Archive for December, 2009

NHS South Gloucestershire

Posted on December 30, 2009. Filed under: GP-led health centres, Press/News Releases | Tags: |

GPs over festive season | accessed December 2009

GP out of hours services

Frendoc and Brisdoc are the out of hours GP services that operate from 6.30pm- 8am Monday-Friday, all weekends and bank holidays. This service is provided by GPs and nurses who can offer telephone advice, face-to-face consultations, or home visits for patients who are housebound. This service is available for treating conditions that cannot wait until your GP surgery reopens. Ring your usual surgery where you will be given instructions or diverted to the out of hours service, or ring NHS Direct on 0845 4647.

GP led health centre

The GP led health centre in Kingswood is open from 8am to 8pm 7 days per week including bank holidays. You do not need to be registered at the health centre – you can use the services offered at the centre as well as your GP surgery. You can use the centre by walking in or phoning to make an appointment.

The Orchard Medical Centre
Macdonald Walk
Kingswood
Bristol
BS158NJ
Tel. 0117 9805100

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A consultation on the development of accessible, modern, high quality health and social care services in East Harrow

Posted on December 23, 2009. Filed under: GP-led health centres, Reports/papers |

NHS Harrow | accessed 23 December 2009 [pdf]

NHS Harrow wants to open new health centres that provide enhanced GP services at times and locations convenient for you. Investing in primary care services is a national priority in order to deliver care out of hospital where possible. This document explains our proposals to achieve this in the East of Harrow.

Executive Summary

We are excited to present this consultation document, which highlights how we aim to further improve healthcare in East Harrow. Our Primary and Community Care Strategy outlines plans for the development of primary and community care services over the next five years and its objectives are to improve choice, and access to quality services for patients. East Harrow was identified as a priority area. Details of this can be found in our Outline Business Case for East Harrow, which is on our website, http://www.harrowpct.nhs.uk

Some changes are already happening. In January 2010, a new GP practice will open at Mollison Way providing services from 8am to 8pm, seven days a week. In continuing to improve services in East Harrow, we propose a new way of
working called a polysystem. This will link both health and social care services together.

We want to give you the opportunity to find out more about the proposed new services and comment on our proposals.
The consultation will run from the 9th December to the 17th March 2010.

Please take time to read this document and return your completed feedback form. Alternatively, you can complete the online version which can be found on our website.

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Wansworth PCT Health Overview and Scrutiny Committee

Posted on December 23, 2009. Filed under: Federations, Polyclinics, Reports/papers |

Wandsworth PCT | accessed 23 December 2009 [pdf]

Par. 2. Primary care, polyclinics and polysystems. A major focus for the work of Wandsworth Primary Care Trust over the past two years has been the development of plans for primary care. In line with the NHS strategy document Healthcare for London, these plans have concentrated on the development of polyclinics, each serving a population of around 50,000. The approach favoured by Wandsworth PCT has been the development of ‘federated polyclinics’ with an identifiable ‘hub’ but retaining individual GP practices and other primary care services in a variety of locations across the area served. The development of plans has hitherto been structured around three localities: Battersea and North Wandsworth, Putney and Roehampton, and South Wandsworth.

On 30th September 2009 the Board of Wandsworth PCT received a report drawing together the plans for these localities and setting out an overall plan for the development of primary care across Wandsworth. Two factors underpinned this report to the PCT Board: (a) criticism in the ‘gateway’ review of plans for Battersea and North Wandsworth at the lack of a co-ordinated Borough strategy and the need to ensure that investment was fairly distributed across the Borough; and (b) the much tighter than expected financial position of the NHS, with correspondingly more cautious assumptions about the availability of funding for capital developments. This has been reflected in the change of terminology within NHS London, the word ‘polyclinics’ being replaced by ‘polysystems’, emphasising the working together of professionals within a locality without the assumption that this requires investment in a new building.

The report proposes the establishment of five polysystems in Wandsworth: Battersea; Putney and Roehampton; Central Wandsworth; Balham; and Tooting and Furzedown. Primary care services within each of these areas will work together to provide a coherent service pattern and to enable a shift of provision from secondary to primary care. Within each area, from March 2010, there will be a service offering extended hours access to urgent GP-led care. However, the most significant thrust of the report is a retreat from previous proposals for significant new capital investment in polyclinic ‘hubs’. The abandonment of plans for the Putney Hospital site SW15 (Thamesfield), signalled in June 2009, is confirmed, and of the four developments in Battersea and North Wandsworth on which the PCT consulted – Grant Road, SW11 (Latchmere); Doddington, SW11 (Queenstown); Bolingbroke, SW11 (Northcote) and Bridge Lane, SW11 (St. Mary’s Park) – there is only a commitment to proceeding with the smallest, Bridge Lane, within the foreseeable future. The report confirms the intention to establish GP services at Queen Mary’s Hospital SW15 (West Putney) from October 2009, and to follow this with the full development of a polyclinic hub at Queen Mary’s in 2010.

This reduced commitment to capital investment reflects the drastic change in the financial prospects for the NHS. It is justified by an audit of existing primary care premises, which suggests that there is scope for much better use to be made of the existing estate. Nevertheless, it is unclear whether the proposed shift of services from secondary to primary care will be seen by patients as an improvement in quality or access if the primary care settings are scattered around localities as space permits, rather than concentrated in a purpose-built polyclinic hub at the centre of the locality served. The abandonment of the majority of investment plans for Battersea and North Wandsworth is likely to be resented by the community in this area, which had been led to consider the new investment as a recompense for the closure of the much-loved Bolingbroke Hospital.

This matter is being reported to the Council at the request of the Chairman of the Overview and Scrutiny Committee and the Opposition Speaker.

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NHS 2010-2015, a summary of the roadmap

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

OnMedica | Dr N Cozens, Medical Writer | 23 December 2009

With the end of the decade fast approaching, the government has been contemplating the development of the NHS over the past ten years and has published its plans for the next five in NHS 2010-2015: from good to great. Preventative, people-centred, productive. Here we summarise the main points of this roadmap.

As a foreword, Andy Burnham admits that whilst the NHS has made huge progress in recent years, there is still potential to transform the NHS from “good to great.” The NHS is due to receive a substantial budget next year which will be crucial in achieving the aims set out during this new financial era.

The government vision, to create a “preventative, people-centred, productive NHS,” builds on Lord Darzi’s vision set out during the NHS Next Stage Review. It outlines the six challenges that a modern healthcare system faces: ever higher patient expectations, an ageing society, the dawn of the information age, the changing nature of disease, advances in treatments and a changing workforce. The government plans to tackle these challenges by focusing on three main areas: patients and the public, NHS staff, and support for staff and organisations. The principal changes that have been proposed are highlighted here.

Patients and The Public

Patients and the public will have a full set of rights, set out in the NHS Constitution. There will be a greater emphasis on patient choice and further services will be available at more convenient times. The primary aim is to reduce the burden of avoidable ill-health by taking the “predict and prevent” approach. Achieving this will depend on encouraging patients to take greater responsibility for their own health via the “big four” lifestyle factors (smoking, diet, alcohol and physical activity). The idea will be to target young people in order to have maximal preventative impact. Policies to improve mental health services and promote public mental health will be outlined in New Horizons: A shared vision for mental health. There are plans in place to enable patients to make self-referrals to a therapist and be seen within two weeks. All 40 to 74 year-olds will have access to NHS Health Checks to prevent heart disease, stroke, diabetes and chronic kidney disease. Greater regulation will allow for safer care. Essentially, patients will be at the centre of care.

NHS Staff

The proposed changes will clearly require staff alterations. Help will be provided for underperforming services and to establish new services. The offer of guaranteed employment is under consideration, but this needs to be weighed up with resulting pay restraints. Ultimately, staff satisfaction will be at the forefront of these changes and the level of satisfaction will be measured in a systematic way. Staff will need to collaborate with different teams and set up social partnerships. Provisions will be in place for teams to share acquired knowledge with staff nationwide. As is the case for patients, staff will have their own rights set out in the NHS Constitution. In addition, consultants and the most senior managers will not receive a pay increase in 2010/11. The document supports the protection of the NHS pension scheme for new and existing staff.

Support for NHS Staff and Organisations

In order to implement the changes set out, the government needs to provide support, incentives and payment rewards for staff and affiliated organisations. Poor quality of care must not be financially rewarded and the services involved will need to show “clear and rapid improvement.” The tariff system will allow for delivery of improvements in quality and productivity. Management costs will be cut in primary care trusts and strategic health authorities in an attempt to free up further capital. Commissioners will be encouraged to collaborate and the NHS will unite with other partners. The significant change for hospital providers is the announcement of a maximum uplift of 0% over the next four years. This will encourage hospitals to consider their costs carefully.

The NHS 2010-2015 plan provides a detailed roadmap of how the NHS will grow during the current economic climate. Much of it highlights initiatives that have already begun, but the focus of the change is to create an NHS where prevention and patient satisfaction is fundamental. We can only wait with anticipation to discover whether the next decade will bring with it the transformation of the NHS from “good to great.”

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How many GP practices are being run by NHS Norfolk or their provider arm?

Posted on December 23, 2009. Filed under: Arm's length providers, Reports/papers |

NHS Norfolk | Freedom of Information | 23 December 2009

Question:

1. How many GP practices are being run by NHS Norfolk or their provider arm? This would include both long term and temporary contracts.

2. What are the PCT’s plans for these GP practices? Is NHS Norfolk planning to divest themselves of these services and what are the time-scales for doing so?

Response:

1. There is only one practice that is run by NHS Norfolk or Provider Arm. This practice is Downham Market Health Centre and is run by Norfolk Community Health and Care.

2. NHS Norfolk has no current plans regarding the future of this practice.

Please be aware that although the information on this page was accurate at the time of publishing, it may not now be, and should not be relied upon.

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Health bosses hit back at Norwich walk-in centre claims

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

Norwich Evening News | Sarah Hall | 22 December 2009

Health bosses have hit back at claims that the new walk-in centre in Norwich city centre has not met expectations.

As reported in the Evening News on Saturday, concerns have been raised that the Timber Hill Health Centre is not seeing as many patients as the walk in centre in Dussindale, Thorpe St Andrew, it controversially replaced.

Last month just over 4,000 people visited the new walk-in centre, which opened in August.

Dr Bryan Heap, NHS Norfolk’s medical director, said: “We envisaged about 15,000 ‘walk-in’ patients would have used the centre by now. In fact it has seen about 17,000 patients.”

He said from April 2007 to April 2008 there were 42,436 patient contacts at the Dussindale centre. If the Timber Hill Health Centre continues to attract 17,000 patients per quarter, it would have had about 68,000 contacts, he said.

Dr Heap added: “It is not ‘failing to deliver;. It is doing precisely what we envisaged it would. It has increased the number of walk-in patients seen at the former walk-in centre at Dussindale; it has provided GP and primary care to people who are traditionally harder to reach and it has ensured more equal access to health care for the people of Norwich and the surrounding area.

“The success of Timber Hill Health Centre cannot just be judged by attendance figures alone. Timber Hill Health Centre was established to provide equitable access to healthcare. Importantly, there are now more people attending from the target postcode areas NR1 and NR3 than Dussindale. These areas contain more deprived households than other areas.”

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New Health and Wellbeing Centre to Open

Posted on December 22, 2009. Filed under: GP-led health centres, News stories, Press/News Releases, Providers | Tags: |

NHS Stoke-on-Trent | 22 December 2009

Hanley Health and Wellbeing Centre, located at 69/71 Stafford Street, will open to the public on New Year’s Eve December 31st.

A new health and wellbeing centre will open in Hanley, where people can get an appointment 8am – 8pm, seven days a week, 365 days a year – and they don’t have to be registered.

Graham Urwin, Chief Executive, NHS Stoke on Trent will be shown around the new Centre on Wednesday 30th, the day before it opens its doors and as well as chatting with the staff, he will have an opportunity to see for himself how the Hanley Health and Wellbeing Centre will operate.

Hanley Health and Wellbeing Centre, located at 69/71 Stafford Street, will open to the public on New Year’s Eve December 31st, offering a full range of GP and nurse led appointments to anyone who wishes to use it, whether they are registered with a GP there or not.

The centre, which is opposite the Stafford Street entrance to The Potteries Shopping Centre, will offer anyone medical advice and consultation without the need to register with a GP at the centre and without an appointment.

Commenting on the new Centre, Chief Executive, NHS Stoke on Trent, Graham Urwin, said: “This new Centre is about providing access to GPs and nurses, as easily as possible, to the people we seek to serve and care for.

“NHS Stoke on Trent has got to continuously evolve and look at new and innovative ways of bringing healthcare to the community and the Hanley Health and Wellbeing Centre is a great service in the heart of Stoke-on-Trent.”

As well as providing a walk-in service for patients with minor illnesses or minor injuries, the Hanley Health and Wellbeing Centre will also offer a GP surgery where patients can register in the normal way.

The centre will be run by BH Health Ltd, a leading independent provider of primary care services, currently providing services to more than seven million patients across England.

NHS Stoke on Trent’s Head of Clinical Effectiveness and Quality Ian Gibson said: “The Hanley Health and Wellbeing Centre will primarily be a GP practice, but you won’t need to register to be seen. If for example you’re feeling ill whilst out shopping in Hanley or you fall and need a treatment for a minor injury, the Hanley Health and Wellbeing Centre will be able to help you. It’s going to be a real asset to the area and will greatly improve access to primary care services.”

Edmund Jahn, Managing Director of BH Health Ltd said:”We are delighted to have been awarded the contract to provide the Hanley Health and Wellbeing Centre. The new facility has been commissioned by NHS Stoke on Trent and is part of a nation-wide programme, led by Lord Darzi, aimed at improving access to GP services and calling on every PCT in England to establish a GP led Health Centre open for 12 hours a day, every day of the week.

He added: “We have experience of running similar centres in other parts of the country and we are excited to have the opportunity of working in Stoke-on-Trent. We look forward to working with other health and social care services to improve health and well being in the city.”

Patients can walk in without an appointment or be referred to the centre by NHS Direct, GP practices, and other local services.

Shoppers can walk in for health checks

The Sentinel | 30 December 2009

A £1.3 MILLION health and well-being centre opens in Hanley city centre tomorrow.

People will be able to simply walk in to the centre to be treated for most non-life threatening illnesses from 8am to 8pm, seven days a week including Christmas Day and New Year’s Day.

Under the weather shoppers and workers will be guaranteed attention from a doctor or nurse within half an hour of arrival.

The first medical complex of its type in the Potteries has been quietly taking shape all year behind the closed doors of one of Hanley’s most prominent buildings.

Its location in the former Yorkshire Bank in Stafford Street, opposite the Potteries Shopping Centre, was deliberately chosen by city’s health officials to be as close as possible to Hanley’s busy commercial heart.

But shoppers have been left puzzled for months over the nature of the refurbishment going on under their noses in the 1907 building. It is only in the past few days that it has become obvious that here is a venture that will eventually be bringing cures and pain relief to thousands of people a year.

Up to four GPs, alongside teams of nurses and therapists, will be tending the sick in the eight interview rooms grouped around a light and spacious waiting area where the pleasing design has cleverly incorporated the structure’s original pillars.

It may not have the X-ray facilities or the scale of the city’s other walk-in centre at Burslem’s Haywood Hospital, but that is nurse-led and the difference in Hanley is that people will get to see a doctor.

The centre will also operate as a traditional GP practice with the aim of eventually having 6,000 patients registered.

And as a bonus three computer screens are available for people to access health information over the internet. Good health and lifestyle messages will also be broadcast from two television monitors in the front window.

The services are in the hands of private company BH Health Ltd which has won a five-year contract let by Stoke-on-Trent Primary Care Trust. It has just appointed Worcester GP Dr Ian Laws as its clinical director and senior doctor.

Dr Laws said: “I am absolutely delighted to be joining the team here and looking forward to developing an entirely new GP-led service for patients in Stoke. Our focus will be on delivering high quality care for patients, seven days a week, 365 days a year.”

The complex is the latest in a string of new PCT health centres transforming primary care in the Potteries. One opened in Meir in September and the next will appear in Middleport on March 1. Planning is also continuing for new health centres in Tunstall and Cobridge. Ian Gibson, PCT head of quality, said: “We looked at other locations in the city centre including the planned regeneration of the bus station site.

“But when this building became available we knew it was in an ideal spot to help people who have gone off their feet while shopping, have become breathless or have had a fall or other minor injury.”

PCT chief executive Graham Urwin, pictured left, added: “NHS Stoke-on-Trent has got to continuously evolve and look at innovative ways of bringing healthcare to the community and the Hanley Health and Wellbeing Centre is a great service in the heart of Stoke-on-Trent.”

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Health matters: The privatisation of health care in Britain

Posted on December 22, 2009. Filed under: GP-led health centres, News stories | Tags: , |

FRFI 211 October / November 2009 | accessed 22 December 2009

Health care for London

‘The days of the district general hospital seeking to provide all services to a high enough standard are over’, said Sir Ara Darzi, responsible for the ten-year plan for reorganising health provision inLondon. Commissioned by Gordon Brown in 2007 and promoted to a ministerial post in the Department of Health, he resigned in June this year.

The NHS Next Stage Review Interim Report, published in June 2008, showed there were significant variations in access to and quality of primary medical care services across Britain. The Equitable Access to Primary Medical Care programme was launched to address this. This includes at least one GP-led health care centre in each Primary Care Trust area.

Darzi’s plan was to shift work from hospitals into polyclinics and urgent care centres. 150 polyclinics (GP-led health centres are linked to this model of service), with long opening hours, would provide community-based care at levels between GP practices and district general hospitals, including pharmacy, dentistry, social and mental health, x-ray and ultrasound services, blood tests and minor surgery.

Darzi’s changes opened the way for private companies to bid to run these centres. The Department of Health expects Primary Care Trusts to commission 15% of their services from the private sector. NHS London’s timetable included inviting suitable providers to tender by April this year and sign contracts for the preferred provider by December 2009. ‘Suitable providers’ include GP practices, NHS bodies, private sector companies and ‘third sector organisations’ such as charities. Clearly GP practices cannot compete equally with multinationals in such a bidding process, and whilst health centres may continue to be described as ‘GP-led’ for public consumption, they will in fact be run for profit by health care multinationals and consortia.

Fifty ‘GP-led’ health centres have already opened around Britain. In 17 of these, up to 80% of the GPs are newly qualified or are just finishing GP training. Once private companies take over, information about what they are doing may become commercially confidential.

On 31 July, Camden NHS awarded a ₤20 million contract for running its new GP-led health centre in north London to Care UK, a company that in April 2009 was criticised for the poor quality of its elderly homecare. Yet again, the decision was made two months before the conclusion of a public consultation. A legal challenge is being mounted.

US multinational United Health currently runs three GP practices in south Camden, despite local opposition. In August, Connect Physical Health Ltd (CPH) was awarded a three-year contract to provide physiotherapy services at the Royal Free Hospital, to treat over 11,500 people a year. The pay of staff who choose to stay will be protected but they will not be able to add to their NHS pension. Camden physiotherapy will now be fragmented while CPH manages the referrals, records and appointments from a central database in Northumberland, 350 miles away.

In Hackney, two ‘GP-led’ health centres are planned and again, sticking to the minimum legal requirement for consultation, it is clear that the Primary Care Trust in Hackney has not adequately informed local people.

Private finance and the crisis

The cost of private finance for hospital building has increased with the global financial crisis. Guarantees for repayments of capital to bond holders are now more risky and so this method has become more expensive. However, bank loans have also become more costly. Before the crisis, interest rates on bank loans were between 0.6 and 0.8% above basic bank borrowing rates; they are now 1.5-1.6% above this rate. The government’s plan to increase public borrowing to support the banking sector means that the public sector is locked into making Private Finance Initiative (PFI) repayments to banks at these higher rates. As Alyson Pollock of the Centre for International Public Health Policy at the University of Edinburgh says: ‘Having bailed out the banks at taxpayers’ expense, the government is further conflicted because in allowing the banks to charge an excessive premium for finance it is protecting shareholders’ and investors’ interests at the expense of the taxpayer, the citizen and public services.’

Cutting NHS staff

Management consultancy firm McKinsey has come up with solutions to the financial shortfall and reducton in NHS budgets. Commissioned by the Department of Health in England, it is advising a cut of 10% in the workforce by 2014. This will drastically affect health care provision. Money is however being wasted on the administration of the increasingly privatised system: it now represents 12% of the total NHS budget, compared to 6% in 1991 before the introduction of the internal market.

As the NHS is progressively broken up and its services sold off, concepts such as inefficiency and productivity become paramount whilst universal health care and needs-based planning fall off the agenda. Competition in this context prevents resources being directed to where they are needed. The privatisation of the NHS must be opposed for the health of us all.

Hannah Caller

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NHS Southampton City and NHS Portsmouth agree to combine community healthcare providers

Posted on December 21, 2009. Filed under: Arm's length providers, Press/News Releases |

Southampton Community Healthcare | About us | News Release | accessed 21 December 2009

NHS Southampton City and NHS Portsmouth Trust Boards have this week given their approval to integrate their provider arms, Portsmouth Community and Mental Health Services and Southampton Community Healthcare.
NHS Portsmouth’s Trust Board today agreed to proposals outlined in the joint full business case which follows the same decision taken yesterday (Thu 19 Nov) by NHS Southampton City.

Following today’s decision, the full business case will now be considered by South Central Strategic Health Authority (SHA) and the Department of Health. If accepted, this decision will mean that as of 1 April 2010, a new NHS community and mental health services provider will be created. As part of this decision, Portsmouth Community and Mental Health Services will transfer across to NHS Southampton City from April 2010.

The current teams will now continue to work together in developing the agreed proposals and shaping services to meet the needs of patients.

Bob Deans, Chief Executive Officer for NHS Southampton City which runs Southampton Community Healthcare and will host theintegrated services, said: “Creating a single NHS community provider, through the integration of Southampton and Portsmouth’s respective provider arms, will allow us to keep services local and provide patients with improved quality of care, increased choice and an even better patient experience. This positive decision will also allow the local NHS to revolutionise the delivery of community services across Southampton and Portsmouth which will benefit both patients and staff.”

Tracy Sanders, Chief Executive of NHS Portsmouth, the Primary Care Trust that currently runs Portsmouth Community and Mental Health Services, added: “By taking this decision, we’re not proposing that patients in Southampton travel to Portsmouth or vice versa to use services. Instead, the decision will allow us to create one dedicated provider through which we can share best practice and deliver improved services to patients across both areas. As we move towards April 2010, we will further develop the proposals we have in place to ensure a smooth integration. The decision by NHS Southampton City and NHS Portsmouth will create a provider with increased financial stability for the years to come and one which is able to offer improved access to healthcare services for patients.”

This decision follows guidance published in Transforming Community Services: Enabling new patterns of provision, published by the Department of Health, which states that Primary Care Trusts must develop a detailed plan for the future of provider services and review the options for most appropriate organisational form.

Ends

Notes for Editors:

NHS Southampton City is responsible for investing in health and care services to effectively meet the needs of the city’s population.

Southampton Community Healthcare is the provider arm of NHS Southampton City. As a provider organisation, Southampton Community Healthcare delivers NHS services in the community.

NHS Portsmouth is responsible for commissioning and providing local health services.

Portsmouth Community and Mental Health Services is the provider arm of NHS Portsmouth, responsible for a wide range delivering a wide range of community health services across the city, and further afield, to meet local health needs.

The Transforming Community Services (TCS) programme aims to improve community services so that they can provide modern personalised and responsive care of a consistently high standard. To find out more visit http://www.dh.gov.uk/en/Healthcare/Primarycare/TCS/index.htm

The transferring of Portsmouth Community and Mental Health Services to NHS Southampton City will take place via Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE).
Following this decision by the respective Trust Boards, a merger proposal will now be presented to the Department of Health, for implementation from 1 Apr. The Full Business Case will now be considered by South Central Strategic Health Authority and various Department of Health Boards

For more information please contact:

PORTSMOUTH: Pat Forsyth, NHS Portsmouth on 023 9268 4835.

SOUTHAMPTON: Matthew Butler, NHS Southampton City on 023 8029 6930.

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Take Care Now loses second out-of-hours contract

Posted on December 21, 2009. Filed under: News stories, Providers | Tags: , , |

Pulse | By Gareth Iacobucci | 21 December 2009

An private out-of-hours provider which came under fire over the death of a patient under the care of one of its foreign locum GPs has lost its second contract in a matter of weeks.

NHS Suffolk has announced it will not renew its contract with Take Care Now – which is due to expire in March 2010 – and has chosen Harmoni to take over out-of-hours responsibility in the county.

Take Care Now, which is based in Suffolk, has been under growing pressure following the death of 70-year-old David Gray last year, who died after being given an accidental overdose by German doctor Dr Daniel Ubani, working his first out-of-hours shift in the UK for the company in Cambridgeshire.

The contract is the second lost by the firm in recent weeks, after it had its contract with NHS Cambridgeshire terminated prematurely last month after failing new spot checks.

It follows a damning report on the David Gray case by the Care Quality Commission, which urged PCTs across the country to place closer scrutiny the performance of GP out-of-hours services, or risk failing to spot serious patient safety issues.

Andrew Hassan, medical director at NHS Suffolk, said: ‘The panel felt the arrangements of this provider [Harmoni] for clinical governance were robust and safe, its quality of care arrangements strong, and ideas for improvement and development of a quality service innovative.’

‘We would like to reassure people across Suffolk that during the transition period between service providers, we will make sure that the safety of patients using the service, and their clinical care, remains our top priority.’

A spokesman for Take Care Now said: ‘Take Care Now has expressed disappointment at not having been re-awarded the contract to run the out-of-hours service for NHS Suffolk but has committed to continuing to deliver innovative and patient-centred care in other areas for NHS Suffolk.’

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NHS spending and the role of the private sector

Posted on December 21, 2009. Filed under: ISTC, Press/News Releases | Tags: |

British Medical Association | Media Centre | 21 December 2009

Note: This paper is intended as background information for the media. It is not intended as a comprehensive BMA policy briefing paper.

Introduction

Funding for the NHS in England is expected to come under pressure after 2011, and there may be real term reductions in spending on health. The BMA understands the need for efficiency, but believes that the focus should be on cutting the waste resulting from commercial provision of NHS services, rather than on cuts to frontline care.

The following paper lists reports of money wasted as a result of market-driven reforms in the NHS.

Private Finance Initiative (PFI)

Under the Private Finance Initiative, the private sector has been contracted to provide new hospitals and other infrastructure and then lease them back to the state for 25 or 30 years.

A 2007 report from the Association of Chartered Certified Accountants stated ‘Unlike capital charges from non-PFI hospitals, the charges raised against PFI schemes represent revenue paid to private consortia and lost from the NHS. More schemes will eventually ensure that more money leaves the NHS in this way. In 2004, it was estimated that capital charges from PFI schemes were costing the taxpayer £125m per year.’

The 2008 National Audit Office report,Making Changes in Operational PFI Projects stated that ‘An estimated £180 million was paid by public authorities to PFI contactors to undertake [contractual] changes in 2006.

According to a report in the Daily Telegraph, ‘during the spending review period in 2011-2014, PFI repayments will rise to £4.18 billion – an increase of over £1 billion at current levels. The inflexibility of PFI contracts means that it is more likely that hospitals will make cuts to services to meet their PFI repayments’. (Hospital to cut services to pay for £60bn private finance deal Daily Telegraph, 8 August 2009)

– According to the Economist, ‘the Treasury recently established a unit to lend money to PFI projects that were experiencing difficulty in securing funds through the banks. In effect, public money is being used to prop up PFI projects’. (The Economist, print edition, 7 February 2009)

– Research (published June 2009) carried out by Dr Chris Edwards of the University of East Anglia looked at one of the first PFI contracts agreed for Norfolk and Norwich University hospital (NNUH) and concluded that:

– £217 million could be saved if the contract were bought out from the private company that originally financed the deal.

– £2.4 billion could be saved on buying out the contracts of 53 PFI hospitals, assuming the same saving as NNUH (however, each hospital would have to be looked at in detail individually).

– According to a BBC News report, ‘the University Hospitals of Leicester NHS Trust scrapped its PFI scheme due to spiralling costs. £23 million of public money had been wasted on initial preparations’. Hospitals scrap revamp plan, BBC News Online, 20 July 2007

– According to a Times report in 2008, ‘HSBC made almost £100million from managing National Health Service hospitals where contractors charge taxpayers inflated bills for simple tasks, such as £210 to fit an electrical socket. The charges, paid at hospitals run by the bank’s subsidiary infrastructure company, raise questions about lax controls in Labour’s private finance initiative’. Hospitals run by HSBC, Times Online, 8 June 2008

Independent Sector Treatment Centres (ISTCs)

Independent Sector Treatment Centres (ISTCs) are owned and run by the private sector, but contracted to provide NHS treatment. They typically carry out large volumes of supposedly simple surgical procedures such as hip replacements. The BMA is concerned that ISTCs are receiving millions of pounds for work which is not being carried out and still being paid, as their income is guaranteed. This means more money is being paid into the private sector for less work than the NHS was promised.

Information provided by the Department of Health to the Health Select Committee showed that across the first wave of ISTCs the cost of work carried out was 12% more expensive than the same work carried out by the NHS.

According to a report in the Health Service Journal ‘more than three years after opening, the Greater Manchester surgical centre has still delivered only 63 per cent of contracted value’. ISTCs: Where are all the patients? HSJ, 18 Sep, 2008

Research published in the British Medical Journal on 30 April 2009 by academics at the Centre for International Public Health Policy at the University of Edinburgh found that in the first 13 months after the Scottish Regional Treatment Centre (SRTC) began accepting patients it carried out work worth only 18% of its £5.6m annual contract for referrals. They found that:

– there was ‘no evidence’ to support claims that the centre was ‘efficient or good value for money’.

– the contract reporting requirements did not conform to NHS standards.

– Scottish health boards may have overpaid up to £3 million in the first year of the contract

– if the same findings apply in England then as much as £927 million or almost two thirds of the total first wave contracts worth £1.54 billion might have been overpaid to ISTCs.

Management consultants

The BMA believes NHS trusts are spending too much money on management consultants, often to help them with the burdens created by the development of the internal market.

The Royal College of Nursing has estimated that NHS trusts in England spent £350 million in the last financial year on external management consultants.

Figures recently published by the Department of Health in response to a Freedom of Information request, show departmental spending on consultancy projects for DH itself comes to over £125 million for 2008/09. Costs for the three previous years came to:

£132m in 2007- 2008
£205m in 2006- 2007
£133m in 2005 – 2006

2009 report from the Management Consultancies Association estimated spending on management consultancy to the wider NHS for 2008 was £300 million.

A 2009 investigation by Pulse magazine found PCT spending on management consultants has more than tripled in the past two years. It analysed figures from 62 PCTs obtained under the Freedom of Information Act, and found:

– Each PCT is now spending an average of £1.217m on external companies: up from £361,000 since 2006-2007.

– The cost of legal and professional fees has also risen dramatically bringing the total paid to external companies to an average of £1.568m per PCT.

– NHS Tower Hamlets, hailed by ministers as a trailblazing PCT, reported the heaviest use of external consultants. It spent £5.682m on various projects in 2008, an eightfold increase since 2006-2007. Pulse, 20 May 2009

For further details about the BMA’s campaign visit Look after our NHS

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Concerns over new health centre

Posted on December 19, 2009. Filed under: GP-led health centres, News stories | Tags: , |

Norwich Evening News | By Sarah Hall | 19 December 2009

Concerns are being raised that the city’s new GP-led centre is not meeting patient expectations, with the number of people who use it falling despite winter being a time when demand on health services would normally rise.

New figures reveal the much-touted Timber Hill Health Centre in The Mall Norwich has been visited by fewer patients than the smaller nurse-led centre in Dussindale it controversially replaced.

Last month, just over 4,000 patients visited the centre, but at its peak the walk-in centre in Pound Lane saw more than 5,000 patients – and that provided fewer services and never had a GP present. And rising A&E attendances in the past few months prove the centre is not helping to alleviate pressure on other health services – something it was designed to do.

While health bosses are insisting the centre is doing well and “meeting expectations”, health campaigners say the new figures realise their worst fears.

North Norfolk MP Norman Lamb, pictured, said: “This centre offers a lot more than the nurse-led walk-in centre and yet there are not as many patients using it. At this time of the year you would think there would be more patients visiting than ever.

“A lot of people were against it opening here and maybe now they are being proved right because it just doesn’t seem that popular. I think the main problem is parking and the fact

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Redbridge: polyclinic strategy mapped out

Posted on December 19, 2009. Filed under: News stories, Polyclinics | Tags: |

Ilford Recorder | NHS Redbridge | 19 December 2009

FOUR polyclinics at the heart of future healthcare in Redbridge could be developed in the next four years.

NHS Redbridge says it is pleased with the impact Loxford Polyclinic has had since it opened in April and has released details of the remaining four super surgeries, which it hopes will be running by 2013.

Work begins next year on the Seven Kings polyclinic system, linking health centres and medical surgeries with polyclinics, and a surgery could be developed on the King George Hospital site, Barley Lane, Goodmayes.

Health officials will look at systems in Wanstead, Fairlop and Cranbrook in 2011, 2012 and 2013, but have not decided in which order.

Research will be done to gauge needs in the communities, which will be compiled with social and economic information.

NHS Redbridge’s borough managing director Conor Burke said: “The proposed changes to services in outer north east London echoes this approach, suggesting the majority of urgent healthcare needs could be out outside hospitals in a polyclinic setting.

“Our five polysystems will increasingly be able to direct funding where they think it is best used in their neighbourhood, while still ensuring we meet national quality standards.”

The Wanstead polysystem could have a clinic at South Woodford Health Centre, High Road, South Woodford, and the Fullwell Cross Health Centre, Tomswood Hill, Barkingside, is the preferred option for Fairlop.

There is no obvious site for Cranbrook yet.

Loxford’s polyclinic has enticed nearly 1,000 new patients to register with GPs.

The spokesman said: “The lessons we’ve learned will prove invaluable when it comes to opening the remaining four polyclinics.

“One of Loxford’s strongest assets is the work of its community panel and this input will be replicated in the planning of the other clinics.

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Contract Performance Report Provider Landscape

Posted on December 19, 2009. Filed under: Reports/papers |

NHS Lincolnshire | Primary medical services | accessed 19 December 2009 [pdf]

NHS Lincolnshire contracts with 97 general practices and its provider arm runs a further 4 GPpractices. There are over 400 GPs currently included in NHS Lincolnshire’s primary medicalperformer list. Practices range in size from single handed GPs to large practices serving 20,000people. The practices operate from 140 premises across the county giving an indication of thedispersed nature of the local population and the large geographical area covered by theorganisation.

Many of the practices are monopolies within a very small geographic area and 66 practices aredispensing practices. 45 practices have General Medical Services (GMS) contracts, 52 PersonalMedical Services (PMS) contracts with the 4 practices operated by NHS Lincolnshire, holdingPersonal Medical Services contracts.

NHS Lincolnshire spends just over £105m (excluding prescribing) on primary medical services andhas a wide range of contracts for enhanced services including a primary care surgical scheme,sexual health services, chlamydia screening, anticoagulation, minor injuries and services forpatients with leg ulcers. NHS Lincolnshire provider arm also provides some of these enhanced services.

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Competition panel rules in GPs’ favour in branch surgery battle

Posted on December 18, 2009. Filed under: News stories, Providers, Uncategorized | Tags: , |

Pulse | By Gareth Iacobucci | NHS Kingston | 18 December 2009

The Co-operation and Competition Panel (CCP) has ruled in favour of a local GP practice after concluding that a PCT’s decision to prevent them from expanding their practice nearby was ‘inconsistent’ with competition rules.

The panel ruled that NHS Kingston’s decision to deny Churchill Medical Centre the chance to open a new branch surgery was at odds with the Principles and Rules for Co-operation and Competition, and urged the DH and NHS London to ensure that the PCT allowed the practice to proceed with its plans.

Pulse first reported the conflict last year, after the PCT blocked the practice’s plans to open a new branch surgery on the grounds that it might have threatened the viability of a new APMS service, run by private provider AT Medical.

The review – which followed a complaint by the practice that the decision was anti-competitive and restrictive to patient choice – said it had taken into account the best interests of local patients, as well as value for money for taxpayers.

The panel concluded that the decision to deny the opening of a branch surgery would have prevented around 1,500 patients from accessing their first choice for more convenient GP services, and may have undermined improvements in service quality for local patients more generally.

Dr Charles Alessi, a GP at the Churchill Medical Centre, who had previously described the PCTs position as ‘untenable’, said he was pleased with the outcome of the case.

He said: ‘I’m very pleased we can put this behind us and concentrate of healthcare. We’re happy we had a fair hearing, I hope the PCT will allow us to proceed.’

CCP Director, Andrew Taylor said: ‘We carefully considered NHS Kingston’s concerns that allowing the new branch practice to open may negatively impact on the viability of a nearby practice and impose additional financial costs on NHS Kingston.’

‘However, the panel’s view is that any potential adverse effects arising from the opening of the new branch surgery are likely to be small or immaterial. Any such effects would not be sufficient to outweigh the potential benefits to local patients and taxpayers of improved access, choice and quality derived from the introduction of the new branch surgery.’

Mr Taylor added: ‘Our recommendation takes into account a number of factors specific to this case, in particular Churchill Medical Centre’s willingness to develop the new branch surgery at its own cost and having not sought reimbursement for this initial outlay, ongoing rent or other costs normally requested by GP practices from a Primary Care Trust.’

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GP Led Health Centres in Rural Areas (Polyclinics) (Agenda item 7)

Posted on December 18, 2009. Filed under: GP-led health centres, Reports/papers |

Breckland Council | Meeting | accessed 18 December 2009

Meeting of Policy Development and Review Panel 3, Tuesday, 16th September, 2008 10.00 am (Item 34.)

Presentation by Clive Rennie (PCT).

Minutes:

Clive Rennie, the Assistant Director for Commissioning (NHS Norfolk), was in attendance for this item.  A presentation was provided and had been attached to the Minutes for information.

The historical background was explained.  Ministers had reaffirmed that there should be at least one GP Led Health Centre in each PCT area.  On 23 November 2007, Ministers had announced a list of 38 PCTs that would receive additional funding to procure 100 new GP practices.

For each locality there was no prescribed national specification for the services provided.  For any new services, the money had to be spent on new provision, not existing provision.

In Norfolk, as per other PCT areas, investment was for additional capacity i.e. extra GPs, nurses and support staff.

In March 2007, Norwich had been identified as the preferred location based on criteria set by the Department of Health i.e. deprivation, population etc for the first GP Led Health Centre.  Consideration had to be given to developing more in other areas of Norfolk. As part of the development of the GP Led Health Centre, NHS Norfolk had agreed to re-provide the Dussindale Centre in the East side of Norwich into the new centre.  The major rational for this re-provision was that a more central location was required to provide equity of access for all residents of the greater Norwich and for commuters and also to target the most deprived areas of Norwich.  Anyone could register with this Practice within the designated catchment area of Greater Norwich; however, if you lived outside the catchment area, you would not be able to register with the practice but you would be able to receive services as a “walk-in” patient.  Clive Rennie then explained how the process worked with medical records if someone registered with a GP Led Health Centre as well as their own GP.

Some Polyclinics, typically London based, could almost be described as ‘mini hospitals’ with services including MRI scanners.  Urgent care could be provided. A Member asked whether urgent care would still be located in the hospitals accident & emergency department.  He also wished to know what GP led stood for – if it wasn’t GP led, was it nurse led.

In response, Clive Rennie advised that nurses could only carry out the service up to a certain point, beyond that, the Doctor had to take responsibility.  It was much more cost effective to attend a walk-in centre rather than an A&E but the decision to attend the walk-in or A&E should be based on clinical severity of the presenting condition.

The Chairman felt that it would be a good idea to have a Polyclinic situated in every market town and he asked how it had been justified in clinical terms, to have the one and only Polyclinic in Norwich.  It was explained that it was not clinically a better service, it was more about choice and the basis of the siting of the GP Led Health Centre in Norwich had been based on a number of criteria; one of the main ones being deprivation.  The GP Led Health Centre in Norwich would be judged on how it worked, and how cost effective it was before any possible roll out to other areas.

Members were informed that to help alleviate the current problems, such as having to wait weeks for an appointment, Doctors had been given the opportunity via a cost enhanced service specification form Norfolk NHS based on a national specification from the Department of Health to extend their current service hours to include opening their surgeries on week day nights and/or Saturday mornings.

Referring to the Local Development Framework (LDF), a Member questioned the Primary Care Trust’s (PCTs) commitment concerning forward planning with other stakeholders.  He felt that it would be useful for Breckland’s planners to be informed whether potential sites in town centres could be identified during the LDF process.  In defence, Clive Rennie explained that the PCT had been heavily involved with the local authority for the Norwich development regarding transportation routes and population demographics.

Members then discussed the Thetford town centre site that originally housed a cottage hospital which, in their opinion, would be an ideal place for a GP Led Health Centre to be situated.  They were disappointed that the PCT was trying to sell the site for further housing development.

It was understood that Norwich was the biggest urban area in Norfolk but at what point did a town become big enough to sustain a Centre?  Members felt that the PCT should consider more remote areas.

RECOMMEND that

1)           the Overview and Scrutiny Commission requests that the PCT, responsible for the people of Norfolk, provide an interactive map on its website, highlighting where these services were or would be situated, including the catchment areas; and

2)           the Environmental Planning Manager, be asked to attend a future Panel meeting to discuss forward planning for Polyclinics sites.

Supporting documents:

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New GP Practices for Rotherham Primary Care Trust

Posted on December 18, 2009. Filed under: GP-led health centres, Reports/papers | Tags: |

Rotherham PCT | A public consultation May to July 2008 | accessed 18 December 2009 [pdf]

Rotherham Primary Care Trust (PCT) is committed toimproving people’s health. One way in which we cando this is by making it easier for people to see theirGP. We want to set up a new GP practice and a newGP-led health centre in Rotherham. They need to belocated in the areas of Rotherham that will bringmost benefits to local populations.

Our plans link in with those of Health Minister, LordDarzi, who is currently running a national reviewcalled ‘Our NHS, Our Future’. Last year he gave acommitment to establish 150 GP-led health centresand 100 new GP practices across the country in areasof greatest need. Rotherham will benefit from newinvestment to support these developments.We have carefully considered where the new Practiceand Health Centre should be, taking into accountthe health needs of particular areas, the location andnumber of current GPs, population trends and wherenew housing is being developed.

New GP Practice

We are proposing to set up a GP Practice in the North of Rotherham in the Wath/Hoober Wards. At this stage we have only identified the area rather than the precise location. The new GP Practice is likely to have four doctors working together to serve at least 6,000 patients. They must offer new services and extended opening hours so people can visit the Practice at different times that go beyond the normal working day.

New GP-led Health Centre

We are planning to provide a new GP Practice in the new Health Centre which will open in Rotherham town centre in November 2008. This facility will allow the maximum integration of a GP Practice with a Walk in Centre and other diagnostic services (including x-ray and ultrasound) that are available on site. They will offer longer opening hours and services to registered and non-registered patients in an innovative way.

How are we going to do it?

We are going to advertise for anyone interested in establishing a new GP Practice or the GP-led Health Centre and we will be looking to award contracts by the end of December 2008. We will be looking for these new GP practices to be run under a contract known as Alternative Provider of Medical Services (APMS). This means that services could be run by local GP practices, NHS organisations or other commercial providers of such services. Regardless of who runs them, the NHS services will remain free at the point of delivery.

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Merger of Ealing PCT’s provider services arm, Harrow PCT’s provider services arm and Ealing Hospital NHS Trust

Posted on December 18, 2009. Filed under: Arm's length providers, Integrated care, Reports/papers |

Co-operation and Competition Panel | accessed 18 December 2009

Ealing PCT’s provider services arm, Harrow PCT’s provider services arm and Ealing Hospital NHS Trust are proposing to merge to form an Integrated Care Organisation.

Consistent with its draft interim merger guidelines, the CCP will examine the costs and benefits of the proposed merger to patients and taxpayers, in order to ascertain whether it is consistent with Principles 9 and 10 of the Principles and Rules of Cooperation and Competition.

In doing so, the CCP will consider the effect of the transaction on patient choice and competition for community or secondary health services in Ealing and Harrow or a wider area.

The CCP would welcome submissions in writing from interested individuals and organisations on this issue or on any other matter relevant to the CCP’s assessment of this transaction under the Principles and Rules of Cooperation and Competition. To submit evidence please email Ealing&Harrow@ccpanel.gsi.gov.uk.

The closing date for submissions is 8 December 2009.

Case documents

Notice of Acceptance (02/12/09) [243 KB]

Administrative timetable

Event Date
CCP publishes Notice of Acceptance 1 December 2009
Closing date for Phase 1 submissions 8 December 2009
Deadline for completion of Phase 1 * 29 January 2010
Deadline for completion of Phase 2 (if required)** 24 May 2010

* At the end of Phase 1, the CCP will either:

  • recommend that the merger be allowed to proceed, or
  • recommend that the merger be allowed to proceed subject to measures agreed with the parties that address concerns identified by the CCP during Phase 1, or
  • proceed to a more detailed Phase 2 investigation.

** Phase 2 allows the CCP to conduct a more in-depth investigation where this is required to fully assess a merger.

NB. This timetable will be updated as required during the course of the inquiry.

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NHS Herefordshire launches new walk-in GP centre

Posted on December 17, 2009. Filed under: News stories, Providers | Tags: , , |

Hereford Times | NHS Herefordshire | 17 December 2009

PEOPLE feeling under the weather can now walk into a new health centre without an appointment to see a GP or nurse in Hereford.

NHS Herefordshire launched the new service, available seven days a week between 8am and 8pm, next to the ASDA store on Monday.

“When we consulted the public, there was strong support for a walkin health centre, which will supplement the excellent service already provided by GPs in the county,” said Chris Bull, chief executive of NHS Herefordshire and Herefordshire Council The centre will open over the festive period and patients can use the service while remaining registered with their own GP.

The phone number for the new service is 0330 123 9309 – the same as the current number to call a GP out of hours.

The centre is being run for NHS Herefordshire by Primecare and is temporary until a permanent walk-in health centre is built next year.

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Social enterprise ‘costs’ PCT £600,000

Posted on December 17, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | 17 December 2009

Plans by a Surrey PCT to hive off NHS services into a social enterprise could cost almost £600,000, according to Unite/CPHVA.

It believes the sum, £4 a head for Kingston’s population, could be better spent on services, such as speech and language therapists, health visitors, physiotherapists and community nurses.

Using a Freedom of Information request, Unite discovered that £181,000 has been spent in 2008/9 on becoming ‘an autonomous provider’ and ‘business ready’ organisation. A further £79,000 has been earmarked for this ‘externalisation of provider services’ for 2009/10.

If the social enterprise is not eligible for VAT refunds for the purchase of goods and services, the extra cost will be £300,000. The NHS is currently exempt from VAT.

A total of £18,000 has already been spent on ‘marketing and branding’ for the proposed social enterprise, which will be a commercial organisation, able to win and lose contracts to provide services to the NHS for a limited period of time, according to Unite.

The union believes the creation of a social enterprise contravenes health secretary Andy Burnham’s recent policy announcement that the NHS is the ‘preferred provider’ for services.

Karen Reay, Unite national officer for health, said: ‘Money that could be going on services, such as speech and language therapists, is being spent on management consultants and the bureaucracy to create the structures for the social enterprise.’

A Kingston PCT statement said: ‘We are disappointed that Unite continue to misrepresent this positive development for Kingston residents. The social enterprise is being established to benefit the local community in receipt of healthcare services. This innovative development does not contravene Andy Burnham’s recent policy announcement. In fact a recent letter from the DoH was sent to the first wave of 20 ‘Right to Request’ schemes, of which Kingston is one, reinforcing the freedoms awarded to staff working in this new type of organisation allowing them to promote innovation and efficiency to serve their patients better, free of the normal constraints of NHS bureaucracy.

‘An independent review showed that a social enterprise was the most effective way to deliver high quality and better value health services for people in Kingston and five-year financial modelling shows our plans are robust.’

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