcy in the USA and at the risk of being presumptuous, I have just three words of advice to give to president Obama about US health reform; “Yes you can!”.

And here’s another reason we don’t want to move to an insurance-based system. Even with the much more generous mix of state provision and private insurance that they have in Australia, when I was there last month, I passed several people begging in the prosperous streets of Melbourne and Sydney with placards stating that they could not afford their medical bills. Conference, I NEVER want to see that on the streets of the United Kingdom!

But there are things that we can do to improve the quality of care for our patients and to try to reduce increases in demand.

First, we need to vastly improve the outcomes’ data for the services we provide. What drives quality in clinicians is knowing that they are doing a good job – even that they’re doing it better than their colleagues!

Second, we must look seriously at the issue of service redesign to provide care more efficiently. I know that will worry some of you and that you will think we are dancing to the government’s tune. No way! I’m talking about difficult decisions but ones that are made for evidence-based, clinical reasons not purely for political or financial expediency.

Third, we need to put a much greater emphasis on lifestyle services to reduce morbidity and hence need.

Fourth, it’s imperative that we adopt a healthy ageing strategy to reduce the dependency of the elderly population and narrow the gap between healthy life expectancy and overall life expectancy.

Just as with tackling climate change, we need a whole-system and across-government approach to improve the health of the public, with every citizen involved from the prime minister, downwards – or upwards, depending on your point of view! Only that way will we slow the inexorable rise in pressure on our National Illness Service and cope with the financial and clinical challenges that lie ahead.

Of course, none of these alone will solve the problems for the NHS and we must look at how we can use scarce resources more efficiently, where we can cut out waste and unnecessary expense.

So what nuggets of advice do I have for England’s new Health Secretary? Well, here’s a few for starters.

Andy, you can cut out the waste and inefficiency of hiring expensive management consultants to try to solve the ills of the NHS. We can tell you what’s wrong with the system and we come a damn sight cheaper than McKinseys or KPMG!

Second, Andy, you can cut out the waste and inefficiency of the Private Finance Initiative. A recent analysis by the University of East Anglia reckoned that the government could save £2.4 billion – yes £2.4 billion – if it bought out the private finance contracts in the NHS. Yet what do we see – the ludicrous spectacle of a government giving taxpayers’ money to private companies so that they can fund PFI contracts to build our public hospitals!

All because Gordon Brown wanted to keep public spending off one part of his balance sheet so that he could deliver on his golden rules. Well, like so many things with this government, the gold has turned to dust and the public and the profession have seen through their three-card trick.

Even Lord Darzi admitted last week that the government was “having a re-think” about PFI.

Ara – don’t re-think it – get rid of it!

But the best advice of all, Andy? End the ludicrous, divisive, expensive experiment of the market in healthcare in England.

Although we’ve been arguing against the market for years, some people have been questioning why we are upping our campaigning now. Well I’ll tell you.

Never has there been a better time to abandon the wasteful bureaucracy of the market. Never has there been a better time to ensure that we use scarce public money for quality healthcare, not for profits for shareholders. Never has there been a better time to ensure that we protect our scarce resources to train the future generations of doctors. Never has there been a better time to put the care of patients before achievement of rigid financial targets. Never has there been a better time for the various parts of the NHS to cooperate rather than to compete. Never has there been a better time to insist on a publicly-funded, publicly-provided and publicly-accountable NHS.

A health service of the people, by the people, for the people.

So my message is, don’t play around with our health service. It’s not a toy you cast aside and replace with the latest product off the shelf when you’ve tired of it. It needs looking after. It’s our NHS, make it yours too.

I also urge everyone in this hall and all doctors watching or reading about this ARM –

sign up to our campaign and to its principles and do it today.

I want to end with three more messages – one for the public, one for the politicians and one for the profession.

To the public, I say this. You have an NHS of which you can be proud. It is not perfect and it can be better and, working together, we can make it so. Like an old friend, there is a danger that you can take it for granted, expect that it will always be there for you and not work to support and develop the relationship.

We want you to be involved, to have your say in the services that you pay for, but not in a superficial, consumerist way, the way politicians seem to think matters, but as true partners in the care that you receive.

To politicians – of whatever political hue, because, in terms of their NHS policies, there’s little to choose between them – I say this.

Be honest with the public and the profession. Stop trying to outbid each other about who’s going to spend more or cut less. It’s not a very edifying spectacle and the public and the profession has seen through the charade that seems to happen every time an election is looming.

Give real and believable meaning to the phrases “Clinical Engagement” and “Clinical Leadership”. For too many doctors they are just empty rhetoric, paying lip service to medical involvement, appearing to seek docile followers rather than challenging leaders.

We have the talent; We have the expertise; We have the drive;We have the commitment; We have the belief; But we will not be taken for fools.

Above all, I say to the politicians, be bold, be brave – don’t cling to failed policies just because you think you might lose face if you are seen to have changed your mind. It’s a sign of strength, not weakness, to admit that new circumstances need new policies.

And, lastly, to the profession, I make no apologies for repeating the challenge I issued last year.

We have a choice. We can be cynical, pessimistic, worry about being tainted by association, and carp and criticise from the sidelines. We might keep our principles pure but I would suggest that it’s on the sidelines that we’ll stay – increasingly marginalised, increasingly irrelevant, increasingly ignored.

Alternatively, we can keep talking, keep involved, keep engaged, and take a leading role, not with some sort of blind and unquestioning acceptance but with our eyes wide open.

If we don’t show true leadership and get really involved, we leave the field open to others or, worse still, the good things that we want to see happen, will not happen. I don’t want that, I’m sure you don’t want that and I don’t intend to let that be the case.

Challenging times, hard choices, difficult decisions – for the NHS, for our patients, for the profession and for the BMA.

A time when it would be easy to dwell on our differences, to indulge in petty squabbling about the details, and lose sight of the broader picture.

Of course there are issues where we don’t all agree, but there are many more issues that unite us and it is on these we must concentrate this week if we are to have any chance of success, if we are meet the challenges, to make the right choices, to focus on the difficult decisions and to really Look after Our NHS.

Thank you.

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Brown to announce private cash for NHS cancer treatment delays

Posted on June 29, 2009. Filed under: Journals | Tags: |

Health Service Journal | 29 June 2009

The significant expansion of private sector involvement in health due to be unveiled by Gordon Brown this week will see cancer patients who face long waits in the NHS given cash to go private. 1203652_Gordon_Brown___smiling

In a radical shift of government policy, the prime minister will promise to strip away top-down targets in favour of “entitlements” for people using services.

Under the measures outlined in Mr Brown’s Building Britain’s Future document, any primary care trust unable to give cancer patients a specialist appointment within two weeks of GP referral will have to provide equivalent funding for a private consultation.

In reality, almost all NHS trusts in England meet the deadline, so the new measure is expected to affect only a few hundred patients.

However, what is regarded as a major change in policy is the principle of involving the private sector in acute treatment.

Currently only elective surgery such as hip replacements and cataract surgery is provided through private treatment.

The two-week target was introduced a decade ago, initially for suspected breast cancer cases, before being extended to all cancers. Although prospects have improved, research has indicated that average five-year survival rates across Europe are still higher than those in the UK.

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DoH ‘considers dropping private finance initiative for NHS buildings’

Posted on June 26, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 26 June 2009

The government is considering ditching private finance initiative (PFI) as its main way of funding new health buildings, Lord Darzi has hinted.

The PFI involves farming out the funding and management of public buildings to private contractors. The DoH has used the PFI to build dozens of new hospitals over the last 10 years. 

But the model has remained controversial, with many observers convinced it delivers worse value than public money and has been favoured purely to disguise costs.

Now Lord Darzi has hinted that the government is reconsidering its position.

‘That model of funding may have been the right model,’ he told the BMA. ‘But I have no doubt that the Department [of Health] will be appraising whether that it is still the model for the future or whether there are other, better models.’

He added, ‘Quality is a moving target and PFIs have been very successful and might be in the future but it needs to be looked at.’

jonn.elledge@haymarket.com

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1,000 visits to new polyclinic in first month

Posted on June 24, 2009. Filed under: Polyclinics, Press/News Releases |

Healthcare Republic | 24 June 2009

The latest polyclinic to open in London has attracted 1,000 visits in its first month.

Over 300 visits were on a weekend or bank holiday, according to Healthcare for London.

The Alexandra Avenue clinic, in Harrow, is open from 8am until 8pm, 365 days a year.

The polyclinic, which forms a network with six existing practices, was officially opened on Monday by health minister Lord Ara Darzi.

Lord Darzi said the health centre was already demonstrating its value and described the local residents’ response as ‘overwhelming’.

Dr David Lloyd, a GP from the Ridgeway Surgery, which moved into the Alexandra Avenue polyclinic, said: ‘One comment we hear from people in the polyclinic over and over again is how much better it is to be able to see a GP or a nurse at a time that suits them and their hectic lives rather than the health service.’

tom.ireland@haymarket.com

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DH to set up social enterprise support framework

Posted on June 23, 2009. Filed under: Journals, Social enterprise |

Health Service Journal | 22 June 2009 | Helen Crump

The Department of Health has launched a procurement drive to set up a framework of organisations to help primary care trust provider arms become social enterprises. DH to set up social enterprise support framework

The department is hoping to recruit a panel of business support providers to offer PCTs “tailored support that is unlikely to be available from within the PCT itself”.

A DH spokeswoman said there was no value for the tender as support would be commissioned by PCTs.

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GPs to negotiate patients’ personal budgets

Posted on June 23, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 23 June 2009

GPs should help patients with long-term conditions who wish to hold personal budgets negotiate the funds they need with primary care organisations (PCOs), health minister Mike O’Brien has told MPs. Mike O'Brien

In a debate on direct payments for healthcare last week, the minister said: ‘Patients would go to their provider—probably their GP initially—say that they want to have a health care package that does a particular set of things and then negotiate the budget with the health care provider.

‘We see that being done primarily through their GP probably, although it will not always be their GP.’

Mr O’Brien said around 70 pilot projects would be set up to assess the effectiveness of personal budgets.

nick.bostock@haymarket.com

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NHS held back by poor management

Posted on June 22, 2009. Filed under: News stories | Tags: |

 Healthcare Republic | 22 June 2009

The health service is being held back by a lack of innovative management, a report has said.

The report, published by the Economist Intelligence Unit, argues that the speed of advances in medical science hadn’t been matched by shifts in the organisation of health services.

It called for health services to be organised around medical conditions, rather than doctors’ areas of expertise. It also called for ‘outside entrepreneurs’ to be allowed into health services, to provide ‘revolutionary change’ when existing services refuse to.

‘Care delivery needs to be organised around the needs of the patient, rather than the clinical specialty of the doctor,’ said Dr Eric Silfen, chief medical officer of Philips Healthcare, which commissioned the study.

This would ‘deliver better patient outcomes at overall lower costs.’

jonn.elledge@haymarket.com

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CRAYFORD: Plans to open a new health centre are approved

Posted on June 17, 2009. Filed under: GP-led health centres, News stories | Tags: |

News Shopper | 17 June 2009

PLANS to open a new health centre in Crayford have been given the green light.

A planning application to convert existing retail space in Crayford High Street into a GP led health centre was approved at a Bexley Council planning committee on Thursday (JUNE 12).

The centre is expected to open next month, providing a normal GP surgery for up to 6,000 registered patients and walk-in-services for up to 10,000 non-registered patients by the end of its first year.

The centre will open from 7am until 8pm on weekdays and 8am until 8pm at weekends.

It will be run by a team of up to five GPs and will provide four consulting rooms and a waiting area.

There are already plans to open a medical centre in Crayford town centre, at the Town Hall site in Crayford Road, but the centre in Crayford High Street will be the first in the borough to offer a drop in service seven days a week.

The planning application was submitted by Mr Yashwant Patel, on behalf of Seldoc South East London’s Co-operative, who was unavailable to comment.

The GP co-operative which operates from Dulwich Hospital provides out-of-hours general medical services to patients.

Bexley Care Trust will provide the costs to the run the centre after receiving funding from theDepartment of Health.

The care trust was unable to disclose the amount of money it received.

It follows a government announcement to invest £250m into supporting primary care trusts nation wide to create at least one new health centre in each primary care trust area.

A spokesperson for the Bexley Care Trust, said: “Bexley Care Trust, in common with all other primary care trust’s in England, is participating in the government’s scheme, Equitable Access to Primary Medical Care, to deliver a GP led health centre in every primary care trust in the country.

“This programme is to address the needs of patients in meeting the government’s access and choice agendas and Bexley Care Trust has determined that that need is most pressing in the north of Bexley borough.”

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Integrated care pilot to be investigated

Posted on June 17, 2009. Filed under: Integrated care, Journals | Tags: , |

Health Service Journal | By Sally Gainsbury | 16 June 2009

One of the Department of Health’s integrated care pilot schemes is to be investigated by the co-operation and competition panel to see if it breaches merger, choice and competition rules.

Under pilot scheme, City Hospitals Sunderland foundation trust plans to merge with a local GP practice. The merger would represent a case of “vertical integration”, which the DH has been wary of due to concerns acute trusts could use control of a GP practice to drive up the number of acute referrals.

DH competition rules, published in 2007, state that primary care trusts must seek permission from the department before contracting for “list-based primary care services” through a hospital provider.

The panel’s investigation will use the Sunderland case to test assumptions and concerns about vertical integration. In a statement, the panel said it would “assess the extent to which the integrated care scheme may limit patient choice in relation to the type of NHS-funded healthcare services provided by each [provider]”.

It will also assess any benefits the model brings patients and taxpayers.

The panel is inviting submissions from interested parties. The closing date is 26 June. The earliest date for the completion of the investigation is early August, with the possibility of it continuing until the end of November if the issues are deemed complex.

More on integrated care

Can integrated care usher in a new age of risk taking?

Integrated care heightens provider monopolies risk

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Transforming health and social care: the Social Enterprise Investment Fund

Posted on June 17, 2009. Filed under: Reports/papers, Social enterprise |

Department of Health | 17 June 2009

This document contains information and guidance about the Department of Health’s Social Enterprise Investment Fund (SEIF) and how the fund supports social enterprises in health and social care.

Download Transforming health and social care: the Social Enterprise Investment Fund (PDF, 1004K)

 

 

A fund to transform health and social care

We want health and social care services to be available to everyone on an equal basis. We want them to be locally responsive, high quality and inclusive, especially in areas of social deprivation. This is a mission that lies at the heart of the National Health Service. But achieving our goal is not always easy. It requires creative thinking and new forms of delivery.

So the Government supports the development of social enterprises – innovative service delivery businesses with explicit social aims, whose profits are predominantly ploughed back for the good of the communities they serve.

The £100m Social Enterprise Investment Fund (SEIF) helps this process. The SEIF provides advice as well as seed funding for social enterprises that are starting up. It also offers development loans for established businesses delivering health and social care services.

Funded organisations include charities, community interest groups, and companies limited by guarantee. Funding awarded ranges from research and development costs, through to payment of salaries and to the purchase of equipment and buildings.

The Fund is managed from June 2009 for the Department for Health by Futurebuilders England, working in partnership with Partnerships UK.

What is a Social Enterprise?

 It’s a business with primarily social objectives whose surpluses are principally invested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners. There are more than 55,000 social enterprises in the UK, with an annual turnover exceeding £27 billion.
What does the Social Enterprise Investment Fund offer?

From June 2009, the SEIF offers:

  •  Loans – they can be used for property, development capital, working capital, bridging finance (until business income starts to flow), to support a merger or to tender for a public service contract.
  • Grants – these can be used to support a new project being set up, for start-up costs, staff costs or other transitional costs. They can also be used for the cost of buildings, vehicles or equipment.
  • Business support – advice on a range of issues: business plans, cashflows, business models, market analysis, marketing, governance and leadership structures, risk analysis, management accounts, client relationships, partnership management, transition management and social return analysis.

If you are already – or wish to start up – a social enterprise delivering innovative improvements to health or social care, you can apply for a loan, grant or business support from the SEIF.

More information about the Social Enterprise Investment Fund can be found at www.dh.gov.uk/seif

Social Enterprise Investment Fund

Care to make a difference?

The Social Enterprise Investment Fund (SEIF) provides investment to help new social enterprises start up and existing social enterprises grow and improve their services. We work to support social enterprises in the delivery of innovative health and social care services.

The Fund was set up in 2007 as part of the Government’s plans for stimulating expansion in the role of social enterprise in the provision of health and social care.

By enabling social enterprises to deliver health and social care services, the Social Enterprise Investment Fund aims to improve the quality of services for patients.

Social enterprise

Transforming health and social care: the Social Enterprise Investment Fund


 

Who can apply?

Social enterprises that can apply to SEIF include:

  1. Multi-agency partnerships, particularly voluntary and community groups wishing to use their expertise to provide services across health and social care
  2. Existing social enterprises looking to expand into health and social care
  3. Groups of professionals, such as nurses or therapists, seeking to form a social enterprise to deliver their services using the ‘right to request’ – see link below
  4. All social enterprises who apply would be expected to have a ‘not for profit’ status.

    Social Enterprise – Making a Difference: a guide to the Right to Request

     

     

    Fund managers

    The Social Enterprise Investment Fund is managed on the behalf of the Department for Health by Futurebuilders England, working in partnership with Partnerships UK.

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    GP condemns PCTs for appointing single-faith provider

    Posted on June 15, 2009. Filed under: GP-led health centres, Press/News Releases, Social enterprise |

    Healthcare Republic | 12 June 2009

    A single-faith provider has been selected by two PCTs to provide primary care services, the LMCs conference heard. Polyclinic

    The selection contravenes a fundamental principle of the NHS, it was claimed.

    Staff working for the provider are required to sign up to its values and vision.

    Manchester GP Dr Mohammed Jiva told the conference that Hope Citadel Healthcare, a social enterprise company, one of whose partners is the Salvation Army, has procured two GP-led clinics in Oldham and one GP-led health centre in Middleton, Manchester across two PCTs.

    Hope Citadel‘s website makes it plain that the organisation is a specifically Christian organisation, Dr Jiva said.

    Hope Citadel aims to provide spiritual care and health care ‘alongside and in conjunction with clinical care’, to take into account ‘spiritual aspects’ of wellbeing and to take ‘every opportunity’ for spiritual development, he added.

    Its vision involves ‘working with local churches and other Christian organisations, and developing ways of linking personal and community and spiritual activity with primary care services in order to offer whole-person healthcare,’ he said.

    The person specification for applicants for GP and practice manager vacancies stipulates as an essential criterion support for the vision and values of the organisation.

    ‘The NHS recognises all faiths and beliefs. Yet two PCTs have identified a preferred provider that recognises one belief over all others. This goes against the core principle on which the NHS was founded,’ Dr Jiva said.

    A spokesperson for NHS Heywood, Middleton and Rochdale said: ‘Hope Citadel is a GP-led consortium which was awarded the Health Centre contract at Middleton following a rigorous procurement exercise that was delivered under a national process. The GPs who lead the consortium have provided services in the Middleton area for many years and their bid specifically addressed the varied health issues in that area.’

    ‘The services it will provide will be accessible to all and absolutely not based on faith. Any suggestion that this is the case is inflammatory and without grounds”.

    In a statement emailed to Healthcare Republic, Hope Citadel said: ‘Hope Citadel, a not-for-profit community interest company, is not a discriminatory organisation. We are committed to the vision and values of the NHS and will work with all sections of the community to provide the best whole person care for our patients.

    ‘We currently have a number of community partners who have a christian faith base however, all of these organisations work with and help people of all backgrounds and beliefs. We have been open and transparent in our tender model which included the submission of our own vision and values as part of the assessment.’

    Prisca.middlemiss@haymarket.com

    Hope Citadel

    Last accessed Tuesday, 10 February 2009 

    Hope Citadel has been founded by local people who have a local focus on improving healthcare and community care in the Greater Manchester area.

    We are aware of the needs within our communities because we are already working in these community.

    The vision of Hope Citadel has been birthed out of a strongly held passion and desire to see change through the provision of whole person healthcare to individuals and families so that we see lasting change, not just for this generation but successive generations.

    We want to leave a legacy of good health.

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    The Framework for procuring External Support for Commissioners (FESC): a practical guide

    Posted on June 14, 2009. Filed under: FESC, Reports/papers | Tags: |

    Department of Health | Leaflet | 12 June 2009

    FESC is a practical and cost effective procurement tool to help primary care trusts (PCTs) address gaps in commissioning capability or capacity by providing easy access to high quality commissioning solutions from pre-qualified and experienced private sector partners. This brochure sets out what FESC is, why you should consider using it and how to do so.

    Download The Framework for procuring External Support for Commissioners (FESC): a practical guide (PDF, 1106K)

    he Framework for procuring External Support for Commissioners (FESC) has been established to provide practical support to PCTs as they work to develop their commissioning skills and move towards being world class. It is a practical, easy to use and cost effective procurement tool available to all PCTs, to help address gaps in their commissioning capability or capacity.
    FESC is a route to accessing thirteen independent sector organisations that have been selected as ideal partners to work with PCTs. All thirteen qualified to be on the Framework following a rigorous due diligence and selection process run by the Department of Health. Each organisation has tried and proven commissioning skills; some offer the full breadth of skills across the commissioning spectrum, while others are specialists in specific aspects of commissioning. These organisations can support you on all areas from better assessing need to managing performance and undertaking service redesign.
    FESC will deliver commissioning solutions, rather than traditional consultancy services. The business model is based around developing medium to long term relationships which can provide PCTs with vital specialist knowledge and experience.
    For these reasons, FESC is different to Catalist and other conventional procurement routes, which NHS organisations have traditionally used for buying consultancy services. FESC is the only framework in place that has the sole objective of enhancing core commissioning skills across the NHS.
    With the Framework already in place, FESC will enable you to move straight to procuring the services you need within a competitive environment, allowing you to focus on the task at hand without getting caught up in costly and lengthy procurement processes.

    What is FESC?

    The Framework for procuring External Support for Commissioners (FESC) has been established to provide practical support to PCTs as they work to develop their commissioning skills and move towards being world class. It is a practical, easy to use and cost effective procurement tool available to all PCTs, to help address gaps in their commissioning capability or capacity.

    FESC is a route to accessing thirteen independent sector organisations that have been selected as ideal partners to work with PCTs. All thirteen qualified to be on the Framework following a rigorous due diligence and selection process run by the Department of Health. Each organisation has tried and proven commissioning skills; some offer the full breadth of skills across the commissioning spectrum, while others are specialists in specific aspects of commissioning. These organisations can support you on all areas from better assessing need to managing performance and undertaking service redesign.

    FESC will deliver commissioning solutions, rather than traditional consultancy services. The business model is based around developing medium to long term relationships which can provide PCTs with vital specialist knowledge and experience.

    For these reasons, FESC is different to Catalist and other conventional procurement routes, which NHS organisations have traditionally used for buying consultancy services. FESC is the only framework in place that has the sole objective of enhancing core commissioning skills across the NHS.

    With the Framework already in place, FESC will enable you to move straight to procuring the services you need within a competitive environment, allowing you to focus on the task at hand without getting caught up in costly and lengthy procurement processes.

    What range of commissioning solutions can you buy from FESC?

    The framework is organised into four categories:

    • Assessment and Planning e.g. Health Needs Assessments

    • Contracting and Performance e.g. Robust contract negotiation processes

    • Performance management, settlement & review e.g. Acute invoice validation

    • Patient and public engagement e.g. PCT prospectus

    Who are the suppliers?

    • Aetna

    • AXA PPP

    • Bupa Health Dialog

    • Partners in Commissioning

    • Dr Foster

    • Humana

    • KPMG

    • McKesson

    • McKinsey

    • Navigant

    • Tribal

    • United Health UK

    • WG Consulting

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    Southampton patients to gain improved NHS access as GP-led Health Centre contract is awarded

    Posted on June 12, 2009. Filed under: Arm's length providers, GP-led health centres, Press/News Releases | Tags: |

    NHS Southampton City | News Release | 12 June 2009

    NHS Southampton City can today announce that a contract has been awarded for a GP-led Health Centre at the Adelaide Health Centre, Millbrook*, to open in November 2009.

    Provided by Southampton Community Healthcare, which has been awarded the contract, the GP-led health centre will offer a service for up to 6,000 registered patients and help to further increase extended GP opening hours available in the City. The service will be open from 8am-8pm, 7 days a week to ensure patients have even more access to healthcare professionals in Southampton.  

     

    The GP-led Health Centre will also be offering services for unregistered patients, including walk-in services for those with long-term conditions and chronic health needs. Long-term conditions affect a high proportion of patients in the City including diabetes, respiratory illness and chronic heart disease.

     

    Additionally, the GP-led Health Centre will help to tackle the specific health needs of the community in the area around Millbrook by providing services needed locally. These will address health and well-being issues such as alcohol misuse, sexual health, mild to moderate mental health issues and other health and social care issues which have been prioritised according to the specific needs of those living locally.

     

    Bob Deans, Chief Executive for NHS Southampton City said: “I am delighted that we have secured a contract for the new practice at the Adelaide Health Centre. The service will further improve access to GP services in the City and also provide walk-in facilities, which is particularly valuable for those with chronic health needs and will target specific health issues affecting the local population. NHS Southampton’s is committed to improving the health and well-being of Southampton people and we will be helping to achieve this through the community-based health services at the Adelaide Health Centre.”

     

    Bob continued: “Patients in Southampton will already be benefiting from the fact that over 80% of our GP practices are offering extended opening hours, and the new centre will add to this access to primary care.The Adelaide Health Centre is a new state of the art facility and will be the first significant step in NHS Southampton City’s strategy to improve health and healthcare services and help it to replace some of the out of date facilities in the City. I would like to congratulate Southampton Community Healthcare on securing this contract and I look forward to the service opening in November 2009.”

     

    Dave Meehan, Joint Managing Director for Southampton Community Healthcare said “We are delighted that Southampton Community Healthcare have been awarded the contract to provide this service at the Adelaide Health Centre. The health centre will not only improve access to primary care for people in Southampton, but will also be complimented by a range of services on the site which will help to improve the care available in the local community.”

     

    Dave continued: “The Adelaide Health Centre will be a significant NHS building in providing excellent, community-led care for the people of Southampton and the new practice will be an important factor in makingthis possible. It is always our aim to provide high quality and patient centred services to our patients in their community wherever possible. This facility will provide us with the opportunity to deliver services in the heart of the west of the City when the service opens its doors in November.”

     

    Ends

     

    Notes to editors:

    • * The Adelaide Health Centre, Millbrook is the new name for the building previously known as the Western Primary Care Delivery site and is based on the Western Community Hospital site. The Adelaide Health Centre is due to open in November 2009 and will benefit the local community by providing a wide variety of primary care services offering extended hours, seven days a week.
    • 83.3% of Southampton GP practices are currently offering extended opening hours for patients.
    • PCTs can enter APMS contracts with any individual or organisation that meets the provider conditions set out in Directions. This includes the independent sector, voluntary sector, not-for-profit organisations, NHS Trusts, other PCTs, Foundation Trusts, or even GMS and PMS practices. If PCTs contract with GMS / PMS practices via APMS, the practice would hold a separate APMS contract alongside their GMS / PMS contract
    • NHS Southampton City is responsible for investing in health and care services to effectively meet the needs of the City’s population.
    • Southampton Community Healthcare provides a range of community-based health services which enables patients to receive excellent quality care in the most appropriate setting.

      

    For more information please contact Matthew Butler, Press Officer, on 023 8029 6930.

     

    Southampton Community Healthcare

    Southampton Community Healthcare (SCH) is the Provider arm of the PCT which provides community health services throughout Southampton and in parts of Hampshire.  SCH’s vision is to be the best provider of community healthcare services locally.

    We are currently on the journey to become a separate organisation and our plans are outlined in our Integrated Business Plan for 2009-2014.  Southampton Community Healthcare (SCH) is proud to be the main provider of community health services to nearly a quarter of a million people in Southampton city.

    We also deliver a range of services to neighbouring areas covered by Hampshire PCT and a further 335,000 people.

    We employ around 2,000 staff (around 1,250 whole-time equivalents). For 2009/10 our forecast annual turnover is £82.6 million.

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    Take on more risk to increase share of health market, private companies told

    Posted on June 12, 2009. Filed under: Journals | Tags: , , , |

    Health Service Journal | BY HELEN CRUMP | 11 June 2009

    Private companies must take on more risk if they want to gain a bigger share of the primary and community care market. Take on more risk to increase share of health market, private companies told

    Harrow primary care trust chief executive and chair of the London PCTs’ commercial board Sarah Crowther said the perception within the health service had been for some time that risk sharing had been working in favour of the independent sector.

    She said: “Perhaps what [independent sector providers] need to think about for the next period of time is how do you incentivise PCTs to change some of their provider relationships, to have the confidence to work with you.”

    Ms Crowther, speaking at an NHS Confederation seminar, said the DH commercial directorate, which has been replaced by local commissioning support units, “hadn’t done the independent sector any favours” by negotiating costly deals which loaded risk back onto the NHS.

    She said: “The days when it was all about how do you get the independent sector involved are gone. Actually what we’re interested in as commissioners is who is the right provider to give us the right deal to provide the right service.”

    But she acknowledged not all PCTs would be taking the same approach to competition and co-operation.

    “That may not be perfect, but it’s the reality. Get over it,” she said.

    She advised independent providers to think about taking on projects that were not of optimum size in the first instance, in order to build a track record.

    Linked to that, PCTs needed to get better at building relationships, she added.

    And the private sector would need to tell commissioners how it was going to help them take capacity out of the health system.

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    Mark Britnell quits NHS for private sector

    Posted on June 11, 2009. Filed under: Journals | Tags: , |

    Health Service Journal | BY RICHARD VIZE | 11 June 2009

    HSJ understands Mark Britnell, NHS director general for commissioning and system management, is to join consultancy KPMG. 1202875_57385_306

    He is on gardening leave from the Department of Health.

    He is expected to play a leading role in KPMG’s European health practice.

    Mr Britnell has been the leading reformer in the NHS management team. He launched the world class commissioning drive, and has always been a staunch advocate of private sector involvement in the NHS.

    He recently established the co-operation and competition panel to ensure fair access to the healthcare market.

    Academic Chris Ham said the panel’s draft interim guidance read as if it had been written “by a neo-liberal economist on speed”.

    Mr Britnell also established the framework for securing external support for commissioners (FESC) to encourage private sector involvement in world class commissioning.

    He was unavailable for comment.

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    New GP Access Centre in Bridlington opens 15 June 2009

    Posted on June 11, 2009. Filed under: GP-led health centres, Press/News Releases | Tags: |

    A new General Practice Access Centre, for the East Riding opens its doors on
    Monday 15th June 2009 offering a range of GP and other health care services
    8am-8pm, 7 day a week. The new GP Access Centre is operated by the
    Bridlington Healthcare NHS Collaborative and is located in newly refurbished
    premises within Entrance A at Bridlington and District Hospital.
    The Access Centre offers patients improved and more convenient access to
    GPs and other healthcare professionals and eases the current pressure on
    some Bridlington GP practices to meet the demand for new patient
    registrations. The extended opening hours provide a greater choice of
    appointment times in the evening and over the weekend, including bank
    holidays. The Access Centre offers high quality services to anyone who
    wishes to attend the practice, including people who are registered with
    another practice or not registered with a GP practice at all. Registered and
    unregistered patients can book an appointment for health advice and
    treatment from skilled health professionals, or, if pre-booking is not possible,
    can be seen on a ‘walk-in’ basis.
    Bridlington Healthcare NHS Collaborative is a new joint arrangement between
    NHS East Riding of Yorkshire Community Services and four of Bridlington’s
    GP practices – Practice 1, Practice2, Practice 3 and Manor House Surgery,
    The services within these practices will continue to operate from their
    premises as normal.
    The Access Centre will, in time, manage around 2,500 registered patients, as
    well as unregistered patients who choose to make use of the service.

    NHS East Riding of Yorkshire | Press Release | 11 June 2009

    A new General Practice Access Centre, for the East Riding opens its doors on Monday 15th June 2009 offering a range of GP and other health care services 8am-8pm, 7 day a week. The new GP Access Centre is operated by the Bridlington Healthcare NHS Collaborative and is located in newly refurbished premises within Entrance A at Bridlington and District Hospital.

    The Access Centre offers patients improved and more convenient access to GPs and other healthcare professionals and eases the current pressure on some Bridlington GP practices to meet the demand for new patient registrations. The extended opening hours provide a greater choice ofappointment times in the evening and over the weekend, including bank holidays. The Access Centre offers high quality services to anyone who wishes to attend the practice, including people who are registered with another practice or not registered with a GP practice at all. Registered and unregistered patients can book an appointment for health advice and treatment from skilled health professionals, or, if pre-booking is not possible, can be seen on a ‘walk-in’ basis.

    Bridlington Healthcare NHS Collaborative is a new joint arrangement between NHS East Riding of Yorkshire Community Services and four of Bridlington’s GP practices – Practice 1, Practice2, Practice 3 and Manor House Surgery, The services within these practices will continue to operate from their premises as normal.

    The Access Centre will, in time, manage around 2,500 registered patients, as well as unregistered patients who choose to make use of the service.

    Jean Oxley, Chief Operating Officer, NHS East Riding of Yorkshire Community Services, said on behalf Bridlington Healthcare NHS Collaborative: “We are delighted to be opening this new GP Access Centre based at Bridlington Hospital. We have fully refurbished the clinical rooms and waiting area to make a modern healthcare facility, which will provide high quality care to residents of Bridlington and surrounding areas, as well as Bridlington’s holiday season visitors.

    “Community Services is the provider of the Neighbourhood Health Team, Macmillan Wolds Unit, Out of Hours Services and other community based services, and this new service will enhance the excellent health care we already provide locally.”

    Note to editors:

    Please contact Emma Shakeshaft, Communications Manager, (external) for photographs and interview requests for the Bridlington Healthcare NHS Collaborative. The official opening of the GP Access Centre will take place later in the year.

    Background information:

    In December 2007 it was announced that every Primary Care Trust must secure a contract for an additional GP-led Health Centre by December 2008, with the new services commencing from 2009.

    East Riding of Yorkshire PCT consulted on the location and range of primary care related services for a new Centre to offer extended and improved access to local GP services in March and April 2008.

    The new GP Access Centre represents major investment in a £4.15 m five-year contract to develop new and enhanced local NHS services.

    Issued by: Emma Shakeshaft, Communications Manager (External), NHS East Riding of Yorkshire 01482 672195. NHS East Riding of Yorkshire press releases are available on our website at http://www.eastridingofyorkshire.nhs.uk

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    NHS provision ‘still preferred option’, says health minister

    Posted on June 11, 2009. Filed under: News stories | Tags: , |

    Healthcare Republic | 11 June 09

    Health minister Ann Keen has reassured union Unison/CPHVA that NHS provision remains the preferred option if it offers the most value for patients.

    She added that there would be no automatic default to outsourcing in a ministerial statement.

    Mick Jackson, Unison’s senior national officer for health, said: ‘We are delighted that Mrs Keen has confirmed that NHS provision is still the preferred option, when it comes to the best value for patients, in a letter to Unison.

    ‘We now have a clear reassurance, in a ministerial statement, which is a small, but very important step.’

    Mrs Keen wrote: ‘I can reassure you that the government’s policy has not changed.

    ‘It remains the position that, although World Class Commissioning encourages market testing, NHS provision remains the preferred option where it provides the best value for patients.

    ‘There is no automatic default to an outsourcing solution.’

    Earlier this week Unite/CPHVA launched a campaign calling for the end of the privatisation of the NHS. Health B4 Profit appears to chime with the BMA’s anti-marketisation drive launched earlier this month.

    neil.durham@haymarket.com

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    Integrated care

    Posted on June 10, 2009. Filed under: Integrated care, Journals |

    British Medical Journal | Feature: Health Policy | Nigel Hawkes, freelance journalist | Published 8 May 2009

    The government hopes that integration of services will improve care, but as Nigel Hawkes reports the pilot schemes have a lot to prove

    Sixteen organisations have been chosen to pilot new models of integrated care in the English National Health Service. The scheme, announced in the Darzi review last July, aims to improve services for defined groups of patients by integrating health and social care, or primary and secondary care, or both.

    The pilots announced on 1 April include seven that will focus on long term conditions or chronic diseases, three on elderly people and end of life care, two on dementia, and one each on falls, mental health, delivery of rural health care, and substance misuse. Geographically the pilots are unevenly spread, with four in the North East Strategic Health Authority, four in the South West, but none in South Central, South East Coast, or West Midlands (box). The 16 were chosen from 100 applications. 

    Integration has long been an article of faith among NHS commentators, and the new Care Quality Commission expresses that faith by combining the regulation of health and social care in a single organisation. But previous efforts to achieve integration have a mixed record. Since 2000 it has been possible to achieve integration through creating care trusts, but only 10 have been set up. UnitedHealth’s Evercare scheme, which sought to achieve seamless care through better case management, was piloted in nine primary care trusts (PCTs) in 2003-4 and achieved some improvements but no significant effect on admissions, bed days, or mortality.

    This uncertain background explains why integrated care is being piloted, rather than launched nationally. The pilots will run for two years before being evaluated for a further three years. They will, says the Department of Health, “allow communities to take a fresh look at how to deliver health and social care, based solely around the needs of the local population.” The successful bidders have been urged “to look beyond traditional boundaries (such as between primary and secondary care) to explore whether new, integrated models can improve health and social care services.”

    Rebecca Rosen of the Nuffield Trust, a general practitioner and an expert on integrated care, says that the challenge will be to show that the extra costs of integrated care are outweighed by savings from fewer hospital admissions. “The evidence base is not very strong,” she admits. “There is very little robust evidence that integrated care can reduce admissions.”

    She says that the pilots cover a diverse range and will be evaluated by experienced researchers. “They will be looking for two things,” she says, “better experience of care for the patients and greater cost effectiveness.

    “Integrated care isn’t new—there are papers in the literature going right back to the 1970s. Generally, patients appreciate it and rate their care as better, but the cost can go up because of better medication. Both prescribing and compliance increase overall, so spending increases.”

    Some pilots have a head start. Torbay is already a care trust and will be piloting integrated care for elderly people across primary, secondary, social care, and mental health services. Chris Ham, professor of health policy and management at the University of Birmingham, writes in a recent report for the Nuffield Trust that Torbay has achieved some improvements in care, including quicker assessment and delivery of intermediate care and an improved rating from the Commission for Social Care Inspection, the predecessor of the Care Quality Commission.

    Will integration work?

    Integration means different things to different people. In the past, it has often consisted of ramming together organisations with different histories and cultures and expecting economies of scale and improved services to follow. “New and better types of care cannot be delivered by housing different professionals under one roof or merging multiple organisations,” said Niall Dickson, chief executive of the King’s Fund.

    “It requires bringing teams together, integrating the way staff work, and creating new relationships between organisations. It is also important that we do not create new monopoly organisations around the NHS which deny patients choice—we need services that are responsive and understand that either patients or commissioners may decide to go elsewhere.”

    US experience also suggests that integration is easier in organisations that are both commissioners and providers of care. PCTs are now under strong pressure to get out of provision altogether, which could work against integration, warns Minoo Irani, a consultant paediatrician who represents the interests of consultants working in primary care in the NHS Alliance. Without clarity about the basics, he says, that integrated care pilots risk perpetuating fragmented health care, while still appearing integrated. “Confused enthusiasm is never a good thing on which to base health policy,” he warns.

    The Audit Commission has also expressed doubts about partnership working in the public sector, warning that it can generate confusion and weaken accountability. “Local public bodies should be much more constructively critical about this form of working,” it said in 2005. “It may not be the best solution in every case. They need to be clear about what they are trying to achieve and how they will achieve it by working in partnership.”

    The only London project to make the cut believes it has met these criteria. Tower Hamlets in East London, one of the poorest parts of the capital, is aiming to improve the health and wellbeing of patients with long term conditions, delay the progress of disease, and increase the uptake of services by hard to reach groups.

    Anwara Ali, lead member for health and wellbeing at Tower Hamlets Council, says: “It’s all about putting local people’s needs to the forefront of everything we do and structuring how we work around that. In Tower Hamlets we have a very strong partnership in place with our health colleagues which will support us in this work.” Alwen Williams, chief executive of NHS Tower Hamlets, says it is one of the trust’s major priorities to improve care for people with conditions such as stroke, diabetes, and cardiovascular disease.

    The evidence for integration, as summarised by the Department of Health, does not inspire huge confidence. It can be a successful way of breaking down barriers between primary and secondary care (vertical integration) and between health and social care (horizontal integration). But the evidence of vertical integration on costs, outcomes, and patient experience remains weak.

    Context is important, the department’s summary says. Supportive leadership, strong local partnerships, and effective information technology and administrative systems are vital. It concludes on a gloomy note: “Integration has seldom increased efficiency. This is due to such factors as significantly different practices existent in the organisations that are to be integrated; and the steep learning curve inherent in joining with another organisation. Longstanding power imbalances between acute and community care makes such integration a challenge.”

    Dr Rosen believes there are several elements that need to be right to make the integrated care pilots work. “They have to be smart about the way they use data. If you are going to achieve real integration, the challenge is to use available data to the full, and you have to invest effort and resources to achieve that. In successful US systems, a lot of what is achieved is down to the clinical information systems, providing prompts or protocols on screen, for example, or risk stratifying patients.

    “Second, you need high quality clinical leadership and governance arrangements that make it clear what you are aiming to achieve. The challenge of good integrated care is to ensure that patients don’t fall between the cracks. You need to build a shared understanding and invest a lot in team development.

    “Finally, my other big question is whether financial incentives can be aligned to make it work. There are other NHS policies, such as patient choice, that can disrupt it.”

    If the pilots fail, at least the time and money wasted will be limited—assuming the department heeds Niall Dickson’s warning not to roll them out before lessons have been learnt, as has happened in the past. If they succeed, they could transform the way health care is delivered, according to enthusiasts such as Peter Reader, medical director of Islington PCT. But past experience teaches caution. Many NHS reforms, heralded as revolutionary when launched, have gone out of fashion and been abandoned before they have had time to show either success or failure.

    Cite this as: BMJ 2009;338:b1484

    Competing interests: None declared.

    nigel.hawkes1@btinternet.com

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