Archive for August, 2009
District nurses embody the high quality workforce envisioned by Darzi, but the sector lacks the commitment to attract new nurses to this 150 year old service, says Daloni Carlisle.
- District nursing is changing to reflect a modern service.
- The workforce is ageing and training has been slashed.
- Renewed commitment to the sector is necessary to deliver the vision laid out in the next stage review.
When Anna Gibbins started as a district enrolled nurse in the early 1980s in Cheltenham, Gloucestershire, she never took her hat off while on duty.
“I was issued with five dresses for summer, five for winter, a cardigan, a blazer, a wool coat and a pillbox hat that I wore at all times,” she recalls. “The Queen’s Nurse in charge told me ‘a district nurse never takes her hat off’, so I didn’t.”
This was just 25 years ago, in the days before the central sterile supply department took away soiled dressings – so they went into the grate. “Every house had an open fire,” says Ms Gibbins.
And district nurses were thrifty, re-using everything and fashioning items from what was to hand – turning eiderdowns into pressure relieving cushions, for example.
That world is hardly recognisable now and seems to have more in common with 150 years ago, when district nursing was founded (see box), than with 2009. In their anniversary year, district nurses are reminded of their past, but also looking to the future to find their place in the post-Darzi health policy landscape.
The home front
District nurses are defined by their place of work: people’s homes. With health policy aiming to provide care closer to home – whether managing long term conditions, preventing unnecessary emergency admissions or delivering end of life care – who better to help develop such services than a corps of district nurses?
That, at least, is the argument put forward by the Royal College of Nursing and Queen’s Nursing Institute, the charity that supports community, or district, nurses. The institute’s report 2020 Vision: focusing on the future of district nursing, published in January, stated: “The principles… that have lasted 150 years still fit the bill today. In today’s terminology, they are known as ‘better care, closer to home’, ‘patient choice’, ‘integrated care’ and ‘co-production’.”
“We know there are a number of people in hospital who do not wish to be there, in addition to the people who are admitted but did not need to be,” says RCN primary healthcare adviser Lynn Young. “The public say they want to die at home and that is pure district nursing. We can provide such care to fabulously high standards.”
Institute director Rosemary Cook says district nurses have the skills to deliver on the new agenda.
“There is a bigger difference between nursing in the home and in clinical settings than between primary and secondary care nursing. Nurses are unsupervised, which has implications for quality of care and their own safety. They have learnt to apply principles such as asepsis [techniques to reduce infection] in an environment where every single case is different,” she says.
Clinically, they have come a long way too.
“District nurses’ work has changed significantly because of the push to discharge patients earlier,” says Sally Bonynge, executive director for long term conditions at Central Surrey Health, a social enterprise led by nurses and associated health professionals.
“We are now taking some complex cases that would historically never have been able to come out of hospital,” says Ms Bonynge. “Yet with different ways of working, partnerships and extended roles there is always a way to do it.”
But do commissioners recognise this?
“It is somewhat taken for granted,” says Ms Cook. “[Primary care organisations] have had district nursing services for a long time and let them get on with it. They know what they do in the home is different but there has been no real scrutiny of the different elements that make up the kind of care they deliver.”
However, there are examples of organisations that have used district nurses’ skills to their full. Examples are in telehealth or in virtual wards, both of which are initiatives designed to help people stay at home and prevent emergency admissions.
Central Surrey Health is a learning centre for the NHS Institute’s productive community initiative.
“We are focusing on the district nursing team and changing current working practices,” says Ms Bonynge. “This could be even more exciting than the productive ward [the model on which the initiative is based], as it is so complex. There is only so much you can do to control the patient’s home environment.”
But all is not well in the sector. Both the QNI and RCN have charted rising case loads and falling numbers of qualified district nurses over recent years.
“There is a whole range of issues facing our members. The national trend has been to employ more healthcare assistants to do the work of district nurses. We are not against healthcare assistants, but you have to get the balance right and we are concerned that there has been a dilution of workforce that will get worse as the elderly population grows and more people need these services,” says RCN director Peter Carter.
The RCN says bald workforce figures showing a rise in the number of community nurses from 50,481 in 2000 to almost 62,000 in 2007 disguise a drop in district nurses, whose roles have been replaced with staff nurses and healthcare assistants. There are now around 10,800 district nurses employed in the NHS.
“If you align the workforce with the government’s push towards care closer to home we estimate that we have actually got about half the number of district nurses needed to do it properly,” says Mr Carter.
The workforce is ageing too. In 2007, 58 per cent of district nurses were over the age of 45 and 17 per cent over 55. Training has also been slashed, says Ms Young, so closing this gap will require long term commitment and investment in creating new training opportunities and attracting young nurses to them.
The QNI is also concerned. The 2020 report says: “District nursing services are currently being diluted by loose use of the title, wide variations in pay banding and career structure, reduction in leadership opportunities and lack of recognition of the value of their specialist education.”
Friends in high places
The role has some friends in high places, however. Health minister Anne Keen is a former district nurse and general secretary of the Community and District Nursing Association. Like any district nurse she is ready to regale you with tales of her time in the community.
“There was the time I got bitten on the leg by a goose,” she recalls with evident glee. “I was nursing a pig farmer but he refused to come out of the pig pen so I had to go to him, get him to drop his trousers, give an injection and then run across the fields chased by geese. I don’t think there are many health ministers who could say they have had that kind of experience.”
In 25 years of nursing, her time as a district nursing sister was her favourite, says Ms Keen.
“Your community is proud of you. You go through the front door and you are in a patient’s home. You have to be a confident practitioner and very knowledgeable.”
She is well aware of concerns about the role’s erosion – and of the potential for the role to develop in the near future.
“The high quality workforce of Lord Darzi’s next stage review is made for the role. We cannot afford to lose district nurses and we need to look after them.”
But skill mix will have to change, with district nurses delegating their skills and knowledge to others, she adds.
Ms Keen also agrees with Ms Cook about commissioners’ views of district nursing.
“We must spell out the value of district nursing to them more clearly. Nurses have not been very good at that in the past and it has been easy for people to dismiss them.”
Welsh chief nursing officer Rosemary Kennedy started as a district nurse in rural North Wales in 1973, caring for a village community and outlying farmsteads.
“We were very much part of the community, seen as ‘theirs’ and almost on a level with the school master or minister. It was a really wonderful feeling of belonging and knowing the people you cared for.”
The NHS in Wales also wants to move care closer to home and Ms Kennedy says she has brought a “huge amount” from her days in the district to her current role. She knows from experience the intensity of nursing that is possible at home, having cared for patients with acute coronary conditions.
“It was a question then of the balance between moving them 52 miles or caring for them at home.”
Ms Kennedy identifies capacity as the main challenge. Some of this will be addressed through skill mix changes, but getting the right levels of specialists will take time. A consultation on the future of community nursing in Wales is due to close in May. It will also consult on a new career ladder that would offer modular education, allowing nurses who want to test out the specialism the chance to do it step by step without having to make the jump in to a full time role or education.
“The crucial thing is that one size does not fit all,” says Ms Kennedy. “Our starting point is this: what is the community? What are their needs and how do we
meet them? In some cases they will be heavily weighted towards specialist nurses delivering intensive and holistic care. In others it will be different.”
Overall, there is a good deal of optimism about the future of district nursing. There are some dinosaurs around but there are many more innovators, says Ms Cook. There are areas where district nursing skills are being diluted and lost but some primary care trusts are investing in them, adds Mr Carter.
In England, there is the prime minister’s commission on the future of nursing and midwifery to look forward to, as well as the primary and community care strategy now being developed, which is chaired by Department of Health director general for commissioning and system management Mark Britnell.
“It is a time for optimism,” says Mr Carter. “We have a great deal of faith in Mark Britnell. If his ideas are properly supported it could transform community services.”
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The history of district nursing
District nursing as an organised movement began when the Victorian Liverpool merchant and philanthropist William Rathbone employed Mary Robinson to nurse his wife at home during her final illness. Following his wife’s death in May 1859, he wrote: “It occurred to me to engage Mrs Robinson to go into one of the poorest districts of Liverpool and try, in nursing the poor, to relieve suffering and to teach them the rules of health and comfort.”
Three months later “she came back saying the amount of misery she could relieve was so satisfactory that nothing would induce her to go back to private nursing, if I were willing to continue the work”.
Florence Nightingale advised Mr Rathbone to start a training school attached to the Royal Infirmary in Liverpool. Built by May 1863, district nursing associations soon spread to other cities, including Manchester, Leicester and London.
The Queen’s Nursing Institute was founded in 1887 with a grant from Queen Victoria’s Women’s Jubilee Fund. Queen’s Nurses later joined the war efforts of both world wars before joining the NHS in 1948. Although training ceased in 1968, the title Queen’s Nurse was again awarded in 2007 to those who passed a rigorous assessment.
For more information seewww.districtnursing150.org.uk/history.htm
Candy Pellett qualified as a district nurse in 1999 and is now a district nurse case manager for Lincolnshire primary care trust.
“My role is with people with long term conditions and palliative care needs. That means I spend longer with patients with more complex needs and delivering a complex package of care. We now do work that was previously only done in hospitals, for example managing Hickman lines [intravenous catheters to deliver medication] or delivering intravenous antibiotics. I have just started undertaking paracentesis [draining fluid from the abdomen] and that is radical.
“This is all very much in line with the Darzi review. I sit on the Department of Health transforming community care review board and think we will see patients being offered more and more complex care in a primary care setting. It is a good time to join the specialism. There are so many different pathways you can follow.”
Unite/CPHVA presented a letter signed by 3,000 NHS members to the DoH calling on health secretary Andy Burnham to halt the privatisation of the NHS.
It was presented by Karen Reay, Unite’s national officer for health.
The campaign is part of Unite’s Health B4 Profit campaign designed to preserve the NHS as ‘a publicly owned, publicly accountable, universal and comprehensive health service managed and run for the public good’.
Unite estimates that £20bn would be spent on creating the bureaucratic market infrastructure for privatisation.
Ms Reay said: ‘We are asking Mr Burnham to protect the heart and soul of the NHS in England and roll back these costly and dangerous plans.’
Mike Parish, chief executive officer of Care UK, the largest provider of healthcare services to the NHS, said: ‘Patients are benefiting from the increased choice that is coming from the introduction of additional providers of NHS services.
Waiting times are reducing, quality is rising and innovation is being stimulated by opening up the NHS to the real world of people being given choice.
‘The best way for the NHS to reconcile rising public expectations and constraints on public spending, is not to take away choice for the public, but to increase it. This will enable the NHS to deliver more with less and will safeguard the founding principle of care free at the point of delivery.’
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THE battle for Poulton’s new health centre has stepped up a gear.
The development was put forward by the Baxter Group Ltd after talks with neighbours, furious at the plans to build a health centre on Vicarage Road.
Rushcliffe Healthcare, on behalf of NHS Blackpool, put forward the original proposals, which are also still awaiting a decision.
Under the Vicarage Road scheme, St Chad’s Tennis Club would be relocated to Moorland Tennis Club and a new church hall would be built.
John Bailie, spokesman for Concerned Residents Of Poulton (CROP), said: “This is very positive news and reflects the massive response our organisation has received in favour of the Station Road site – around 3,300 so far.
“This is not just a far better and more spacious location for the medical centre, it is also a fantastic opportunity to rid the town of an ugly, derelict area and a great chance to turn Poulton round to its rightful position as the showpiece of the Fylde.”
Both schemes would house Queensway Medical Centre, Poulton Clinic and Lockwood Avenue Surgery as well as providing other facilities, such as a pharmacy and a cafe.
In a statement, a spokesman for Baxter Group, said: “There are two advantages of this app-lication, which are the development of a long standing derelict site and cleaning up a contaminated site and bringing it back into use.”
The Station Road application includes highway improvements, including signal controlled pedestrian crossings at the crossroads of Breck Road, Station Road and Parry’s Way, a bus lay-by and resident parking bays on Station Road and the widening of that road to two lanes.
A total of 118 parking spaces, including 12 mobility spaces, would be provided as well as a drop off area, turning circle, motorcycle and cycle parking. The plans also detail landscaping throughout the site.
Letters of support state the scheme would regenerate a derelict site and smarten up the main route into Poulton.
But the council has also rec-eived letters of objection citing reasons such as the site is “out of town”, Breck Road is frequently congested and the development will cause noise.
The plans were re-submitted in April after being shelved last year following criticism from residents over concerns of loss of community facilities and increased traffic problems.
NHS Lancashire bosses say it would cost more than £2m to prepare the Station Road land for development while £600,000 had already been spent on the other scheme.
A spokesman for Wyre Council said: “Negotiations are still ongoing with the applicant so we cannot comment on when the application will be determined at this stage.”
Wyre Council planning committee will discuss the Station Road application on September 2.Read Full Post | Make a Comment ( None so far )
North Shropshire MP Owen Paterson has visited the former Cambrian Works building in Oswestry to see how the work on a state-of-the-art medical facility is coming along.
Work on the £6 million development began in April and has been supported by an investment worth £1.3 million into the construction of a new access road by Advantage West Midlands’ Rural Regeneration Zone, working with Shropshire Council.
The interior of the building has been completed gutted and work will see the cavernous shell turned into a three storey facility with a combined area of one-and-a-half football pitches.
When complete, the transformed 19th century building will be able to host up to six GPs, a minor injuries service including X-ray facilities, a dental surgery, physiotherapy, podiatry, speech and language therapy services, a health promotions unit and advanced primary care services.
Castlemead Developments Ltd is undertaking the work in partnership with Shropshire Primary Care Trust with work expected to be complete by late 2010.
Visiting the site, Owen Paterson MP said: “I am delighted to see work has moved on and this much-needed development is well underway.
“I was here when the work started on the access road back in October and already a great deal has changed.
“This health centre will benefit the town massively, particularly as the population increases as it will provide truly 21st century care.
“But also, this is an important investment in this part of Oswestry at the gateway to the town.”
Peter Pawsey, Executive Chairman of the Rural Regeneration Zone, said: “This Health Centre is a quantum leap for services in Oswestry and I am delighted that the Zone’s investment has enabled this site to be opened up.
“Improving access to services is a key aim of the Rural Regeneration Zone and this development will mean the town having a health centre they can be proud of.”
Cllr Martin Bennett, who represents Oswestry East Division on Shropshire Council, said: “I am pleased that this historic building which played a huge part in the lives of people in the 19th century, will be meeting the health needs of the town and area in the 21st century.
“The project has taken the efforts of a number of partners working together and, when it finally opens, will be a credit to everyone involved. Then we need to get on with Phase 2!”
Angus Hannagan, Chairman of Shropshire Primary Care Trust, said: “Having this sort of facility on the edges of the town centre is going to be a major boost for health provision in Oswestry.
“We are very excited at the plans for care in this part of the county and it is great to see work well underway on the transformation of this landmark building.”
Joe O’Donnell, Managing Director of Castlemead Developments, said: “We’re pleased with how the work is going at the moment and we’re delighted to be involved in such an ambitious and innovative project.
“This is really is going to be something special and we were delighted to have the chance to show Owen Paterson MP just how well the work is going.”Read Full Post | Make a Comment ( None so far )
The number of primary care trusts in England could be significantly reduced under Conservative health plans, HSJ has learnt.
If they win the next election, HSJ understands the Conservatives are likely to require all GP practices to become practice based commissioners. Most of their commissioning functions would be performed through federations of GP practices operating as consortiums. This would result in a reduction in the commissioning role of PCTs in some areas, potentially leading to a raft of mergers.
The Conservatives would welcome such mergers as part of an organic process but stress they would be voluntary. They hope to encourage more GPs to take up commissioning by turning the currently indicative budgets into real cash budgets.
Shadow health secretary Andrew Lansley told HSJ this would give practices “real opportunities to save and reinvest, and real control over contracts”. However, he was clear that any underspends would remain ringfenced for patient care, not practice profits.
Mr Lansley said this would combine “the decision-taking responsibility for where and how patients are treated with the finances which are necessary to support it”.
David Furness, health project leader at the Social Market Foundation think tank, said the implications of an enhanced role for practice based commissioning were “much more significant than has been [previously] discussed”.
If consortiums took on more responsibility for commissioning health services there could be less rationale – and management funds – for all 152 PCTs.
In some areas, such as north London and the East Midlands, PCTs have already merged some of their commissioning responsibilities to reduce costs and potentially increase their relative strength over acute providers.
Asked if the Conservatives would want to see more such mergers, a spokesman said: “It would be perfectly reasonable to aggregate, but it will be up to them [PCTs] to decide. It would be done on an organic bottom-up way if [they] choose to do so.”
Sources within the NHS, who have been asked to advise the Conservatives on the development of their health policy, said they thought the party would ideally like to see strategic health authorities and PCTs merged to create maybe 40 strategic commissioning bodies, organised around city regions.
That would resolve the perceived problem of PCTs being “too small” to negotiate good value from large acute hospitals.
However, a spokesman for the Conservatives denied they were planning to merge SHAs and PCTs. He said it was “very clear that’s not what we are planning”. However they do foresee SHAs moving their focus away from providers as more become foundation trusts.
Both Tory leader David Cameron and Mr Lansley have pledged they will not subject the NHS to another round of structural reorganisation.
Mr Lansley said PCTs would play an important role organising contracts between commissioning consortiums and acute providers.
The Conservatives will also expect PCTs to negotiate prices for acute care at a rate under the payment by results price – a plan that will only work if PCTs can get acute trusts to compete for their custom.
Management consultants advising the party have said it should allow private contractors to take over SHA functions on a “franchised” basis.
Organisations smaller than SHAs, charged with a mixture of current SHA and PCT roles, would be attractive to private sector commissioning organisations that have been disappointed by the opportunities and size of contracts available to them under the framework for procuring external support for commissioners (FESC). These could resemble US-style health management organisations if GPs were allowed to choose which they contracted with.
Nick Bosanquet, consultant director of the think tank Reform, said work at the Nuffield Trust to develop an NHS funding formula more sensitive to individual health needs would make it possible for patients to choose their commissioner.Read Full Post | Make a Comment ( None so far )
The Department of Health has denied claims the foundation trust pipeline is “on hold” despite a significant slowing of authorisations. Last year, there were 25 authorisations between January and August; this year there have been 10.
Monitor has said it is concerned about the lack of applicants. Its executive chair Bill Moyes this week criticised the government for the slowing transition to an all-foundation system. At the present rate, this would not be complete until 2015, he told the Financial Times. He said reform had slowed when Alan Johnson was health secretary and, although Andy Burnham backed change, he had been focusing on swine flu.
The chief executive of one trust expected to begin the authorisation process this autumn said it was effectively “on hold” because of uncertainty about the impact of the recession. Oxford Radcliffe Hospitals trust acting chief Chris Hurst said trusts needed more certainty about future income to go into the process. It was difficult at present for any trust to know “with complete confidence” that their plans were secure, he said.
More clarity should come in the 2010-11 operating framework this autumn, said Mr Hurst. “Until [the NHS and Monitor] have those parameters… the pipeline is probably on hold for acute trusts.”
NHS East of England strategy director Stephen Dunn said: “We have had a degree of slippage and that is taking people closer to our cut-off deadline of the end of the year [to enter the pipeline]. We expect people to rise to the challenge.”
A Monitor spokeswoman said it understood it was “difficult” to plan at present but the NHS would be able to deal with investment cuts better if more trusts became foundations.
A DH spokesman said: “The FT pipeline remains a priority and has not been put on hold. NHS trusts applying to be FTs have a clear framework… [for] their financial plans. The number of applicants has always varied quarter by quarter.”Read Full Post | Make a Comment ( None so far )
A study claims the high interest rates being charged for private finance initiative projects are helping banks restore their profits.
Researchers at Edinburgh University claim the quality and financial performance of NHS services is being impaired because PFIs are forced to pay “unjustified” interest rates.
They say the government is allowing banks to restore profit levels at the expense of PFIs and that the opportunity presented by the taxpayer takeover of two major banks to negotiate better interest rates has been missed
The team analysed the 149 major PFI hospital projects that have been signed by the NHS so far.
They found that two banks in which the government is the major shareholder – Royal Bank of Scotland and Lloyds – have lent money to or invested in 54 separate PFI projects.
In total these projects have raised £12.27bn under PFI, but over the next 30 to 60 years the public sector will pay off a total of £41bn in capital costs alone.
Professor Allyson Pollock, of Edinburgh University’s Centre for International Public Health Policy, said: “Instead of using the opportunity of the taxpayer bail-out to reopen the contracts, the UK government is allowing the banks to restore their balance sheets.”Read Full Post | Make a Comment ( None so far )
PCTs are no longer facing an October deadline to decide what to do with their provider arms, a DoH letter reveals.
The move represents a softening of the DoH line on the need to separate PCTs’ provider and commissioning functions.
But it does mean that GPs directly employed by trusts will be waiting longer to find out whether they are to be farmed out to private companies or social enterprises.
PCTs were originally told to come up with plans for how to spin off their community service provision by October 2009. The options on the table include creating a social enterprise and integrating them with other NHS organisations.
But in a letter sent to PCT and SHA bosses, NHS chief executive David Nicholson said that ‘we will take a more flexible approach to the timetable’.
SHAs will now be in charge of deciding a timetable for developing and testing the plans, he said.
‘This does not represent a change in policy,’ he added. ‘It is about keeping PCT decisions safe while moving faster, not slower, to deliver transformation.’
The DoH previously expected all PCTs to spin off their pro-vider arms into entirely new bodies.
But it has recently softened its stance. PCTs are now able to retain their provider functions, where there is ‘strong leadership’ and ‘proper and sufficient separation from commissioning’.
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Health campaigners warn of slippery slope to privatising NHS
ANTI-PRIVATISATION campaigners are calling on patients to boycott a new “super-surgery” in Euston.
Private company Care UK as been named the preferred bidder to run the GP-led health centre ahead of a consortium of south Camden doctors and without any consultation.
NHS Camden, the borough’s Primary Care Trust, believes it does not have to consult on the centre, which is expected to open in Hampstead Road in December.
But lawyers disagree and are poised to launch a legal challenge that could stall the process and land NHS bosses up in the High Court.
Candy Udwin, chairwoman of Camden Keep Our NHS Public, said: “A privatised GP health centre is just the next step on the privatisation road that threatens the National Health Service as we know it. We are telling patients at nearby surgeries to boycott the health centre.”
The decision to give millions of pounds of NHS funding to a private company, ahead of a consortium of local doctors, mirrors the decision last April to award the American healthcare giant UnitedHealth contracts to run three south Camden surgeries.
Decisions on who runs what are made by NHS Camden board members and overseen by the official patients’ representative group, Camden Link.
Link chairman Neil Woodnick, who sat in on the committee that awarded United Health a contract, said: “We asked, specifically about the GP-led health centre, how much weighting there was on value for money. I was told 70 per cent was quality of the service, and 30 per cent was value for money.
“The big thing about United Healthcare was that value for money seemed to come in later. It was said that the PCT moved the goalposts during the consultation. Value for money suddenly became an important thing – UH bid £25 less per patient than the GPs.
“The fact is that these contracts are set up as legal contracts obliged to offer it to other firms. You cannot say we are not prepared to take any bids from the private sector – it’s illegal to do that. The whole thing is about outcome.
“Are the patients satisfied? If you look at United Health practices, the numbers of patients has increased r oughly by 8 per cent. If they are not happy, patients will walk with their feet.”
Campaigners are to sue the NHS after control of a new health centre was awarded to a private company.
GP leaders in London are demanding that NHS Camden rethink its decision to award the contract for a new GP-led health centre to private company Care UK.
They warned there is ‘no evidence’ that the PCT ‘has effectively or meaningfully consulted with the people of Camden’, and urged trust bosses to reconsider, claiming the centre is not the best use of resources or most effective way to provide care.
In an open letter to the PCT’s chair, Dr Paddy Glackin, medical director of Londonwide LMCs, said local GPs had concerns about the scoring system used to award the contract, as well as the extent of public consultation.
It comes as the Keep Our NHS Public campaign group mulls whether to press ahead with a legal challenge to the contract award.
The anti-privatisation campaigners, supported by local GPs and patients, sent a ‘letter before action’ to the PCT on behalf of a local pensioner earlier this month.
They have now received a response from the PCT and are discussing with solicitors whether to proceed with the challenge.
In the letter released today, Dr Glackin said: ‘We have seen no evidence that the PCT has effectively or meaningfully consulted with the people of Camden about whether they feel that opening a GP-led health centre would be the best and most effective manner of spending money to improve their care. We seriously doubt whether this is the best use of scarce NHS resources.’
‘Given the PCT’s repeated failure to consult adequately with the local community we call on the PCT board, its executive and non-executive directors, to reconsider its decision to award the contract at this time and to ensure that adequate meaningful consultation with the local community occurs in all future tendering processes.’
Dr Glackin added: ‘We have concerns about the scoring system used by the PCT, which gives no weighting to local knowledge or experience. We believe that organisations and individuals with a proven track record of providing high quality clinical services to the people of Camden should have had some recognition of that fact. ‘
And he also raised concerns about whether the new centre – near Euston and St Pancras stations – would be used more by commuters and walk-in patients than by local patients.
A spokesperson for NHS Camden said: ‘Unfortunately we have not yet officially received this letter from the LMC. However, if the contents are the same as the text sent to the newspaper, then we are very surprised at the LMC’s views.’
‘Throughout the tendering process for the GP led health centre, a representative from the LMC was involved, taking an active role in the decision-making process, and they raised no concerns with process or the final outcome.’Read Full Post | Make a Comment ( None so far )
The majority of Conservative MPs support moves to give the private sector an increasingly prominent role in the NHS in the future, a new survey has found.
The cross-party poll of 150 MPs found that Conservatives, younger MPs and those from the south of England were most likely to view the NHS as unsustainable in its current form, and most supportive of the need to involve the private sector.
The survey by COMRES on behalf of BMI Healthcare – which will come as a blow to Tory leader David Cameron’s campaign to present the Conservative party as ‘the party of the NHS’ – suggests that the predicted high turnover of MPs at the next general election will lead to greater support for the private sector.
Over three quarters of Conservative MPs agreed that the NHS should fund patients’ treatment through private providers if it reduced waiting times, compared to 47% of Labour and 55% of Lib Dem MPs.
Similarly, 67% of Conservatives agreed that patients should receive co-payments for treatment funded jointly by the NHS and the private sector, compared to 36% of Lib Dems and 14% of Labour MPs.
Party disagreements were stark on whether private providers should be invited to run NHS hospitals where they had failed to meet minimum standards of care, with 84% of Conservatives agreeing, compared with 30% of Lib Dems, and just 17% of Labour.
Over two thirds of Conservative MPs supported the introduction of income tax relief on standard rate income tax for private medical insurance, compared to just 5% of Lib Dems and 1% of Labour MPs.
Similarly, 55% of Conservative MPs supported the introduction of tax relief on private healthcare fees, compared to just 1% of Labour MPs.
The survey found that 72% of MPs born before 1950 believe the current NHS model is sustainable for the next 60 years, compared to 42% of MPs born after 1960.
There was also a regional split of opinions – with 82% of MPs from the North believing the NHS is sustainable, against 52% in the South.
Andrew Hawkins, chief executive of Comres, said: ‘These results show that Conservatives and younger MPs are more sympathetic to the role private sector companies can play in the NHS than their older, non-Tory counterparts.
‘Given that we can expect a relatively high turnover of MPs at the next General Election – perhaps more than a third of the House – we should expect that the direction of travel for the House is towards more support for private sector involvement in the health service.’Read Full Post | Make a Comment ( None so far )
A HALT has been called on a new health centre project for Pendle amid a financial crisis in the NHS.Read Full Post | Make a Comment ( None so far )
Planning permission for the new GP-led health centre, scheduled to open in spring 2010, has been given the go ahead by Wandsworth Borough Council. Situated right next door to the Clapham Junction Station entrance, on Grant Road, this state of the art centre will be constructed in a very convenient location for people living in the Battersea and north Wandsworth, particularly its younger population, not registered with a GP or finding it difficult to fit appointments into their busy lifestyles.
A change of use planning application was submitted to the Council in May 2009, outlining proposals to redevelop five railway arches. Currently used as storage, over the next six to eight months this space spanning over 500 square metres, will be transformed into a contemporary, purpose built medical centre.
With a wide range of services for both registered and unregistered patients, the centre operated by Care UK will open from 8am to 8pm, seven days a week, including all bank holidays. It will offer bookable and walk-in appointments, diagnostic testing and treatments for minor illnesses and injuries. It will also provide additional GP registration capacity in the area for up to 6,000 new patients.
Graham Mackenzie, Director of Commissioning, NHS Wandsworth said: “Based in the heart of a busy residential and commuter area, the new service could not have been placed in a better location. The GP led-health centre will significantly extend the healthcare options open to people living and working in Battersea and north Wandsworth. Not only complementing existing GP provision, including the 12 GP surgeries already offering increased opening hours in the area, the centre also allows us to provide the additional services local residents told us they wanted as part of their response to the Battersea and north Wandsworth consultation.”
In May 2009, Care UK, who will be supported by AT Medics were awarded a five year contract to run the GP-led health centre. This contract will be reviewed regularly to ensure levels of patient satisfaction remain high and the provider consistently meets and maintains a range of targets, known as Key Performance Indicators (KPI).
Working in close partnership with these two organisations means NHS Wandsworth and local residents will benefit from Care UK’s vast experience of setting up and running similar centres across the country, as well as AT Medics’ extensive clinical and healthcare knowledge of the south west London area.Read Full Post | Make a Comment ( None so far )
A NEW GP health centre will bring more services into Blackburn and slash the number of patients per doctor.Read Full Post | Make a Comment ( None so far )
The increasing numbers of GPs who organise themselves into companies to bid for contracts from primary care organisations should ensure their company has adequate indemnity in place, according to the Medical Defence Union (MDU).
GPs’ individual indemnity will not cover their company if they are sued because of a failure in company procedure or the actions of a staff member for whom it has vicarious liability.
The MDU has introduced an insurance policy for companies which dovetails with the policy that individual members receive to ensure all their clinical negligence claims are covered.
Dr James Armstrong, MDU medico-legal adviser, said: ‘While an individual doctor may be sued for missing a diagnosis of breast cancer, the company could also be sued if, for example, errors in the system for reporting laboratory results were found to have contributed to a delay in diagnosis.
‘Companies are also vicariously liable for the staff they employ and could, for instance, be sued if a nurse failed to follow correct protocols when immunising a patient, resulting in the administration of a wrong vaccine.’Read Full Post | Make a Comment ( None so far )
The latest development as part of North East Lincolnshire CTP’s Estate’s Strategy, Freshney Green Primary Care Centre, opens its doors to patients on Monday 7th September.
Three local GP practices, Field House Medical Centre, the Littlefield Practice and the Woodford Medical Centre, will move into the new £14m health centre and will provide improved and extended services to patients.
A wide range of services will be available under one roof, including dental services, a new mental health unit, a pharmacy, minor surgery and community health and social care services. The centre will also include a café run by Jobs4All, offering work opportunities to adults with learning disabilities.
Dr Derek Hopper from Fieldhouse Medical Centre said:“All three practices will still be offering the same family doctor services and will remain as separate practices but will work together for the benefit of patients. Patients can be reassured that they will see the same doctors and nurses, just from new and improved premises and they will continue to be registered with their current practice.
“The centre will be a focus for service development and education. The centre has been approved as an advanced training practice, the only one in the area, and will offer multi-disciplinary training opportunities. It will help to attract high quality new staff to the area”
Jane Lewington, Chief Executive of North East Lincolnshire CTP said: “The centre will offer a greater number of services under one roof. It is the eighth development to be completed as part of the CTP’s Estate’s Strategy which has beensuccessful in transforming the provision of primary care services in NE Lincolnshire.
“Freshney Green is unique in a number of ways. It has been designed to give careful consideration to its carbon footprint with the inclusion of solar panels and rain water collectors. It represents a high level of quality throughout the design, materials and delivery of the project. It is also the first of our primary care centre to provide new surgery accommodation for a local dental practice. This has been made possible by the commitment of everyone involved following long and detailed negotiation, and careful project planning and design to deliver state of the art facilities for NHS patients.”
The address of the new centre is:
Freshney Green Primary Care Centre
Sorrel Road (formerly Central Parade)
The three practices will have new telephone numbers as a result of the move as follows:
Fieldhouse Medical Centre Tel No: 01472 254600
Littlefield Tel No: 01472 246100
Woodford Medical Centre Tel No: 01472 372100
The centre has been developed and funded by Assura, a leading health provider organisation and primary care investor along with development partner LSP Developments.
Amanda Horley, regional development manager at Assura said:
“Together with LSP Developments we are delighted to have completed this state of the art facility and provide a high quality building. It will make a significant contribution to improving healthcare facilities locally, as well a being an important part of the overall regeneration of the area.
“ Assura is also providing an integrated pharmacy service which, in addition to the store being physically located close to the surgeries, means working closely with local GPs to meet the individual needs of our patients.
” The co-location of the new pharmacy will mean that patients will be able to have their prescriptions completed before they leave the Centre. The store will also offer a free prescription collection and delivery service, dropping off medicines to a home or work address within the local area. The store also has 2 private consultation rooms where Assura pharmacists will be happy to discuss any health concerns with patients.Read Full Post | Make a Comment ( None so far )
More than a fifth of GP practices employ practice nurses in extended hours, but just 8% receive funds to pay for it.
A poll by GP newspaper found practices are losing up to £30,000 a year from extended opening hours.
The survey, of 301 GPs, also found 27% felt relationships between partners, staff and managers had become strained since the introduction of extended hours last year.
In England, the extended hours directed enhanced service only pays practices for GPs’ time, while the Welsh and Scottish governments provide extra funding for nurses.
The BMA has always argued that practice nurses and receptionists are vital for a ‘meaningful’ extended hours service.
Many practices have agreed more flexible local deals with their PCTs, but the poll found just 8% have negotiated funding for practice nurse time.
Sara Richards, former chair of the RCN practice nurse association, said the government risks making practice nurse shortages worse with under-funded, ‘wearying’ initiatives.
‘Any new work takes so long to negotiate and the government never seems to realise this. As soon as you get organised with one initiative, another comes along, she said.
‘There is a lack of practice nurses anyway, and in the future it will be considerably worse. We may get more nurses simply leaving practices if they feel they are being made to work long hours. This will certainly cause problems, especially for single-handed GPs.’
- Read the full version of this story in this week’s Independent Nurse dated 24 August.
The use of overseas doctors to cover out of hours and weekend care must be reviewed due to potential safety issues, according to GP leaders.
Professor Steve Field, chair of the Royal College of GPs, said the college was worried about the quality of out of hours care provided for patients in some parts of the country.
He said: “It is the responsibility of primary careorganisations to ensure that patients receive good quality care by commissioning appropriate services. This is obviously not working and something needs to be done.
“We believe a radical review of out of hours and weekend care is needed,” he said.
His comments follow the recent case of a 70 year old man in Cambridgeshire who was accidentally killed by an overdose of painkillers delivered by a GP from Germany on his first shift in the UK.
Professor Field added: “I am particularly worried about the use of doctors from Europe flying in to provide out of hours care and then flying back to their home countries to provide services there.
“Doctors from Europe who come to the UK to work in out of hours services must prove they are of the same quality as our home-grown doctors. We are not convinced there are appropriate checks in place to ensure they are,” he said.Read Full Post | Make a Comment ( None so far )
A poll has revealed that two-thirds of Conservative MPs support tax relief on private health insurance, reigniting controversy over the party’s commitment to the NHS.
Chancellor Alistair Darling accused the party of having “two faces” when it came to healthcare.
Shadow health secretary Andrew Lansley insisted the Conservatives were committed to ensuring people had access to high quality healthcare without the need to take out private insurance.
However, he said a “serious debate” was needed on how healthcare was best delivered through the NHS.
Some 66 per cent of Tories supported tax relief on standard rate income tax for private medical insurance, according to a poll of 150 MPs.
In contrast, the ComRes poll for private hospital group BMI Healthcare revealed that 1 per cent of Labour MPs and 5 per cent of the Liberal Democrats backed the idea.
More than half the Conservatives – 55 per cent – backed the introduction of tax relief on private healthcare fees, compared with only 1 per cent of Labour MPs.Read Full Post | Make a Comment ( None so far )
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