Archive for October, 2009

New GP practices open doors on Monday

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

Rochdale Online | NHS Heywood, Middleton and Rochdale | 30 October 2009

Two new GP practices are set to open on Monday (2 November). 

The Kirkholt Medical Centre, located on Queens Drive, and The Kingsway Practice located at Morrisons, Kingsway will have four new doctors and be open from 8:30am to 6pm, plus a further four hours per week, of which 90 minutes will be on a Saturday. 

Both practices will offer core GP services as well as focussing on cardiovascular disease, diagnosis and treatment of hypertension and diabetes, stop smoking service, weight management service and Choose and Book. 

John Pierce, Chairman of NHS Heywood, Middleton and Rochdale, said: “I have managed to get a sneak preview of the practices and meet staff before they open and think they are a fantastic addition to general practice in Rochdale. 

“These new practices will provide the additional resource needed to start tackling key health issues in Rochdale, as well as providing routine treatment and care. 

“They will also help to make getting a GP appointment easier and relieve some pressure from GPs in the surrounding areas. Both services are proactive in their nature and will seek to build relationships with the local community to ensure that the care they provide meets local needs.” 

Oldham-based Go to Doc Primary Care will be providing services at The Kirkholt Medical Centre and Rochdale-based GP Care Services will be running The Kingsway Practice. 

Another practice will open in Heywood on 1 December, as well as a GP-led health centre in Middleton, where patients can either register or walk in and see a GP.

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Four new polyclinics planned for Redbridge

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

Yellow Advertiser | By Peter Henn | NHS Redbridge | 29 October 2009

REDBRIDGE will be the first borough in the country to implement a radical change in the way people receive their healthcare. 

NHS Redbridge, which provides GP services to residents in the borough, is set to follow up on the success of Loxford Polyclinic, in Ilford, by establishing four further units. The Loxford Polyclinic opened earlier this year. 

The Trust is planning to set up polyclinincs in Cranbrook, Fairlop, Seven Kings and Wanstead wards, which will serve a population of around 50,000 people each. 

Health bosses claim the new way of working will mean people will be treated for the majority of ailments in their own area. 

NHS Redbridge’s borough managing director, Conor Burke, is ‘confident’ the polysystems were the way forward. 

He said: “We know people want easier access to health services in terms of both journey times and opening hours. 

“We are leading the country in what is a very innovate approach to healthcare.” 

Dr Narinder Sharma, clinical director for Loxford Polysystem, wants to establish a ‘seamless’ service for patients near their homes. 

He said: “The vision of the polysystem is to bring more services out of the hospital and into the heart of the community with local clinicians working with secondary care colleagues and stakeholders.” 

The news comes as the Trust announced it will transfer control of its £400million budget to health professionals. 

The scheme will see GPs call the shots about how and where health cash is spent, and will be responsible for commissioning services and meeting Department of Health targets. 

* The PCT is calling for people to come and join the panels, which will help shape the way healthcare is provided in their area. 

The Trust is currently looking for people to join the panels for the Cranbrook, Fairlop, Seven Kings and Wanstead polysystems. 

For more, call Amy Burgess on 020 8926 5048 or e-mail amy.burgess@redbridge.nhs.uk

Email: redbridge@yellowad.co.uk

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Company struggling to find site for new health centre

Posted on October 30, 2009. Filed under: Uncategorized | Tags: |

Leicester Mercury | NHS Leicester County & Ruthland | 30 October 2009

A private company brought in to run a new health centre in Leicestershire is struggling to find premises to open.

United Health Primary Care, which won the contract from NHS Leicestershire County and Rutland, was due to have the centre up and running by the end of the year.

But two planning applications to convert empty shops – one in Oadby and one in Wigston – have both been rejected by planners.

Now, bosses at the company, which is also due to open a GP practice in the city centre for NHS Leicester City, have asked for help in finding premises.

Once up and running, it will open from 8am-8pm, seven days a week, and anyone needing to see a GP can turn up without an appointment and does not have to be registered with the doctors.

There will also be a new GP practice within the centre to cater for a total of about 3,500 people once fully established.

But the plans have caused controversy with local residents and among GP practices.

Doctors are worried that a new practice will take patients from their surgeries and force them to close or cut back on services.

They say money would be better spent on helping to modernise and expand existing practices in the area.

But a spokesman for NHS Leicestershire County and Rutland said: “The development is part of a drive by the primary care trust to offer greater choice and convenience by providing a wider range of services for patients with a variety of needs and at times which are convenient to them.

“The Oadby and Wigston area was chosen as a preferred location because there are areas there that have higher than average levels of hospital admissions and there are fewer community health services currently available.

“We are now looking at other options regarding the exact location of the premises.”

The Leicestershire County Council’s health scrutiny committee has already backed a new health centre for the area.

Tony Sampson, director of external affairs for United Health Primary Care, said there is now a possibility of using premises already owned by NHS Leicestershire County and Rutland.

He is optimistic that the company will be able to open the new health centre and GP practice by the end of the year.

He said: “We would have liked to have been offering services before now but we hope to open as soon as possible.”

He said that plans for a new GP practice were still on track.

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Health trust faces legal review

Posted on October 30, 2009. Filed under: Arm's length providers, News stories | Tags: |

Hull & East Riding Mail | 30 October 2009

A judicial review has been called for over NHS Hull’s decision to transfer frontline health services to a social enterprise company.

As previously reported in the Mail, the primary care trust (PCT), wants to transfer staff and services, including district nursing and health visiting, to City Health Care Partnership (CHCP).

Now, the move, which has faced criticism from unions, has been delayed after NHS Hull received a call for a judicial review.

The trust said it was initially served notice of a proposed claim for a judicial review “by an individual” last month.

The claim was disputed by NHS Hull’s solicitors, but the PCT has subsequently received a formal claim.

It now has to file a “formal acknowledgement of service” to the court by mid-November and the court will then decide whether or not to undertake a judicial review.

Tina Smallwood, director of human resources at the trust, said it is aiming for the services and staff to separate from NHS Hull during or before March.

However, this could be delayed further if the courts decide to review the decision.

Ms Smallwood said: “NHS Hull has received a claim for judicial review.

“This means a legal challenge has been made against the decision taken by NHS Hull to transfer its provider arm to a community interest company.

“The primary care trust is required to compile a response by mid-November, following which the case may enter the judicial system.”

As reported in yesterday’s Mail, Unite, alongside other staff unions, will be asking managers at the PCT to hold a ballot of the staff as to whether they are in favour of transferring to CHCP.

Ray Gray, regional officer for Unison, said: “We are aware of the judicial review.

“I believe it’s two patients who have asked for it.

“The reason they have done it is because the public weren’t consulted and they were completely unaware of it.

“In April, the trust said it was advised by solicitors it didn’t have to consult the public. That’s a stupid move.

“It’s a major change to health services in Hull and there’s no way they can get away with it without consulting the public.”

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Closing A&E just doesn’t add up

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

Ilford Recorder | 29 October 2009

THERE are worrying inconsistencies in the information from NHS Redbridge and Barking, Havering and Redbridge University Hospitals Trust (BHR) in proposing the closure of King George’s A&E.

Heather O’Meara, for example, from NHS Redbridge, claims that 200 people from Redbridge in an eight-week period used the Loxford polyclinic for urgent treatment who might otherwise have used King George A&E.

But this figure (averaging just 25 per week, all of them self-selected as minor cases) is not significant in the context of the sustained high caseload seeking A&E care at KGH and Queen’s Hospital over the past decade and more.

In the past full year the BHR Trust dealt with 177,000 first attenders at A&E – equivalent to 3,400 per week.

The 200 who attended Loxford polyclinic between 8am and 8pm was less than one per cent of the Trust total in the same period.

According to Ms O’Meara, 76,000 people attended KGH A&E last year – the Loxford polyclinic caseload is equivalent to less than two per cent of these.

Incidentally, BHR also admits that KGH is its only hospital meeting waiting time targets for A&E, while Queen’s lags behind.

But more significant are the very large numbers of local patients who require emergency admission to hospital. The most recent full-year figures show almost 50,000 emergency admissions to Queen’s and King George – NONE of which could be properly treated in Loxford polyclinic.

Given the evident chronic pressure on beds at Queen’s, where red alerts run for weeks at a time, and the persistent above-average and increasing bed occupancy in the BHR Trust, it seems unwise – and even dangerous – to close the KGH facility for emergency admissions, and run the risk of swamping both Queen’s and Whipps Cross with cases they are not resourced to handle.

It is impossible not to conclude that the “clinical” arguments wheeled out by trust and PCT bosses are a smokescreen to divert attention from the real reason for these changes – the trust’s disastrous £105million cumulative deficits.

DR JOHN LISTER

Director 

London Health Emergency

GPs ‘back axing of hospital A&E’

Ilford Recorder | NHS Redbridge | 25 October 2009

GPs IN REDBRIDGE are backing plans to axe King George Hospital’s A&E department, it was claimed this week.

In a meeting at the Barley Lane, Goodmayes hospital on Monday, health chief Heather O’Meara told the Recorder clinicians, including doctors, nurses and midwives, support the proposals.

And Ms O’Meara, who is sector chief executive for outer north east London, which is driving the changes, stressed the plans were different to the ill-fated Fit For the Future proposal in 2006.

“This process has been absolutely clinically driven from the beginning. It’s not being management led,” she said. 

The proposals by Health for North East London are the result of regular meetings by six working groups made up of medical staff. 

Stephen Burgess, who is leading the urgent surgery clinical working group, said: “I think there’s a view that the care people are getting within north east London is not as good as it could be.

“The public perception of an A&E and what it actually does is very different. Only 15 per cent of the people we see are actually ill or injured enough to need admission to hospital.”

The remaining 85 per cent are already starting to consider going elsewhere, such as to a polyclinic for emergency treatment. 

Ms O’Meara, who is also chief executive of NHS Redbridge, added: “Within the first eight weeks of Loxford Polyclinic opening, 200 people presented there, who would have been emergency patients.”

One thousand people also registered with a GP at the polyclinic, many of them for the first time.

Mr Burgess added: “This is not about the closure of King George Hospital and not about not having urgent care.

“There will be a 24/7 facility at King George where things like diagnostics, blood tests and rapid blood tests will be carried out.”

Since 2006, heart patients have been taken to the London Chest Hospital, Bethnal Green and stroke and trauma victims to Queen’s Hospital, Romford. 

Patients with other injuries are taken to their nearest A&E.

Ms O’Meara added: “Ten per cent more people survive a heart attack if they are taken straight to the specialist hospital and we want to deliver the best healthcare outcomes for Redbridge.”

Dr Hector Spiteri, Redbridge GP and Clinical Director for Seven Kings Polysystem, said yesterday (Weds): “The Health for North East London proposals have been developed by local doctors and are all about improving the care we provide to our patients.

“These plans will help us medical practitioners do more to enable people to live healthy lives and significantly improve health outcomes across north east London.” 

KGH looks set to hold on to its rehabilitation services and outpatient services such as chemotherapy, securing the future of the hospital’s Cedar Centre, built with the help of funds raised by Recorder readers.

The 14-week consultation is due to begin in November but the plans will be tested by the Joint Committee of PCTs and the Department of Health.

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Exclusive: Tories to end UK GP contract and write new one

Posted on October 28, 2009. Filed under: News stories | Tags: |

Healthcare Republic | By Tom Ireland | 28 October 2009

Shadow health secretary Andrew Lansley has confirmed there will be a new GP contract if the Conservatives take office.

After his speech to the NHS Alliance conference in Manchester last week, Mr Lansley told GP newspaper that in order to put commissioning responsibility in the hands of GPs: ‘We would need a new contract. And legislation, too.’

A Conservative spokesman confirmed the UK-wide contract would be split up, as the commissioning policy would be enforced in England only.

Mr Lansley insisted that the ‘real budgets’ GPs will be handed to buy and organise health services locally will be kept separate from practice income: ‘If [GPs] have a deficit on their budget it doesn’t come out of their practice’s income.’

However, GPs who persistently fail to balance the books could lose their contracts, the Conservative spokesman made clear.

Mr Lansley also confirmed that GPs will be able to let GP consortia or private firms commission on their behalf.

Following ‘considerable discussions’ with the GPC, the Conservatives are now working on the best way to use data to work out how much GPs are allocated.

The shadow health secretary added that the outcomes-focused QOF the Conservatives plan to develop should mean GPs’ efforts to redesign services are rewarded as public health improves.

GPC chairman Dr Laurence Buckman said he would discuss funding plans for GP commissioning in detail only if the Conservatives are elected next year.

But his main concern was how GP income is kept separate from commissioning performance. He suggested GPs may be put off if their basic income was under threat.

He added: ‘What happens if the money runs out? What happens to GPs who are not trained or not very good, at managing budgets?’

Dr Buckman was also concerned about GPs being able to hand commissioning responsibility to private companies. ‘Consortia aren’t a worry, private companies are. That will allow the private sector to get into all sorts of things, like commissioning services from themselves.’

  • Read this week’s GP dated 30 October for the full version of this story
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Heart Of Hounslow Is A Big Hit, Local Residents Give Polyclinic Thumbs up

Posted on October 28, 2009. Filed under: News stories, Polyclinics, Providers | Tags: |

The Gov Monitor | Source: NHS Hounslow | 28 October 2009

The Heart of Hounslow has been a big hit with local residents in its first six months as a polyclinic.

Over 11,000 people have used the walk-in service (known as The Practice Heart of Hounslow, open 8am to 8pm every day of the year) and over 2,000 patients have chosen to register at the new GP practice.

This demonstrates its value to local residents by providing convenient and accessible high-quality services.

Polyclinics deliver a one-stop-shop approach to healthcare by making it possible to access a wide range of services in one centre. New services at the Heart of Hounslow include access to cardiology services and a range of diagnostic tests and treatments, usually only available within a hospital setting, since September 2009. The range of services at The Heart of Hounslow polyclinic continues to expand:

  • patients will be able to access onsite x-ray, ultrasound and mammography services, usually only available within a hospital setting, in February 2010. It will be possible for patients to have their scans within the hours of GP referral for x-ray and ultrasound
  • healthy food café and advice will shortly be available in the new Health Zone. The new Crussh café will specialise in fresh juice, smoothies and healthy eating

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NHS Hounslow Chief Executive Nick Relph says “Polyclinics are designed to make it easier for people to receive better health and social care where and when they need it. The walk-in service complements the GP care that already exists in Hounslow by giving patients additional access to care at times when surgeries maybe closed or difficult to get to. As well as this, we have made it easier for people to get an appointment with a GP when they want one — most of our GPs open for longer earlier in the morning, later in the evening and on Saturday mornings.”

Nick added “We know a lot of people go to A&E with problems that aren’t life threatening or are worried about their health. Often it’s because people aren’t sure where the best place to go is or because other services are closed. Offering routine access to a GP for 12 hours every day of the year at a town centre location should reduce the need for patients to use hospital accident and emergency departments. Patients do not need to register to use a walk-in centre at The Heart of Hounslow polyclinic and no appointment is needed.”

Dr Michael Tsamis, GP at The Practice Heart of Hounslow walk-in centre says “I have been a GP since its opening and I have been pleasantly surprised by the large numbers of patients that use our service. Clearly they have had positive experiences as many of them subsequently decide to join our surgery list.”

Dr Tsamis added “I have treated patients with a wide variety of acute and chronic clinical conditions such as chest and urinary infections, asthma, hypertension and diabetes. These patients would have either had to face a potentially very long wait in a crowded A&E department or wait unnecessarily to access the services from their own doctor.”

NHS Hounslow is responsible for the health of over 250,000 people living in Bedfont, Brentford, Chiswick, Feltham, Hanworth, Heston, Hounslow and Isleworth. We plan, deliver and purchase a range of care and treatment to meet local health needs.

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We use NHS money to make a difference to

  • decide how NHS funds are spent locally
  • arrange for healthcare in hospitals, in community and by GPs and dentists
  • ensure there are healthcare options and choices for patients
  • improve the standard of healthcare
  • advise and help local people on staying healthy

More www.hounslowpct.nhs.uk or follow us on Twitter www.twitter.com/NHShounslow

Services at The Heart of Hounslow polyclinic includes: four GP surgeries; one walk-in centre for minor illnesses and injuries; community services (that includes district nursing, midwifery); diagnostics; out patient services; well being and support.  In addition to these services, The Heart of Hounslow also offers stop smoking support and sexual health services.

The GP walk-in centre operates seven days a week, from 8am to 8pm, including bank holidays. Any member of the public can walk in and see a doctor. They don’t need to be registered with the centre and can remain registered with their own local GP practice as well seeing a GP at The Heart of Hounslow walk-in centre, if it is more convenient.

Walk-in centres offer fast access to health advice and treatment. Some examples of conditions that may be treated include: cuts that need stitching or dressing, sprains and strains of muscles and joints, minor bone fractures – such as broken ankles or wrists, superficial burns, removal of foreign bodies, skin complaints such as rashes and bites and stings.

The Heart of Hounslow can be found on 92 Bath Road Hounslow TW3 3LN.

Hounslow’s new polyclinic gets the thumbs up with residents, after just one month

The Practice | News | 2 June 2009

The Heart of Hounslow has been a major success in its first month open as a polyclinic, with1,333 patients using the 8am-8pm walk-in service.

People can use the walk-in service even if they have not registered with a GP; they can call and ask for an appointment on 020 8104 0810 or walk in and ask for an appointment. For continuity of care we recommend that patients register with a GP.

A number of extra services were added to the existing The Heart of Hounslow to make it a polyclinic. For example, a walk-in service is open 8am-8pm every 365 days a year including weekends – for registered and unregistered patients – so everyone has the opportunity to see a GP at a time which is convenient to them. Ideally, people should see their own GP, but this gives another option for where, when and how they are treated.

NHS Hounslow’s Chief Executive Nick Relph said: “We are very pleased to see how popular this new service has been to provide local people with a new, improved choice for receiving health care.”

Nick added: “Offering routine access to a GP for 12 hours every day of the year at a town centre location aims to reduce the need for patients to use hospital accident and emergency facilities, for illnesses they would normally see their GP for. It complements the GP care that already exists in Hounslow by giving patients additional access to care at times when surgeries maybe closed or difficult to get to.”

Commenting on the walk-in service, local patient Mrs Khan said: “My mother-in-law recommended this service to me as my small children always seem to be ill on a Friday. These services give me great peace of mind that I can get a doctor to see them quickly and easily.”

The local pharmacy, located near the polyclinic at 106 Staines Road, is open now from 8am- 8.30pm, seven days a week, allowing patients to get their prescriptions at a time convenient to them. Herbert & Herbert pharmacist and co-owner Mr Sagar Patel said the increased number of patients they have served in the last month have told them that it is very convenient in having a pharmacy open till later hours that match the opening hours of Heart of Hounslow polyclinic.

Mr Patel said: “They also say it is good that they can pick up their prescription straightaway from us after seeing the health professionals there; especially in urgent cases when they need painkillers or antibiotics, for example.”

The Walk-in services at Heart of Hounslow polyclinic are provided by The Practice plc. The Practice is a primary care company providing innovative community based healthcare for the NHS. Founded in 2005 by two GPs they are one of the UK’s leading providers of primary care services.

For further information on this news item please contact Sarah Jeffery on 01494 690930

 

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Fylde super clinic opens

Posted on October 28, 2009. Filed under: GP-led health centres, News stories, Polyclinics |

Blackpool Gazette Fleetwood | NHS North Lancashire | 28 October 2009

FLEETWOOD’S new health super-centre has officially opened.

The Same Day Health Centre provides care for patients with minor injuries and illnesses.

It is now open from 8am until 10pm every day.

The health centre is temporarily based at the Pharos Street side of Fleetwood Hospital but a new £10m building will open on Dock Street in early 2011.

This will have GPs, services for drug and alcohol problems, mental health and sexual health and possibly a new NHS dentist.

Those needing treatment for minor injuries or illness can see a GP or a nurse the same day.

Kevin McGee, director of commissioning and performance at NHS North Lancashire, said: “The centre gives people easy access to high quality healthcare services, particularly in the evenings and weekends.”

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GP leaders ousted following private firm’s report

Posted on October 28, 2009. Filed under: News stories | Tags: |

Pulse | By Lilian Anekwe | 28 October 2009

Exclusive: NHS managers are implementing draconian measures against GPs, including forcing local GP leaders to resign from their posts, following the recommendations of a private consultancy firm.

Guest_editor_stamp_120A report by accountancy firm KPMG has set out a series of measures to bring cash-strapped NHS Hillingdon back into the black, including appointing a new PEC chair more willing to drive efficiencies and clamping down on GP referrals.
Since the report was commissioned, Dr Chris Jowett, a GP in West Drayton, Middlesex, has resigned as chair of NHS Hillingdon PEC – for ‘personal reasons’, according to the PCT. Dr Sabby Kant, a local GP and former member of the PEC, said the PEC had ‘effectively been dissolved’ in response to the report.

Dr Mitcholl Garsin, a GP in Uxbridge, Middlesex, has also quit as chair of Hillingdon PBC group, although he remains chair of Hillingdon LMC.

The trust’s referral management scheme is to be scrapped and replaced with tougher management of GP referrals, with balanced scorecards to be used to penalise GPs for ‘inappropriate use of urgent care’.

It is the first of what is likely to be a series of cost-cutting measures introduced on the say-so of private consultants, after Pulse revealed the amount spent by trusts on consultants had tripled in the past two years.

NHS London parachuted in KPMG to audit NHS Hillingdon’s finances, and gave the trust just two months to apply the measures ‘to the letter’ in return for writing off its £20m deficit.

KPMG’s draft report, seen by Pulse, identifies the key reason for the overspend as ‘poor financial controls’ by NHS Hilling-don, but concludes that tough management of practices is the best way to balance the books.

‘GPs are not held to account for high referral patterns or inappropriate use of urgent care’, the report says, adding the PCT should review and manage primary care contracts ‘for value for money and quality [by] use of the balanced scorecard with incentives for compliance’.

The report warns demand for hospital services is ‘higher than planned’ even though the local referral management system successfully cut acute admissions for a range of conditions.

It urges the trust to review referral management and the urgent care centre at Hillingdon hospital ‘as an urgent priority’. Pulse understands six-month termination notices have since been served on both services.

KPMG said the PEC and the PBC group had failed to engage GPs, undermining their ‘ability to influence behaviours’.

The trust is facing a GP rebellion as it advertises for chairs who are prepared to, in KPMG’s words, ‘strengthen accountability for GP performance and their impact on PCT budgets’.

All 49 practices in the trust are now threatening to quit PBC.

Dr Garsin, chair of Hillingdon Health, the GP-led provider of the urgent care centre, told Pulse the PCT had made him choose between being PBC chair and LMC chair, because of ‘conflict’ between the roles: ‘They are putting all the blame on GPs – it’s incredibly unfair.’

A spokesperson for NHS Hillingdon said: ‘It is our duty to put in place cost-effective arrangements.’

HOW NHS MANAGERS HAVE FOLLOWED REPORT’S RECOMMENDATIONS

Recommendation: ‘Reconstitute the PEC and appoint a chair who is willing and able to take clinical leadership… Consideration should be given to how to reduce the potential risk of role conflicts.’

Action: PBC chair told he could not hold that and LMC role. PEC dissolved, with chair to be replaced.

Recommendation: ‘It is suggested the PCT recive its performance management framework to ensure it is aligned to achieving the strategic goals for the PCT through improved clinical service cost-effectiveness.’

Action: Balanced scorecards and referral audits to be used to examine and reduce referrals within practices.

Recommendation: ‘GPs are monitored via the balanced scorecard but we understand there to be no consequence of good or poor performance. In the absence of these controls the PCT’s ability to influence performance and ultimately its financial position is at risk.’

Action: High referrers to be penalised while high-performing practices are to be given incentives for compliance.

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Union calls for staff ballot on social enterprise plan

Posted on October 27, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | Kingston PCT | 27 October 2009

Staff at a Surrey PCT should be balloted over proposals to hive off NHS services into a social enterprise, according to union Unite/CPHVA.

The call to Kingston PCT follows the announcement by the DoH that the NHS should be the ‘preferred provider’ of choice.

Unite describes social enterprises as commercial organisations which can win and lose contracts to provide services to the NHS. It fears social enterprises may have to pay VAT, a tax from which the NHS is exempt.

Peter Storey, Unite’s regional officer, said: ‘It is clear that social enterprises are a leap in the dark in terms of provision of services; the employment conditions and pensions of NHS staff that could be severely eroded, or even lost; and the viability of the financial model proposed, if VAT is charged on its services.

‘You could get a situation where a visit by a health visitor to a young mum suffering from postnatal depression will result in the organisation having to pay VAT when it comes to internal accounting. That is unacceptable.’

Kingston PCT was unavailable for comment.

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A picture of health as GPs take the ‘polysystem’ lead

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

Public Service | NHS Redbridge | 26 October 2009

Clinicians will increasingly call the shots about how and where money is spent in the local health economy, says Conor Burke, borough managing director for NHS Redbridge primary care trust

NHS Redbridge (NHSR) is moving ahead with a phased handover of its commissioning function that could eventually see clinicians in east London gain control of an annual budget of up to £400m. NHSR’s decision reflects its Rich Picture, a map capturing the organisation’s five-year vision of bringing healthcare closer to people’s homes.

The borough’s three practice-based commissioning clusters were replaced by five “polysystems” earlier this year following more than a year of intense negotiation between the trust and health professionals. The new GP-led network of care professionals will have designated budgets and eventually be responsible for commissioning services and meeting statutory health targets set by NHSR and the Department of Health.

It reflects the organisation’s move towards providing better access to health services closer to home, as well as taking it a step closer to becoming a world-class commissioner.

The polysystems will:
• Promote the health and wellbeing of all the people in the community
• Maximise independence and quality of life for people with long-term conditions
• Improve services for people with non-critical acute care needs.

The decision to introduce the polysystem model is being driven by a commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The Royal College of GPs (RCGP) reinforces the need for a federated approach to primary healthcare with teams and practices working together to improve services in its paper The Future Direction of Healthcare: a roadmap.

Each polysystem covers a distinct geographical area of the borough comprising 50,000 people and is managed by a polysystem board made up of local clinicians.

Clinicians’ intimate understanding of their communities will help them design and deliver healthcare measures that not only address current need, but anticipate future trends such as the rise in diabetes and obesity.

NHSR recognises that the polysystem boards have little or no direct experience of commissioning services and will provide the necessary training and support via a Clinical Commissioning Board (CCB) made up of the five polysystem clinical directors and PCT officers. The transfer of commissioning duties will be phased in with the CCB monitoring the poly- system boards’ performance over a number of years.

Health practitioners will also be shown how to analyse their performance and to identify trends where appropriate resources need to be targeted.

The fledgling polysystem boards’ first challenge is looking at ways of reducing the number of first outpatient referrals made by GPs. There has been a 36 per cent increase in referrals in the past three years, with huge variations in referral rates between different practices. One practice made 400 per cent more cardiology referrals than a neighbouring practice, incurring an additional £130,000 in annual costs.

The referral management scheme aims to reduce first referrals for outpatient appointments by 30 per cent by April 2010, making a £3m saving. Several specialist areas have already been highlighted where referrals are noticeably high, including ophthalmology, dermatology, trauma and orthopaedics.

NHSR has introduced a savings incentive framework to encourage both GPs and polysystem boards to meet the challenge. The distribution of savings would be divided among GPs and polysystems to reinvest in their local community and NHSR.

Polysystems will play a key role in bringing the organisation’s Rich Picture to life by treating the majority of patients’ needs in the community, saving unnecessary hospital appointments. The polysystems will operate on a hub and spoke model with a polyclinic at the heart or hub of each polysystem with surrounding surgeries, pharmacies and hospitals forming the spokes that radiate out into the community offering a seamless level of healthcare.

The first polyclinic opened in April 2009. Loxford Polyclinic in south Ilford opens seven days a week and offers more than 20 services including GPs, an in-house pharmacy, healthy living café and a variety of services more traditionally based in hospitals, including diagnostics and outpatient appointments.

A unique point is the inclusion of community groups on the premises, with some 15 community and voluntary groups based at the polyclinic, offering advice, support and information on services including benefits, employment, housing and domestic violence.

The creation of polysystems also has the potential to save the NHS money at a time when it faces severe spending restrictions. Better access to healthcare and raising awareness of the need to adopt healthier lifestyles logically reduces the need for treatment, especially in illnesses aggravated by poor diet and lack of exercise.

GP-led services

Health Service Journal | YOUR IDEAS AND SUGGESTIONS | 29 October 2009

GPs will increasingly call the shots about how and where money is spent in the local health economy, writes Conor Burke.

NHS Redbridge is moving ahead with a phased handover of its commissioning function that could eventually see clinicians in east London gain control of an annual budget of up to ₤400m.

NHSR’s decision reflects its Rich Picture, a visual map capturing the organisation’s five year vision of bringing healthcare closer to people’s homes.

The borough’s three practice based commissioning clusters were replaced by five polysystems earlier this summer following more than a year of intense negotiation between the primary care trust and health professionals.

The new GP-led network of care professionals will have designated budgets and eventually be responsible for commissioning services and meeting statutory health targets set by NHSR and the Department of Health.

It reflects the organisation’s move towards providing better access to health services closer to home as well as taking it step closer to becoming a world class commissioner.

The polysystems will:

  • Promote the health and wellbeing of all the people in the community
  • Maximise independence and quality of life for people with long-term conditions
  • Improve services for people with non-critical acute care needs

The decision to introduce the polysystem model is being driven by a commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The Royal College of GPs reinforces the need for a ‘federated’ approach to primary healthcare with teams and practices working together to improve services in its paperThe Future Direction of Healthcare: a roadmap.

Each polysystem covers a distinct geographical area of the borough comprising of 50,000 people and is managed by a polysystem board made up of local clinicians.

Clinicians’ intimate understanding of their communities will help them design and deliver healthcare measures that not only address current need but anticipate future trends, such as the rise in diabetes and obesity.

NHSR recognises that the polysystem boards have little or no direct experience of commissioning services and will provide the necessary training and support via a specially convened clinical commissioning board made up of the five polysystem clinical directors and PCT officers.

The transfer of commissioning duties will be phased in, with the board monitoring the polysystem boards performance over a number of years.

Practitioners will also be shown how to analyse their performance and identify trends where appropriate resources need to be targeted.

The current governance arrangement will see the five polysystem boards report to the clinical commissioning board who, in turn, report to the PCT board.

The fledgling polysystem boards’ first challenge is looking at ways of reducing the number of first outpatient referrals made by GPs.

There has been a 36 per cent increase in referrals in the past three years with huge variations in referral rates between different practices.

One practice made 400 per cent more cardiology referrals than a neighbouring practice incurring an additional £130,000 in annual costs.

The referral management scheme aims to reduce first referrals for outpatient appointments by 30 per cent by April 2010 making a £3m saving.

Several specialist areas have already been highlighted where referrals are noticeably high including ophthalmology, dermatology, trauma and orthopaedics.

NHSR has introduced a savings incentive framework to encourage both GPs and polysystem boards to meet the challenge.

The distribution of savings would be divided among GPs and polysystems to reinvest back in to their local community and NHSR.

Polysystems will play a key role in bringing the organisation’s Rich Picture to life by treating the majority of patients’ needs in the community, saving un-necessary hospital appointments.

The polysystems will operate on a hub and spoke model with a polyclinic at the heart or hub of each polysystem with surrounding surgeries, pharmacies and hospitals forming the spokes that radiate out into the community offering seamless healthcare.

The first polyclinic opened in April 2009.

Loxford Polyclinic in south Ilford opens seven days a week and offers more than 20 services including GPs, an in-house pharmacy, health living café and variety of traditionally hospital based services, including diagnostics and out-patient appointments.

A unique point is the inclusion of community groups on the premises.

Up to 15 community and voluntary groups are based at the polyclinic, offering advice, support and information on services including benefits, employment, housing and domestic violence.

The creation of polysystems and devolution of commissioning functions to their respective polysystem boards also has the potential to save the NHS money at a time when it faces severe spending restrictions.

Better access to healthcare and raising awareness of the need to adopt healthier lifestyles logically reduces the need for treatment, especially in illnesses aggravated by poor diet and lack of exercise.

Source: Conor Burke is borough managing director for NHS Redbridge

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Community Health Partnerships

Posted on October 26, 2009. Filed under: LIFT, Press/News Releases, Providers |

CHP website | accessed 26 October 2009

Community Health Partnerships (CHP) develops, creates investment in and helps deliver innovative ways to improve health and local authority services.

Its main activity has been to deliver the Local Improvement Finance Trust (LIFT) Initiative which provides clean, modern, purpose-built premises for health and local authority services in England.

So far it has developed public-private partnerships to establish 47 LIFT companies, covering two thirds of England’s population. They have delivered over £1950 million of investment in more than 250 buildings that are either open or under construction. More recently, CHP has developed developing new models of public-private partnership, such as Community Ventures and Social Enterprises, to improve health and social care.

Community Health Partnerships (CHP) – known until autumn 2007 as Partnerships for Health (PfH) – is an independent company, wholly owned by the Department of Health.

Community Health Partnerships is a national organisation, rooted in local delivery of better community health and local authority services.  

It has a proven track record of innovative thinking and practical on-time delivery of projects tailored to local need. It fosters continuous improvement as it brings together the financial and organisational skills of the public and private sectors.  

CHP’s experience in driving innovation and continuous improvement through the Local Improvement Finance Trust (LIFT) programme has prepared its staff well for broader public-private ventures.

Its goal is to become a recognised centre of excellence in:

  • Efficient and effective delivery of capital projects in the health and local authority sectors

  • Public-private partnerships across the NHS and local government

  • Innovative and creative solutions to procure and develop assets that enhance health and social care provision

Community Health Partnerships offers a number of financial, management and consultancy services including:

  • Building public-private partnerships

  • Collation and dissemination of best practice in public-private partnerships within the health and social care fields

  • Development of LIFT Companies (LIFTCos) – CHP sets up and generates investment in new LIFTCos

  • Development of new capital projects within PCTs with existing LIFTCos

  • Advice to LIFTCos seeking to work within non-LIFT areas

  • Advice to PCTs in non-LIFT areas that want LIFTCos to work on projects

  • Benchmarking, for the Department of Health, of LIFT costs

  • Reporting improvements developed in the LIFT programme for the cross-departmental Innovation Programme

  • Managing and promoting the Department of Health’s Social Enterprise Investment Fund

  • Support to Strategic Health Authorities for the allocation of funding for Community Ventures via the Community Hospitals Fund. CHP also works with PCTs on detailed project development of Community Ventures.

  • Work on Strategic Estate Development – the re-development of real estate in primary healthcare 

     

LIFT

Local Improvement Finance Trusts (LIFT) have secured a dramatic improvement in primary and social care services and facilities.

Together 47 LIFT companies have generated over £1950m in investment to develop more than 250 new integrated community facilities that are either open or under construction. 

These LIFT companies are partnerships of public-private finance and expertise. The partnerships are able to create integrated facilities more quickly, particularly in disadvantaged areas, in ways tailored to local needs, than is normally possible.

The LIFT concept has inspired partnerships, enabling true innovation and exciting community care models to be developed, such as incorporating housing and benefit advice, mental health services and voluntary agencies, within one building.

LIFT is breaking down the organisational silos that have traditionally existed between the primary and secondary healthcare sectors and between the NHS and social care.

LIFT establishes a public-private partnership company – a LIFTCo – which works with local organisations to provide bespoke, tailor-made facilities.

The LIFTCo is formed from three groups: 
– local public sector health and care organisations (including PCTs and Local Authorities), 
– the selected private sector organisation, 
– and Community Health Partnerships. 

A Strategic Partnering Board, including all key local health and social care organisations, is established to collate the service requirements of all local providers.  The Board plans and then delivers an integrated service strategy.

The LIFT model allows a range of buildings to be procured, from small GP practices to one stop centres to community hospitals and multi-million pound, multiple agency, health and social care centres.

LIFT assets are owned by the public-private partnerships, run by the LIFTCo and leased/rented to service providers. This frees up the public sector to concentrate on service strategy and commissioning. The public sector, however, still has a 40 per cent stake in the ownership of the assets through its shareholding in LIFTCo. So the assets are therefore NOT exclusively owned by the private sector.

Express LIFT

Following the successful establishment of 47 LIFT companies covering more than half of the population of England, Express LIFT has been developed to provide a ‘fast-track’ procurement route. A ‘private sector partner’ is selected from a nationally procured framework of pre-approved partners, without the need for a ‘traditional’ competition based around the design of sample schemes, making it more cost effective.

The difference between Express LIFT and a traditional LIFT procurement

In a ‘traditional’ LIFT procurement, bidders are required to provide fully costed designs for the sample schemes in competition. This is a time consuming and costly process for all bidders and PCTs. In Express LIFT, public sector participants will be required to have an outline SSDP which they will utilise assistance from their LIFT company to complete. This means that the LIFT company can have a far greater influence on what it is that the PCT is trying to achieve through its commissioning and estates strategy. There will be no competitive design element (which will significantly reduce both time and cost) and no obligation to establish a supply chain for delivery and maintenance of defined projects at this stage.

Procurements under the Express LIFT programme will be significantly shorter. PCTs will need to undertake a reasonable amount of preparatory work before commencing a competition and will, of course, have to be mindful of the logistics of obtaining all the requisite Board approvals, however, it ought to be possible for a PCT to run the competition process in less than three months.

National procurement

The Department of Health ran a national procurement, which resulted in the following seven companies being selected to join a national framework as prospective LIFT company partners in March 2009:

Subject to receiving the necessary approval, PCTs can now commence their local call-off procurements. All of the prospective partners have demonstrated that they are able to provide the partnering services in a manner capable of realising and demonstrating value for money.

Framework timeline

Under EU procurement rules, a framework contract can exist for a maximum of four years. Our intention is for the Express LIFT framework to run for two years with the option on the part of the Secretary of State to extend the framework for a further two years.

National competition

The Department of Health ran the national framework procurement on behalf of the Secretary of State for Health with the assistance of Community Health Partnerships and other external advisers.

For further details please see the following – Memorandum of Info for PCTs – April 2009

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The future of West Essex Community Health Services

Posted on October 26, 2009. Filed under: Arm's length providers, Integrated care, Providers, Reports/papers, Social enterprise |

NHS West Essex Community Health Services | September 2009 | accesssed 26 October 2009 (pdf)

West Essex Community Health Services (WECHS) is the current provider arm (arms length trading organisation) of NHS West Essex. 

What is a social enterprise?

Social enterprise is a “badge” that a company or charity can adopt that brings certain benefits and says certain things about the ethos of the business. 

The key defining characteristics of a social enterprise are that it is not for profit, it works for the public benefit and any surpluses it makes are re-invested in the organisation. Beyond that social enterprises can be modelled in different ways to support the specific aims and purpose of the organisation. 

What all social enterprises share is an enterprising, innovative, business-based approach to achieving social and environmental aims.

A social enterprise can access monies through the Social Enterprise Investment Fund (SEIF) which an NHS trust is unable to do.

What is a not for profit company and how might it work?

The company is owned by staff who could be the shareholders. It is possible that it would be structured as a
company limited by shares of a nominal value, for example £1 each. The shares would be owned by staff and would not be available for resale. This means that staff could be the true owners of the business but without any personal financial risk. 

Shares could not be transferred and this would mean the business could not be bought by a third party. Any money saved or made by doing things better, differently, or by marketing developing services and products, could be re-invested for the benefit of patients and staff. If the company made a loss, it would need to look for greater efficiencies, just as an NHS trust would have to.

An alternative to a social enterprise

• PCT provider unit (current arrangement) 

This would be an arms length trading organisation (ALTO) within the PCT, led by a provider board and accountable to the PCT. This is essentially the structure which has been in place since April 2008. This is unlikely to remain an option given the long standing national policy to separate the commissioning and provider functions of PCTs. How long we could stay as an arms length trading organisation is unclear. There has been a public verbal statement from the Department of Health that ALTO will not be acceptable after April 2010, but this has not yet been enshrined in policy or guidance – the PCT Board are clear that this is not a long term option for WECHS.

• Community foundation trust (CFT)

CFTs are independent organisations accountable to Monitor, an independent regulator, and not the Department of Health. They are legal entities in their own right – the PCT Board consider this not a viable option as WECHS is considered too small an organisation to become a CFT in its own right and would have to consider joining with another provider arm to pursue this option. This would not necessarily encourage the focus on local communities or integration with primary care which is at the heart of commissioning intentions. In any case there is little chance of many more community foundation trusts being established and the infrastructure costs of a new trust may in any case be unaffordable given the recession.

• Horizontal integration with other community care services

Integration of care services provided by the PCT with other community care services provided to the same population by other government agencies, and in particular by the local authority. This is not an option the PCT Board currently believes serves the needs of their commissioning plans. Currently many local authorities are transferring their directly provided services to the private or third sector. But not in partnerships with local GPs

• Vertical integration with an acute trust 

Integrate the PCT’s community services with acute care provided by Princess Alexandra NHS Trust or a neighbouring acute foundation trust – the aim of the commissioning plan is to transfer services from acute care to community and primary care settings not to increase the size of portfolio of acute services.

• Horizontal integration with a non acute trust for example mental health 

While these trusts often have a strong community focus which might be beneficial they also cover large geographical areas and are usually very specialised in what they do. This might detract fromlocally sensitive services.

• Managed dispersal

Through the procurement plan, services are gradually transferred to the organisations successfully awarded a contract. It is likely though that WECHS will need a temporary host while this happens as NHS West Essex are clear that they will not remain the hosting organisation.

• Integration with primary care forming a social enterprise model

Community services would be integrated with primary care services within west Essex. Staff and potentially GPs establish an organisation themselves which provides community services. This may be registered as a social enterprise, a not for profit organisation, working for the public benefit, that can re-invest any surplus in services – this is the PCT Board’s preferred option at this time and on which staff are now being consulted through this consultation paper.

• An integrated organisational model led by local GPs

This would be a company which would have a contract with the PCT. Apart from the social enterprise model described above, this is the only model that would secure the same benefits for patients of a locally focussed integrated service provider. For this reason, this is the PCT’s present preferred alternative option if staff do not want to establish a social enterprise.

Big Changes For Staff And Patients At Saffron Walden Community Hospital

Saffron Walden Reporter | 23 October 2009

A SHAKEUP in the way health services in the region are run could mean big changes for staff and patients at Saffron Walden Community Hospital.

Some of the services currently delivered by NHS West Essex – the primary care trust (PCT) which covers Uttlesford – could become part of a new independent organisation.

If the plan gets the go-ahead it would mean that the hospital, as well as many other services such as district nursing and health clinics, will become a separate not-for-profit company known as a social enterprise.

Branch chairman of Unison (the union for public sector workers), Terry Ward, believes the proposals could give a raw deal to employees and service users.

“If this split happens then it’s possible that the PCT will buy cheaper services from elsewhere, rather than the facility at Saffron Walden, which makes a mockery of the idea of a community hospital,” he said.

“And staff, who have worked for the NHS for a long time and want to continue to work for the service which they are very proud of, are now being asked to privatise themselves.”

“A lot of resources are being used to push the social enterprise model and we want to make sure that employees are fully aware what they are voting for.”

There are a number of alternatives to privatisation and staff will be given a vote on December 9, after a 90-day consultation, on whether to adopt the idea.

The vote concerns the future of the provider arm of the PCT, known as NHS West Essex Community Health Services, which has an annual income of £34 million and employs nearly 1000 people.

It provides health services in community hospitals, clinics, health centres, GP surgeries, children’s centres, schools and other locations across Uttlesford, Harlow and Epping Forest.

Managing director Vince McCabe said: “What ever happens, local people will continue to receive all their NHS services as they have before, free at the point of delivery, paid for out of the public purse and commissioned by NHS West Essex.”

He added that the social enterprise model would be the best way to “protect and develop” services for the future.

“It would give our frontline staff greater freedom to make decisions closer to patients,” he said. “They would also have a bigger say in how things are run.

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Alliance calls for NHS providers to get priority

Posted on October 26, 2009. Filed under: News stories, Press/News Releases | Tags: , , |

Pulse | By Gareth Iacobucci | 26 October 2009

The NHS Alliance is urging the Government to slam the brakes on privatisation of NHS services by adopting new rules on APMS tendering.

Under its proposals PCTs would be barred from approaching independent providers unless they could satisfy detailed criteria that existing NHS services were not meeting quality standards.

In Scotland legislation has already been brought in to bar private companies from taking over the running of NHS services.

It also backs the Department of Health’s advice to NHS trusts to give current providers ‘at least two chances’ to improve where they are found to be under-performing, and for alternative providers to only be considered as a last resort.

In a paper entitled Rebalancing the Market, launched at last week’ NHS Alliance Conference in Manchester, the organisation backs the Government’s shift in emphasis, and recommends a revamp to the way services are tendered for.

For years PCTs have been encouraged to court private providers to bid for APMS contracts but the Alliance advises that in the future, PCTs should only invite private bidders in to bid to run services where there are no current providers of sufficient quality willing to tender.

It also calls on SHAs and PCTs to offer ‘formal support’ to NHS bidders during the tendering process, and recommends bidders be assessed on their ability to provide continuity of care and engage with local patient groups.

Dr Brian Fisher MBE, public and patient involvement lead, at the NHS Alliance, who presented the paper, said: ‘This will respect the importance of continuity in integration of local services and organisations that have historically provided a good local service.

‘It will encourage competition where services are of insufficient standard or too expensive, without destabilising primary care provision when it is already good.’

Market forces need to be put in service of patients

NHS Alliance | 21 October 2009

NHS organisations should be the first choice for commissioners as preferred providers, says the NHS Alliance. 

In a paper entitled Rebalancing the Market, which will be launched at the NHS Alliance 12th Annual Conference in Manchester, the organisation suggests two new approaches to tendering and commissioning that would improve cooperation and increase efficiencies. 

The paper states that tendering for services to include private bidders should be encouraged only when there are no current providers of sufficient quality prepared to offer extended services or conventional GP services at the right price. 

Dr Brian Fisher, National Public and Patient Involvement Lead, NHS Alliance, and the paper’s author, said: “Too often, the result of a business model is an NHS organisation that looks for increased income, which can come at the expense of patient care. The Alliance would like to see market forces better directed to improve the service to patients.” 

Although working with the independent sector has its advantages, it also poses many challenges, not least to the patient who, instead of being at the centre of healthcare planning, becomes part of a tug of war between primary and secondary care. 

Independent sector organisations may be more expensive and exit the market when the going gets tough. They may also decide to cut costs using short-term and/or inexperienced clinicians.

The paper also highlights that collaborative commissioning, programme budgeting and horizontal/vertical integration could be the answer to creating an environment where all partners have a common interest in improving care pathways and producing efficiencies. It says: “It may be that a cooperative approach works in some situations and not in others – there may well be a mixed set of approaches both within and between PCTs.”

For a copy of Rebalancing the Market or to arrange an interview with Dr Brian Fisher please contact the NHS Alliance press office on 07951204999/pressoffice@nhsalliance.org 

Ends.

Notes to Editors
1. For more information, please contact the NHS Alliance press office on 07951204999/pressoffice@nhsalliance.org 

2. The NHS Alliance is the only independent body that brings together primary care trusts’ chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.

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Integrated Care Network – An Introductory Guide

Posted on October 26, 2009. Filed under: Integrated care, Reports/papers | Tags: , |

Department of Health | accessed 26 October 2009 (pdf)

The programme of Integrated Care Pilots (ICP) is a two-year Department of Health (DH) initiative. Its purpose is to explore different ways of providing health and social care services to

help drive improvements in local health and wellbeing.

The programme of Integrated Care Pilots (ICP) is a two-year Department of Health (DH) initiative. Its purpose is to explore different ways of providing health and social care services to help drive improvements in local health and wellbeing.

Integrated care is an important building block within the strategic plan for improving the health and wellbeing of the population of England, as highlighted in both the NHS Next Stage Review report High Quality Care for All and the concordat Putting People First. Both documents stress the importance of improving local health and care services by offering personalised, flexible and high quality services, where the individual is at the centre and engaged in service organisation. Integration may refer to partnerships, systems and models as well as organisations; crossing boundaries between primary, community, secondary and social care.

Each of the 16 pilot sites participating in the national programme has developed an integrated model of care to help respond to particular local needs. Using their in-depth knowledge of the local population, the pilots are designing services that should be flexible, personalised and seamless.

The ICP programme is one of a number of initiatives looking to deliver these objectives. All pilots will be working with local organisations involved in world class commissioning (WCC) assurance Year 2, and participation in ICP should enable sites to demonstrate success against many of the competencies for WCC assurance.

The following pages provide summaries of the work each pilot will be doing over the next two years as they explore the potential and impact of their models, whilst identifying learning and best practice to be shared with others.

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PBC is alive and real budgets a ‘maybe’, says tsar

Posted on October 26, 2009. Filed under: Journals | Tags: |

Pulse | 26 October 2009

Primary care tsar, Dr David Colin-Thome has set the record straight about reports he called PBC a ‘corpse’.

He told Practical Commissioning: ‘I asked a rhetorical question – I can’t remember the exact words, but it was essentially, are we reinvigorating a corpse? I then went on to say that actually there is plenty of good practice which is hardly saying there’s a corpse. And actually all the press reported that I was saying that there’s good in parts. What I’m saying is we need to get those energetic (PBC groups) to have more influence and power and maybe (real) budgets and need to be even more ambitious about what we can do in re-shaping care.’

He added real budgets were ‘always part of our policy if people were confident enough. And that’s a local decision.’

Primary care tsar, Dr David Colin-Thome has set the record straight about reports he called PBC a ‘corpse’.
In his speech to the NHS Alliance conference this week, health minister, Mike O’Brien, said: ‘Some of you may have read David’s reported description of practice- based commissioning as being like a ‘corpse’..

Well, reports of its death have been greatly exaggerated.’

‘It is certainly true that it has not taken off everywhere, and we need to change that, but, and as indeed David Colin-Thomé actually said in his speech, where it has the results have been truly impressive.’

Click here to find out more!Primary care tsar backs PBC

Pulse | 23 October 2009

National primary care tsar Dr David Colin-Thomé has insisted that he continues to support Practice Based Commissioning – just days after describing the troubled initiative as a ‘corpse not for resuscitation’.

Speaking at the NHS Alliance conference in Manchester, Dr Colin-Thomé said: ‘Of course I don’t think the darn thing’s dead.’

His remarks at a conference in London earlier this month had been misinterpreted, he claimed but he added: ‘I’m certainly disappointed with the impact PBC is having.’

Health minister Mike O’Brien also moved to defend the under-fire initiative in his keynote address to delegates, insisting ‘reports of its death have been greatly exaggerated.’

He said: ‘It’s certainly true that it’s not taken off everywhere and we need to change that. But as David also said in his speech, where it has taken off results have been truly impressive.’

Primary care czar jokes about PBC ‘corpse’ blunder

Healthcare Republic | 22 October 2009

Primary care czar Dr David Colin-Thome has said his description of practice-based commissioning (PBC) as a ‘corpse not for resuscitation’ was misunderstood and even joked about the blunder.

Addressing the NHS Alliance annual conference in Manchester on Wednesday, Dr Colin-Thomé said: ‘Perhaps the C in (my initials) DCT should stand for corpse, not Colin.’

Dr Colin-Thomé, England’s clinical director of primary care, made the controversial comment last week and it has been the talk of the NHS Alliance conference this week.

Health minister Mike O’Brien also took advantage of his appearance at the conference to defend PBC.

Mr O’Brien maintained that Labour’s drive to improve quality could deliver enough efficiency savings to reign in NHS finances.  ‘The only way forward in these times is to continue on the reform path we are on,’ he told delegates.

Earlier, shadow health secretary Andrew Lansley set out his vision of a drastically different NHS, where GPs commission all local health services for their population, including urgent and emergency care.

Mr Lansley said patients wanted GPs to make difficult rationing decisions about the care available to them. 

‘There will always be rationing in the NHS because we have finite resources. But ask people who they trust to make these difficult judgements – it’s not the secretary of state, it’s not PCT managers. The public are looking for someone they can look to, to manage their care.’

GP commissioning shows little sign of life – David Colin-Thomé

Health Service Journal | By Steve Ford | 14 October 2009

The government’s primary care tsar has admitted that efforts to “resuscitate” the “corpse” of practice based commissioning have had little effect.

National clinical director for primary care David Colin-Thomé said last week that the Department of Health is “hard at work trying to reinvigorate” practice based commissioningbut said it “isn’t really taking off, in any systematic way”.

He told delegates at the Wellards annual conference in London that it was hard to say why this was. “But it’s certainly not seen as a major vehicle for change,” he said.

The DH published extra guidance in March intended to mark the start of a new push to get practice based commissioning “working to its full potential” – five years after the policy was first launched. 

The document, Clinical Commissioning: our vision for practice based commissioning, included various ideas intended to try to “reinvigorate” the stalled policy.

It set out entitlements that commissioners could expect, including that primary care trusts should make decisions on practice plans and business cases within a maximum of eight weeks, and that PCTs would be held to account for the quality of their support.

Dr Colin-Thomé said: “We thought we’d try and reinvigorate it, and we had all sorts of ways of doing it – entitlements and things like that.

“But I think the corpse is not for resuscitation. There doesn’t seem to be much traction,” he said.

“We’re struggling to make it systematic,” he added. “There’s a lot of support around it but it’s not really taking off out there.”

However, Dr Colin-Thomé insisted that clinicians do need to have some form of budgetary responsibility in order to “reshape how clinical care is provided and challenge inappropriate and ineffective interventions”. “Clinicians, doctors especially, we spend the money,” he said.

The apparent failure of practice based commissioning has not deterred the Conservative Party from sticking to its policy of giving GPs “real” budgets if they win the election.

Writing in HSJ earlier this month, shadow health secretaryAndrew Lansley said: “We will hand them real budgets to manage the costs of their patients’ care. They will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in care.”

Speaking at the Wellards conference last week, NHS Confederation director of policy Nigel Edwards said the Conservatives were “basically betting the ranch on hard budgets for GPs as a mechanism for change”.

“I’m torn on this,” he told delegates. “There are some big questions.”

Mr Edwards said he would have no concerns about GPs he had met who already do practice based commissioning and “do this well”. But he said: “There are some really interesting questions about what to do with the people who don’t want to do it or don’t have the skills or the capacity.”

He added: “The other issue of course is that GPs are also providers. If you want to bring new providers in, which is also part of Conservative policy, then it’s quite hard to do that if the commissioner is one of your potential competitors.”

Birmingham East and North PCT chief operating officer Andrew Donald said: “I tend to agree with the principle of giving GPs hard budgets because actually they are the ones who create most of the cost. They write referrals, they write prescriptions, their patients got to A&E, their patients have emergency admissions.”

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Burntwood GP patients urged to have their say on future of practices

Posted on October 25, 2009. Filed under: GP-led health centres, News stories |

The Lichfield Blog | South Staffordshire PCT | accessed 25 October 2009

Patients registered with a GP in Burntwood are being urged to have their say on the location of their practice.

South Staffordshire Primary Care Trust (PCT) is staging another event to encourage patients to help shape the future of healthcare in the area.

The PCT, in conjunction with Lichfield District Council, will hold a further public meeting on tomorrow (October 24) at 10am at Burntwood Library, Sankey’s Corner.

It follows the launch of public consultation events on August 10 which will continue until November 9 enabling patients registered with the eight GP Practices in Burntwood to have a say on their preferred choice of relocations.

The PCT carried out an appraisal of all potential sites in Burntwood, between January and April 2009.

Jim Barlow, Head of Primary Care Commissioning, South Staffordshire PCT said:

“This is a major project and an exciting time for the people of Burntwood to develop health services in the area. We want patients to give us their views as this will form an important part of the decision making process.”

In addition, a leaflet will be sent to residents in and around Burntwood throughout the consultation period. The leaflet includes a feedback sheet to enable people to say what their preferred location is.

Mr Barlow added:

“The reason for the change is due to GP Practices in the Burntwood area outgrowing their current premises and they are unable to offer new or extended services as they do not have the space. New facilities will be designed as a multi-purpose building which will provide an extended range of health and social care services including Children and Life Long Learning, Age Concern, Citizens Advice Bureau, Burntwood Live at Home, Alzheimers Society, Carers Association and Community Nursing staff.

“We will also maintain in the new facilities the opening hours offered through Burntwood Health and Wellbeing Centre, the new style of health centre which opened in March 2009, 8am to 8pm, seven days a week, 365 days a year – offering a walk-in service.”

It is estimated that the new healthcare facilities will be open by late 2012. During the development period all GP practices will be operating as normal from their existing premises.

The PCT encourage the public to get involved in the range of public consultation activities, to either attend public meetings or to contact the PCT by telephone on 01889 571758 or by emailing sue.nabbs@southstaffspct.nhs.uk.

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BMA chairman rejects GP commissioning plans

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

Healthcare Republic | By Nick Bostock | 23 October 2009

GPs should not be handed full responsibility for commissioning, the head of the BMA has told MPs.

At a health select committee evidence session on commissioning on Thursday, BMA chairman Dr Hamish Meldrum appeared to reject Conservative plans to make GPs responsible for commissioning 24-hour care for their patients.

His comments come less than a week after RCGP chairman Dr Steve Field said GPs should take on 24-hour commissioning responsibility.

‘I don’t think putting all the power in the hands of GPs is the right thing,’ he told MPs.

Commissioning should operate as a collaborative process between NHS organisations, including GPs, he argued.

Giving commissioners full control of budgets seemed a ‘crude’ method of bringing people to the table where relationships between NHS organisations were poor, Dr Meldrum said.

Dr Meldrum said that commissioning was most effective in parts of the country where NHS organisations had ignored the ‘purchaser-provider split’ currently operating in the English health service.

He pointed out that in Scotland, Wales and New Zealand, this separation had been abandoned in favour of a more collaborative system.

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Public-private partnerships: getting NHS finance that adds up

Posted on October 23, 2009. Filed under: Journals | Tags: |

Health Service Journal | BY STEPHEN LANSDOWNSHELLEY THOMAS | 23 October 2009

Public-private partnership arrangements can be the right alternative to PFI for some trusts’ equipment upgrades, say Stephen Lansdown and Shelley Thomas

The need to balance finances, manage risk and drive efficiencies are common themes in today’s NHS. Delivering high quality, safe patient care while achieving the 18 week target is a constant demand.

Technology in radiography, diagnostic imaging and nuclear medicine is developing fast. Indeed, the NHS’s electronic system PACS demands hospitals have up to date equipment, training, and support and maintenance services to achieve the Department of Health’s objective of joined up, modern healthcare provision.

But such equipment is often costly, expensive to maintain and quickly superseded by newer technology.

A trust considering an equipment upgrade might implement a managed replacement project. Nothing new there. New medical equipment has been procured through largerprivate finance initiative schemes for some time. Trusts which have engaged specialist contractors for this have been able to call on private sector expertise.

Expected constraints on capital expenditure budgets beyond 2012-13 will reduce the amount of PFI. And for some trusts that is not in any event the right solution.

A standalone managed equipment replacement project based on a public-private partnership allows a trust to manage the cost and spread it across the life of a contract with an external provider (typically 15-20 years). The project is “stand-alone” in the sense that it is procured without a larger private finance scheme.

Radiology and diagnostic imaging are where the equipment is most suitable for this type of project, but the principles can be applied elsewhere in the trust’s operations, such as anaesthetics, patient monitoring, ophthalmics and endoscopy.

In essence, the contractor takes on responsibility on an outsourced basis for supplying, maintaining, repairing and ensuring the operation of the equipment, for a regular payment from the trust. Typically the contractor will fund the equipment replacement programme using asset finance.

All-inclusive

The public-private arrangements typically involve the contractor, as well as bearing the capital cost of the required upgrade, providing services such as maintenance, support and training to the trust.

Some new or replacement equipment is usually installed at the start of the project and then, working around the life cycle of the current equipment, other equipment is replaced on a pre-agreed rolling basis.

Benefits include:

  • delivering cost savings;
  • removing unpredictability in long term capital expenditure;
  • offering certainty as to equipment uptime and service quality (most payment mechanisms in these projects are based on equipment availability times and monthly performance measurements);
  • providing new and up to date equipment at regular, pre-agreed intervals;
  • reducing capital charges (if off balance sheet treatment can be secured).

Despite the introduction of international financial reporting standards, carefully structured managed equipment replacement projects which transfer significant technology, financial and other risks to the contractor may still be off the NHS balance sheet. Some examples of major risks that the trust should expect a contractor to bear include:

  • supply, maintenance and repair of the equipment
  • equipment downtime
  • technology updates
  • equipment obsolescence
  • changes in maintenance and support charges, interest rates and other costs
  • removal of the equipment on expiry or earlier termination.

Case study

Southport and Ormskirk Hospital trust entered into a 20-year managed equipment replacement project in 2007.

The contract involves the diagnostic imaging equipment at the trust’s two main hospitals being replaced and refreshed with the latest technology, following a pre-agreed phased programme. Service and training are included, and significant technology, financial and other risks are transferred from the trust to the contractor. New equipment in the initial phase includes: digital, general and mobile X-ray; fluoroscopy; digital mammography; ultrasound and mobile C-arms. At the end of the lifecycle of the current equipment, the trust’s CT scanners, MRI scanner and direct digital chest X-ray will also have been replaced.

This contractor financed programme is allowing the trust to reorganise services and improve the patient experience.

www.southportandormskirk.nhs.uk

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Andy Burnham extends preferred provider vow

Posted on October 22, 2009. Filed under: Journals, Providers | Tags: |

Health Service Journal | By Steve Ford | 22 October 2009

Non-NHS providers of services will only be contracted as a last resort, the health secretary has assured the general secretary of the TUC.

Following his announcement in September that the NHS would be the “preferred provider” of services, Andy Burnham has written to Brendan Barber promising that where NHS service providers underperform, the primary care trust will work with the provider, giving them “at least two formal chances” to improve.

Even after this point, the health secretary has assured Mr Barber, the PCT will give the NHS provider every opportunity to continue to provide the service if it can demonstrate improvement.

The letter says: “Only if there was insufficient improvement within a reasonable timescale, and the scale of underperformance was significant, would the PCT consider engaging with other potential providers or other solutions (eg franchising).

“If market testing was subsequently pursued, the PCT would be expected to continue to engage the provider and its staff, and give them the opportunity to compete on a fair and equal basis.”

Andy Burnham assures Mr Barber an almost identical scenario would occur if NHS providers needed to improve services or their capacity; where there was a risk of clinical or financial uncertainty; or where patient choice needed to be increased. Tendering for alternative providers would be a last resort and the original NHS provider “would be able to bid on a full and fair basis”.

In contrast, it says where an independent or third sector contract expires, the PCT would tender openly from the outset, giving NHS providers a chance to bid.

Mr Burnham’s letter was included as an appendix to one sent by NHS chief executive David Nicholson to all PCT and strategic health authority chief executives last week.

Mr Nicholson said the letter was to clarify how the commissioning process will change in light of the shift in policy.

There will be new guidance to replace Necessity – Not Nicety, which was published just five months ago, and the Department of Health will issue a revised procurement guide and “refined” rules for cooperation and competition.

Mr Nicholson wrote: “In addition to the revised guidance, there will be implications for assurance processes, including for world class commissioning and transforming community services.”

But he said: “It is too early to tell what these are likely to be”.

He added the DH “remained committed” to the establishment of regional commercial support units and the national strategic market development unit and to the participation of independent and third sector providers “where this is the right model for patients”.

Primary Care Trust Network director David Stout warned against “inventing new barriers” to commissioning high quality services in the current financial climate.

NHS Partners Network director David Worskett described the policy shift as a “great pity”, which risked slowing procurement. He said Mr Nicholson’s letter still failed to address whether the “any willing provider” policy had been dropped.

“It doesn’t clarify anything at all – it’s a thoroughly incoherent bit of policy. I find it hard to see how it helps anyone,” he said.

HSJ’s Intelligent Information for World Class Commissioning conference is on 8 December, for details seewww.hsj.co.uk/conferences

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