News stories

PCT and UnitedHealth end deal

Posted on August 20, 2010. Filed under: Commissioner, News stories | Tags: |

HSJ |18 AUGUST, 2010 | BY STEVE FORD

NHS Northamptonshire has terminated its contract for commissioning support with UnitedHealth UK a year early.

The primary care trust signed a three year deal with UnitedHealth, under the framework for procuring external support for commissioners, in 2008.

The NHS landscape has changed significantly since the deal first began; PCT priorities have shifted

NHS Northamptonshire chief executive John Parkes said both sides had agreed to conclude the project in July, 12 months early.

He said: “The NHS landscape has changed significantly since the deal first began; PCT priorities have shifted.”

Mr Parkes noted the partnership had “notable successes”, including improvements in the use of data and pathways for patients with chronic disease.

He said: “UnitedHealth have had a significant impact in the organisation’s improvement as a first class commissioner and I’d look forward to working with them again.”

UnitedHealth used the Northamptonshire deal as a case study in its evidence to the Commons health committee inquiry on commissioning in January, setting out how the framework had enhanced NHS commissioning.

UnitedHealth’s submission said PCTs were “not always able to build critical mass to be world class commissioners” on an individual basis.

It stated: “To achieve the goals of improved quality and access while meeting important productivity and efficiency targets, successful commissioning with tested external organisations should be continued and expanded.”

NHS Northamptonshire improved moved up this year’s world class commissioning league table by five places.

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Take Care Now set for takeover

Posted on February 18, 2010. Filed under: News stories, Providers | Tags: , , |

Healthcare Republic | Susie Sell | 18 February 2010

Private out-of-hours provider Take Care Now is set to be taken over by larger private firm Harmoni, after heads of agreement have been signed between the two companies.

David Cocks, chief executive of TCN, suggested the future of the company is ‘best placed with a larger organisation’.

He said: ‘Harmoni is a key operator in the delivery of healthcare services to the NHS in England. They are of a size and scale which enables them to take the work TCN has done in delivering timely and appropriate care forward to the next stage.”

Dr Tony Snell, medical director of Harmoni, said: ‘We are delighted to have the opportunity to provide primary urgent care out of hours services to patients across these new areas of the country for Harmoni.

‘We believe that Harmoni will be able to provide strong business management and leadership, safe systems and processes based on our experience elsewhere, and the right level of support to enable them to deliver the best quality service possible for local people.”

Harmoni currently delivers services to more than 7 million patients on behalf of around 20 PCTs predominately located in south England and the West Midlands. TCN provides health services to around 1.5 million patients.

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Managers oppose BMA’s anti-commercialisation campaign

Posted on February 15, 2010. Filed under: News stories | Tags: |

Healthcare Republic | Neil Durham | 15 February 2010

The NHS Confederation has declared its opposition to the BMA’s Look After Our NHS campaign against the commercialisation of the NHS.

Nigel Edwards, NHS Confederation director of policy, said: ‘With the £20bn of savings in the NHS required over the next five years, the focus must continue on reducing costs while also driving up quality. Given the scale of this challenge, to rule out any use of the independent or third sector would remove a very important source of innovation and change that can help to deliver improvements.

‘It is clear from surveys and opinion polls that the public are far more interested in the quality of care they receive within the NHS than whether it is from an existing or independent sector provider.’

Susan Anderson, the CBI’s director for public services and skills, said: ‘Patients should come before politics. We shouldn’t deny high-quality healthcare to communities just because it is offered by private sector providers as part of the NHS.’

James Gubb, director of the health unit at independent think tank Civitas, said: ‘The BMA’s stance goes to the heart of the debate in the NHS at present: whether the financial challenges facing the NHS meant taxpayers’ money should be spent supporting NHS providers, or spent on the provider – NHS or non-NHS – that can offer the best deal on quality and cost.

‘I suspect most of the public would side with the latter. Affinity lies with the values underlying the NHS: universal, comprehensive healthcare, free-at-the-point-of-use, rather than who provides the service.’

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Ten ways to face down competition from a Darzi centre

Posted on February 12, 2010. Filed under: GP-led health centres, News stories |

Pulse | 12 February 10

Hemmed in by seven Darzi centres all wanting a share of his practice list, Dr Michael Taylor had to come up with new ways to hang onto his patients. Here he shares the secrets of his success

Marketing isn’t rocket science – it isn’t about spreading false truths or spending lots of money. It is about making sure patients know that what you offer is closer to they want than your competitors.

I bought a dozen books on marketing after I realised there would be seven new Darzi practices within a four-mile radius of my small practice. To meet their targets, the closest practice needed a quarter of my patients and the same from my two closest neighbours – prompting me to draw up a battle plan to revamp our practice image.

Competition may not have entered your high street yet, but the Government’s plans to erase practice boundaries will ensure that it soon will. Here are my tips to help you keep your patients and gain even more.

1. Know what patients want

We think we know what patients want, but it can come as a surprise when you actually ask them about their priorities. Don’t wait for negative comments to find their way onto NHS Choices website – ask your patients to be critical.

We set up a Sceptical Friends Group, whose composition depends on the task in hand. It is not fully representative of the practice list, but is made up of people whose opinion we respect.

We also regularly form mini-focus groups of four to seven patients to discuss current issues or a facet of the practice. The pattern is usually similar:

a) a few questions prepared by us

b) the opportunity for free conversation

c) conclusions for improvement.

We report the results in the newsletter, sending a fuller report to all participants.

2. Create a 10-year vision

Sit down with your partners and decide what your practice should be like and what you want to achieve. Where do you want to be in 10 years’ time?

Check the practice has the three foundation blocks of good clinical, business and political skills. You should function well as a generalist – perhaps with some more specialised skills – but also be skilled at pleasing your patients. Make sure you not only have good political skills, keeping your paymaster happy, but also business acumen (and not just cost containment).

3. Write a mission statement

Drawing up a mission statement is fun and gives a focus for corporate activity that is often absent in general practice.

You may think they are old-fashioned, but a good mission statement will repay the effort many times over.

You can prepare the first draft, but defining the statement should involve as many of the practice team as possible, as it needs to be their mission statement too.

The statement should be:

• short – if it takes more than three breaths to read aloud, it’s too long

• durable – concentrate on core function and values as you don’t want to change it, at least for a couple of years

• credible – your staff have to believe it

• exciting – so it can be inspirational

• memorable – laminate it and stick it on the wall in prominent positions

• important – make it a key part of your practice.

We came up with: ‘Our mission is to care for the patient by understanding the person. Together we aim to excel.’

4. Make a SMART marketing plan

Just as the mission statement reflects the practice values, your objectives should reflect the mission statement. Each objective in your plan should answer the question ‘where do we want to go?’

SMART objectives should be:

• Specific – precise and unambiguous

• Measurable – include numbers

• Achievable – just do the important ones first

• Realistic – make sure you have the resources to deliver

• Timed – state when you will deliver.

The real skill is to balance the major drivers in your practice. These include your colleagues’ wishes for the practice, your staff members’ lives and responsibilities, the PCT’s demands and the patients’ needs.

5. Appoint a leader

We now know where we are going, but how do we get there? Although there are many ways of working together, in reality it is the quality of leadership that will ensure delivery. There are many styles of leadership but don’t waste too much time choosing one – the commitment of a senior member of the team is key.

6. Define a budget

When you talk to your partners, start with the fact that marketing will cost money. Save yourself the heartache of preparing for a marketing campaign only to be disappointed when the practice won’t come up with the funds. Approval of a modest amount is a statement of intent.

Our practice expenditure on preparing the premises, staff and promotions was about £15,000, but within a year we know this has been well spent as the patient list size has risen by more than 10%.

7. Develop a customer focus

Excellence in customer service is crucial. A satisfied patient is more likely to remain loyal, to recommend you to other patients and to be concordant with agreed plans. They are also less likely to complain formally and (heaven forbid) involve you in legal proceedings. Patients are all different, but their perception is their reality, and their reality must become our reality – uncomfortable as that may be.

8. Think ‘touch points’

Would M&S allow toilets to run out of toilet paper? Would GSK have old magazines in the waiting room? If your premises and staff look smart then the first impression is that your practice is professional. Remember you don’t get a second chance to make a good first impression and the sum of each little difference will make your surgery stand out.

9. Make patients feel special

Retention is much better if your patients feel special. Ensure they are recognised and greeted the moment they walk in the door. Touch-screen computers may be more efficient at registering the arrival of patients, but there is nothing to match a receptionist’s smile of recognition.

GPs with superior consultation and empathetic skills gave greater patient satisfaction and if you want to keep good staff – make them feel special too.

10. Don’t be afraid to advertise

We GPs are often reluctant to advertise services as it risks antagonising colleagues in nearby practices, but not doing so is arguably worse. My good friend Bob Wood put a simple ‘We welcome NHS patients’ poster outside his surgery. It cost him £250 and has gained him 100 patients! You get my drift.

Marketing your practice: final checklist
1 Who is leading?
2 Are the resources of money, time and intellect in place?
3 Are there any residual doubts about the vision being shared by all stake holders?
4 Are the plans too ambitious?
5 Are the timescales adequate?
6 Are most or all of the marketing mix boxes ticked?
7 Are all of those leading on a project /objective committed and up to speed?
8 Are the interim checks agreed to ensure effective monitoring?
9 Have you already scheduled the review meetings to discuss obstacles and progress?
10 And finally, when is the celebratory party?
Source: Dr Michael Taylor

Dr Michael Taylor is head of external relations at the Family Doctor Association and is a GP in Heywood, Lancashire

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GP-led health centres cost three times more than practices

Posted on February 12, 2010. Filed under: GP-led health centres, News stories |

Healthcare Republic | Neil Durham | 12 February 2010

New GP-led health centres have received three times the funding per patient of regular GP practices, despite in some cases very few patients registering with them, according to the BMA.

This is one of the statements in a brochure warning of the impact market-based reforms are having on the NHS as the BMA opens up its Look After our NHS campaign to the public.

Dr Hamish Meldrum, BMA chairman, said: ‘We want an NHS with patients, not profits, at its heart. The public values the NHS as a publicly provided, publicly funded service. Like doctors, they do not want vital funding to be diverted to shareholders.

‘NHS staff see on a daily basis the waste of taxpayers’ money caused by this fixation with market ideology. Particularly as the public purse strings tighten, it is crucial that public money is no longer wasted on expensive commercial experiments.

‘Doctors have already backed the campaign. Now members of the public can show politicians the extent of opposition to commercialisation of their NHS.’

The BMA’s campaign website has been revamped so that members of the public can show their support.

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Should GPs commission out-of-hours services?

Posted on February 10, 2010. Filed under: News stories | Tags: |

GPs on the front-line are much better placed than PCTs to monitor out-of-hours care, argues Dr Charles Alessi. But Dr Ravi Mene disagrees, warning that if GPs take back out-of-hours it is bound to be underfunded.

Change is inevitable, growth is intentional… without doubt, the NHS is coming to terms with the fact that change is inevitable. We remain poised on the brink of a further acceleration of the pace of change. But then, growth requires change and involves risk – stepping from the known to the unknown.
The NHS has not stood still since the early nineties – but the pace and scale of change that is now being attempted goes far beyond what had been attempted before. The significant efforts being made to downsize the role played by acute hospitals and transform the district general hospitals to intermediate care community hospitals will combine primary, community and the less specialised aspects of acute care in one setting.

Access to urgent care is also in the process of transition, with a need for the multiplicity of access points to care to begin to converge. At present patients can access care via traditional out-of-hours GP services, accident and emergency, GP-led health centres, walk-in and urgent care centres. Clearly this is unsustainable. The multiplicity of these routes of entry with separate funding streams may well be economically unsustainable in the new environment of cost containment.

A further fundamental change which makes the input of primary care in out-of-hours services compelling lies with the development of polysystems. There is renewed urgency to ensure that leverage by GPs in commissioning is increased and made much more robust. A new world is emerging where primary care is expected to be more consistent in the way it offers services to patients and more predictable in the quality it offers.

There is also the near certainty that hard budgets for polysystems will become a reality – likely to happen sooner than many anticipate. If the patients of polysystems are going to benefit and general practice is going to be engaged, there seems to be no option but for practices to be the prime commissioner of out-of-hours services, given it is their money that is being spent in their operation and that if any efficiencies are to be realised it is to their populations that these will accrue.

So how to move from where we are now to where we need to be? Some practices have made a choice and opted out of the provision of out-of-hours services, giving the responsibility to PCTs to manage this aspect of patients care. There certainly seemed at the time to be minimal financial disadvantage to practices in doing so, as well as major reductions in risk and workload.

But it is now becoming clearer that primary care is much better placed to a more distant PCT to commission and manage these services. The role of PCTs needs to evolve into one where they need to ensure the services are delivered to a consistent and high-quality standard. Their role should be limited to performance-managing polysystems, which then commission services.

There is further change in the offing, which may make GP input in commissioning of out-of-hours services even more compelling. The new primary care choice agenda, with the potential for patients to have access to multiple entry points into primary care services, is a significant structural challenge. The potential exists for significant medico-legal risks, which need to be actively managed. Sharing of the care record is likely to be fundamental both in and out of hours, if risk is going to be managed effectively. How can we achieve all this without GPs taking a role in the commissioning and performance-management of out of hours care?

Dr Charles Alessi is a GP in Kingston upon Thames, Surrey, and medical director of the Kingston Co-operative Initiative

When the handover of responsibility for out-of-hours care was agreed with the Government of the time, it had broad support supported among all parties, although there were some exceptions even at that time who argued that it was our responsibility to provide out-of-hours cover. Some indeed continued to do so.
The Department of Health then started raising the quality thresholds to nudge out these providers, with the process of gaining approval for out-of-hours services increasingly becoming a tick-box exercise. The co-operatives were priced out of the game, and more and more private providers muscled in with the offer of a cheaper service – to the joy of PCT managers.

The rules of the game changed to suit the managers. The calls were screened and the decision to visit was taken from a remote place by anonymous people who did not even know the geography of the area. We had to part with £6K for no longer providing the service and responsibility was with PCTs. They soon realised it was not easy to provide the service with skeleton staff. If we had taken some of the decisions they make not to visit (triaging, as it is now known) we would have been hauled in front of the disciplinary panel. Now, staff are covered by the Government indemnity scheme, no one is responsible for their actions and every mistake is masked as a ‘significant event’.

Out-of-hours care was being run efficiently by GP co-ops, using local doctors who provided a local service for local people. This Government is hell-bent on destroying the ethos of primary care and has largely succeeded with the help of its friends in the media. Having made out-of-hours an emotive issue, ministers would no doubt like to pass it back to us.

Whether it will be backed by adequate financial resources is doubtful, however, given that the media has already softened public opinion by portraying GPs as fat cats doing no work. GP leaders have been ineffective in defending the hard work all of us do. If you say yes to Government requests, there is no guarantee that the pressure will cease.

If we were to be handed back the responsibility the round the clock care, we would be starting from scratch again, as most of the Co-op-type organisations have been extinct for several years. The organisation of an immensely complex service in a short time would be a big task. If we GPs accept the commissioning responsibility, mistakes are likely to happen in an underfunded service (which it will be) and this will give the politicians and the GP bashing media another stick to beat us with.

What guarantees would we need to take back out-of-hours? Would they reinstate the per visit fee as an item of service, or we will be expected to do on- call cover for a pittance, or commission it from others from our own pocket? This is anybody’s guess in the current economic downturn. It is more than likely some of your funding will be based on patients’ perception of how you respond to out of hours calls – a perfect ploy to obtain a service for free? The losers will be our patients, who will be left with an unsafe service in the name of an economy drive.

Dr Ravi Mene is a GP in Trafford, Manchester and a member of Salford and Trafford LMC.

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GPs set up company to prevent ‘McDonald’s-style’ practices

Posted on February 8, 2010. Filed under: News stories | Tags: |

Pulse | By Christian Duffin | 8 February 2010

An LMC is taking the extraordinary step of setting up a company to run out-of-contract practices on a short term basis – to block private sector companies stepping in.

Essex LMCs expect to finalise plans and register with Companies House this week.

The company, which as yet remains unnamed, would have six GP directors offering a service to PCTs of stabilising small practices for six months after a contract ends. This might be because of a doctor’s illness or death, retirement, emigration or poor performance.

Essex LMCs chief executive Dr Brian Balmer said: ‘I believe we’re the first LMC to formally attempt this. It probably means we are either very brainy or crazy.’

Currently, some PCTs bring in private providers temporarily when practices are out of contract, but this gives these providers an unfair advantage if they apply when the contract is later tendered, said Dr Balmer.

‘I don’t want McDonald’s-style practices. We want the practice to stay within the NHS, not become something corporate. The advantage is that we are independent, although we will not be coming in and running the practice.’

Fees for lawyers, accountants and set up charges amount to less than £5,000, funded by ‘external sources’, said Dr Balmer. He said if PCTs drag their heels in finding permanent contractors then the company will give notice of pulling out.

Dr Balmer said North East Essex PCT had responded favourably to the plans, although a PCT spokesperson said: ‘We will be meeting on March 17 to discuss the issue.’

NHS South West Essex recently announced plans to farm out ten GP practices as APMS tenders.

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NHS managers question viability of polysystems rollout

Posted on February 8, 2010. Filed under: News stories, Polyclinics | Tags: |

Pulse | By Ian Quinn | 8 February 2010

Exclusive: NHS managers have raised serious doubts about the viability of controversial plans to group GPs in polysystems and transfer hundreds of thousands of hospital cases to them.

Documents uncovered by Pulse demonstrate concerns within at least one PCT that some of the so-called polysystems being launched by NHS London could end up costing more money than they save.

The revelation comes with the BMA urging GPs to attend a rally at its headquarters on 25 February – where GPC chair Dr Laurence Buckman will be one of the key speakers – as it spearheads the battle against the ‘unproven’ polysystems model.

A report reveals NHS Westminster, meeting two days before NHS London unveiled plans for more than 100 polyclinics across the capital, claimed the policy of having groups of GPs practices serving up to 80,000 patients, based around major ‘hub’ buildings, was not practical in large areas.

Areas including Paddington, Queens Park and the northern half of central London do not have ‘sufficiently sized premises’, it said.

The report also raises fears over the affordability of the polysystems proposals.

‘A key principle in designing each polysystem is that it costs less than the existing service and delivers savings,’ it adds.

‘This requirement has a fundamental impact on the feasibility of delivering certain elements… It will be essential sufficient activity and funding can be diverted from A&E to the new service to make it financially viable,’ says the report, adding: ‘This may not be achievable in certain parts of the PCT.’

The report claims there is also a danger of polyclinic buildings threatening each other’s viability.

Neighbouring Kensington and Chelsea PCT is developing a major polysystem hub at St Charles Hospital, which Westminster claims means its cross-border plans ‘would not make sense from a service or economic perspective’.

The development of polyclinics in London has been fraught with controversy, with the economic crisis forcing a massive scaling back of the original plans put forward by Lord Darzi and now fears growing over the viability of the hub-and-spoke model.

A report by NHS Hillingdon reveals the evidence for its polyclinics strategy was branded as ‘weak’ by NHS London itself, which said it lacked evidence of affordability and how GP practices would work together, as well as ‘justification’ of the chosen sites.

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Government to bring in national model contract for out-of-hours care

Posted on February 5, 2010. Filed under: News stories | Tags: |

Pulse | By Gareth Iacobucci | 5 February 2010

The Government is to introduce a national model contract and tougher minimum standards for PCTs to use when procuring out of hours services, in order to create tighter controls on GPs providing out-of-hours care.

The announcement – which will also create more robust skills and knowledge testing for out-of-hours GPs – comes after a Government-sanctioned report into the standard of GP out-of-hours care revealed ‘unacceptable variation’ in commissioning and service provision around the country.

Launching the report today, health minister Mike O’Brien also pledged to give GPs a bigger role in planning local out-of-hours services, but ruled out making it compulsory for GPs to commission, a central plank of the Conservatives’ health manifesto.

The report, commissioned following the death of a patient given a fatal overdose by out-of-hours German locum GP Dr Daniel Ubani, said that although requirements were in place to provide ‘safe, high quality out-of-hours services’, this was undermined by the ‘unacceptable variation’ in implementation and monitoring by PCTs.

‘General Practice Out-of-hours Services,’ has been published to coincide with the coroner’s verdict on the death of David Gray, who was ruled to have been ‘unlawfully killed’ by Dr Ubani.

In a damning conclusion to the inquest, the coroner said the case amounted to gross negligence and manslaughter, and criticised weaknesses in the out-of-hours system.

It comes just a day after a confidential report leaked to Pulse revealed that patients have been placed at risk of ‘significant harm’ by a series of failings in an out-of-hours system in West Yorkshire.

The Government report – produced following a review by the Department of Health’s primary care tsar Dr David Colin-Thome and RCGP chair Professor Steve Field – makes a series of key recommendations for improving the commissioning and provision of out of hours care.

These include the requirements for PCTs to performance management arrangements in place for their out-of-hours services, and for the DH to issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary launguage skills.

The Department of Health has accepted all the recommendations in the report, but also pledged to go further in creating a model contract and tougher standards, the content of which will be consulted on before being introduced by the end of this year.

Mr O’Brien said: ”I am accepting all the recommendations made in today’s report and setting out new measures that go even further. These will tighten existing controls and ensure that out of hours providers are employing competent clinicians, providing safe and effective care.’

‘I expect all PCTs to act on these recommendations as a matter of urgency. It is unacceptable for any Trust to fail to meet its obligations on safety and quality of care.’

Dr Colin-Thome said: ‘The quality of out of hours care for most people is better than it was in 2004, but there is unacceptable variation in how services are implemented and monitored around the country.’

‘However, I am confident that by implementing the recommendations from our report, the system can be strengthened and vastly improved.’

Professor Field added: ‘The report outlines a number of important recommendations which will remind PCTs of their legal obligation to provide safe, high quality out of hours care.’

THE REPORT’S KEY RECOMMENDATIONS

• PCTs should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose;
• The Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary knowledge of English;
• The Department of Health should develop and introduce an improvement programme for PCTs to support their commissioning and performance management of out-of-hours services;
• Out-of-hours providers should consider the recruitment and selection processes in place for clinical staff to ensure they are robust and that they are following best practice;
• Strategic Health Authorities should consider how they monitor action taken by PCTs in response to this report and in carrying out appropriate performance management of out-of-hours providers; and
• Providers should co-operate with other local and regional providers (both in and out-of-hours) to share any concerns over staff working excessive hours for their respective services.

Reaction to the report

Click here to read the latest reaction to the Government’s report as it comes in.

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PMS funding diverted to pay for ‘polysystems’

Posted on February 4, 2010. Filed under: News stories, Polyclinics | Tags: |

Pulse | By Ian Quinn | 4 February 2010

Exclusive: NHS managers are planning to scrap growth funding for PMS practices across London and use the cash to fund a new network of 100 ‘polysystems’ – the successors to Lord Darzi’s polyclinics.

Plans unearthed by Pulse show trusts plan to make huge savings by denying growth money to practices in the capital, and have earmarked it to finance their latest policy drive rather than pay off deficits.

Polysystems are designed to serve populations of up to 80,000, working around polyclinic hubs many of which may be run by private providers.

The Department of Health’s policy implementation arm, NHS Primary Care Commissioning, has lent its backing to a policy developed by controversial PCT NHS Camden to finance polysystems using PMS cash.

An NHS Camden policy document posted on the PCC website as a model for other trusts sets out plans in which ‘the PMS growth money will be taken out and invested in the polysystem’.

At a meeting of PCT and DH representatives, PCC endorsed the Camden model and urged trusts to use ‘contractual levers’ to squeeze money out of PMS.

It said: ‘NHS Camden has conducted a PMS review and illustrated how to reinvest into a 40% shift from acute medicine to a primary care polysystem.’

NHS North Central London – a group of five PCTs including NHS Camden – plans to move 87,291 outpatient appointments into polysystems in 2011/12, which it claims will save more than £20m a year.

Elsewhere, PMS practices in NHS Newham have been served with breach-of-contract notices after refusing to sign up to plans to cut funding (see left).

NHS London last week announced potential sites for more than 100 polyclinics across London, with care coordinated around each in a polysystem. But it admitted there was a high risk of local and national opposition jeopardising the plans, which will dramatically reduce the number of singlehanded practices and require those GPs who take part to extend their opening hours.

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, said: ‘Polysystems are being imposed on GPs as a political imperative rather than being led by clinicians. It’s the antithesis of the rhetoric we were given in the Darzi report. Just taking money from PMS practices to fund them is a highly crude approach that can only serve to further alienate GPs.’

The BMA is staging a rally at its headquarters on 25 February to protest against NHS London’s plans, and is strongly opposing the polysystem drive.

Dr Kevin O’Kane, chair of the BMA’s London regional council, said: ‘Polysystems are being used to bring in multinational companies and increase competition. This will enable them to replace small practices.’

LEGAL FIGHT TO SAVE CONTRACTS

GPs fighting against NHS plans to slash the terms of their PMS pay have been threatened with breach-of-contract notices.

Dr Surendra Dhariwal, a GP in Newham, east London, heads up a group of more than 30 PMS practices who have consulted lawyers in an effort to stop NHS Newham bringing in new targets and cutting the funds per patient.

Dr Dhariwal said: ‘The attitude of the PCT is totally alien. All the PCT staff who negotiated the first PMS contract and understood its benefits have now left.’

FROM POLYCLINIC TO POLYSYSTEM

Networked polyclinic: A hub-and-spoke model with various GP practices linking to the hub for specialist services. Hub premises could be an existing GP practice, a private provider, a new-build or a new existing building.
Hospital-based polyclinic: To be based at the front of the hospital, with a network of care operating from community locations.
Same-site polyclinic: Services such as GP practices provided from the same building. The GP practices could run independently or merge.

Source: NHS London report

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Leaked report damns ‘serious’ out-of-hours failings

Posted on February 3, 2010. Filed under: News stories | Tags: |

Pulse | By Ian Quinn | 3 February 2010

Exclusive: Patients have been placed at risk of ‘significant harm’ by a series of failings in an out-of-hours system spearheaded by NHS Direct, a confidential report leaked to Pulse warns.

An investigation into West Yorkshire Urgent Care Service, by the doctor who drew up the Government’s national standards on out-of-hours care, identifies a catalogue of ‘serious’ errors in the exchange of clinical information between NHS Direct and on-call GPs.

The report, dated 21 December, comes amid intense scrutiny of out-of-hours services, with the inquest into the death of a Cambridgeshire patient at the hands of a German locum set to deliver its verdict this week.

Report author Dr David Carson warns lessons from that tragedy and similar incidents, such as the death of London patient Penny Campbell in 2005, have not been acted upon.

In a disturbing echo of the Campbell case, his review finds the SystmOne mobile communication system used by the service failed to reliably update on-call GPs on patients’ clinical histories or highlight when they had called on multiple occasions.

NHS Direct, which triages calls for the service, provided no way for doctors to see how many cases were being dealt with at any one time, meaning ‘doctors may be passing urgent calls into a system that does not have the capacity to respond’.

NHS Direct was also criticised for classifying as many as 60% of cases as urgent, leaving the system at risk of being overloaded and true emergencies missed.

Dr Carson, director of the Primary Care Foundation and a leading out-of-hours expert, concluded: ‘I cannot emphasise enough the serious concern I have over the issues identified.

‘Any system requiring so many manual workarounds to ensure patients do not get lost must be unfit. If information about previous consultations is not available to clinicians, these are serious risks. The deficiencies are more serious given the complex provider network… I have no doubt there is a risk of significant harm to patients.’

The investigation came after fears were raised by GPs working for Local Care Direct, a non-profit organisation providing out-of-hours care in the area alongside private firm Care UK.

SystmOne is used by more than 1,000 practices covering 14 million patients as part of the national GP Systems of Choice scheme. It is used for out-of-hours across the huge Leeds-Bradford urban centre. The report says the mobile version was prone to freezing and losing data. Logging on in a moving vehicle at night took 15 minutes, while GPs were forced to read tiny laptop screens using a six-point font and could not update records.

Last week, Pulse revealed the Primary Care Foundation’s concerns about out-of-hours services using more than one provider. It warned: ‘We highlight the consequences in areas where the service is split or where misallocation of case type takes place.’

Dr Trefor Roscoe, a GP in Sheffield and long-term campaigner for better IT safety, said: ‘I’m appalled at these findings.’

Dr Mark Napper, out-of-hours clinical commissioning lead for the five PCTs that run the out-of-hours service with NHS Direct, insisted it had been ‘performing well’, but admitted: ‘There is room for improvement’.

He said the system had been updated to ‘red flag’ patients in contact in the previous 72 hours and check whether messages from NHS Direct had got through. But other key issues remain unsolved. Dr Napper said there was ‘no completion date’ for providers to agree on a system to monitor numbers of cases in the system. GPs are still unable to update patient records using the mobile equipment, although this ‘should be resolved by the end of the month’.

Pulse raised the report’s allegations with TPP, which produces the SystmOne software.

A spokesperson said: ‘TPP was pleased to attend the meeting when Dr Carson’s report was received and able to correct errors in it. Where problems were identified TPP was pleased to provide rapid improvements. We are continuing to work with the service to deliver system enhancements.’

Despite requests, TPP did not clarify what the ‘errors’ were.

OOH SAFETY FEARS

• ‘Serious risk’ information about repeat callers not being passed on to GPs
• GPs unable to update system, meaning a risk ‘up-to-date information not available’
• Mobile computers hard to read and prone to losing data
• Up to 60% of calls classified by NHS Direct as ‘urgent’, placing doctors under ‘significant strain’
• No way for doctors to see how many cases were in system, threatening overload

Source: Report by Dr David Carson commissioned by NHS Kirklees

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Conservatives urged to step up role of polyclinics and private sector

Posted on January 29, 2010. Filed under: News stories, Polyclinics, Providers | Tags: |

Pulse | By Steve Nowottny | 29 January 2010

The founder of a private provider running a series of GP practices across the country has issued a public plea to the Conservative party to maintain the ‘momentum’ of the polyclinic rollout if they win the general election.

Dr Jeremy Rose, clinical director and founder GP of The Practice, which currently runs nine GP practices and four GP-led health centres, and plans to open a further four shortly, also urged the Conservatives to bring in more private providers to help drive up health outcomes.

Writing in the Times, Dr Rose argued that polyclinics had helped shift care to the community and improve patient choice.

‘With a change in government and policy, momentum will inevitably be lost,’ he wrote. ‘Many of the reforms in the manifesto are not new, but combined and introduced in a sustained way, they could effect change in the NHS.’

‘Facilitated by the polyclinic concept with an array of GP services, outpatient clinics, health information and so on in one place, the number of clinicians a patient needs to see and the number of clinics they attend is reduced, thus speeding up the process.’

He added: ‘As the NHS has evolved over recent years the presence of independent organisations has increased and a notion of payment by results is becoming more widely accepted. At the core is a drive for clinicians to achieve the best health outcomes for everyone, wherever they live.’

‘The possibility of more independent providers could be a catalyst for just this.’

Pulse reported earlier this month that the Conservatives have opened up talks with a series of private providers after pledging to step up the role of the independent sector in the NHS. The party said talks were ongoing with ‘a wide range’ of providers from the private and voluntary sectors.

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Private providers to cover GP extended hours

Posted on January 28, 2010. Filed under: GP-led health centres, News stories, Providers | Tags: , |

Pulse | By Gareth Iacobucci | 28 January 2010

Private firms will be able to cover extended-hours shifts for practices that do not to provide the service, under the next stage of the Government’s controversial drive to widen access to primary care.

Neighbouring practices could also take on the shifts, in a move the GPC has denounced as ‘a terrific recipe for fragmenting care’.

A letter sent to PCTs and SHAs by Gary Belfield, DH head of primary care, sets out how the Government plans to implement prime minister Gordon Brown’s pledge that all patients would have access to evening and weekend appointments.

The letter, providing details on the extension of the extended hours DES for 2010/11, makes clear that practices will not be forced to offer extended opening themselves, but that other providers will be drafted in where a practice does not.

It says: ‘A key priority is to seek to provide access to evening/weekend appointments for patients whose practices are not providing extended opening, for instance by asking other practices to provide this services, or by commissioning out-of-hours providers to offer bookable appointment slots for routine care.’

One firm, the Practice PLC, which has won a string of GP-led health centre contracts, has already indicated its willingness to take on extended-hours shifts.

Dr Jeremy Rose, clinical director and founder GP of The Practice, said: ‘The Government’s proposal is something we support and is a principle already being delivered at GP-led health centres to non-registered patients. The traditional view patients value continuity of care more than convenience is becoming questionable.’

Latest figures show around 77% of practices offering extended hours, but the Government wants access for all patients and has agreed PCTs should plough £161m into commissioning extended opening 2010/11 under the updated DES.

But GPC chair Dr Laurence Buckman attacked the proposal, calling it ‘an aggressive act against general practice’.

‘Patients will be baffled by this, practices will be angered by it,’ he said. ‘It’s deliberately designed to antagonise practices who are not offering extended hours, and I’m not sure it will improve the care of those patients either.’

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Complaints about GPs on OOH shifts soar by 50%

Posted on January 27, 2010. Filed under: News stories | Tags: |

Pulse | By Gareth Iacobucci | 27 January 2010

A leading defence body has warned that complaints against GPs related to out-of-hours consultations are growing in number, with a 50% increase seen in the past two years.

The Medical Defence Union said it had been notified of 517 complaints related to out-of-hours consultations by GP members in 2007 and 2008, compared to 337 in the previous two years, an increase of 53%.

The study follows renewed calls from the Conservatives for GPs to take back responsibility for out-of-hours care, and the on-going inquest into the death of a patient given a fatal overdose by out-of-hours German locum GP Dr Daniel Ubani.

The MDU’s study found that OOH complaints now represented around 10% of the annual total of GP complaints, compared to 8% in the previous two years.

In total, the MDU reported 73 claims related to OOH consultations over the two years of the study, compared to 41 in the previous two years.

It also said only two claims have been settled to date, and in the MDU’s experience, around two-thirds of claims are discontinued or unsuccessful.

Dr Stephen Green, head of risk management at the MDU, said: ‘OOH care continues to represent a significant and growing proportion of the complaints we see. This analysis also highlights the communication challenges associated with OOH consultations which may make a complaint more likely if something goes wrong, compared to consultations within surgery hours.

‘For example, OOH consultations are generally associated with high levels of stress and anxiety for patients and their families: there may have been a wait to be seen by a doctor they have never met before; and they may feel more vulnerable because it is the middle of the night.

He added: ‘We are advising OOH doctors to pay particular attention to the need for clear, unambiguous communication with patients and colleagues, including accurate and comprehensive note-taking and arranging follow-up if necessary.’

Shadow health Minister Mark Simmonds blamed the increase on the Government’s changes to the OOH system back in 2004.

He said: ‘I have no doubt that this increase in complaints is mainly down to Labour’s flawed changes to the GP out-of-hours system, which took responsibility for the service away from GPs and gave it to local bureaucrats.’

KEY FINDINGS IN THE MDU STUDY

– 120 complaints and 52 claims included allegations of apparent failures or delays in diagnosis or referral. Most common conditions involved were myocardial infarction, septicaemia and meningitis. While it is inevitable that diagnoses will occasionally be missed, the MDU advises doctors to undertake and document the patient’s history and examination, including relevant negative and positive findings.

– 75 complaints and 17 claims were made following the death of a patient. It is impossible to rule out a sudden deterioration in a patient’s condition but it is important to review any diagnosis if there is any change and explain to patients and careers what to do if the condition does not improve.

– 71 complaints included allegations of rudeness or that the doctor had an uncaring or off-hand manner. One case featured an allegation that the doctor was chewing gum during the home visit.

– Problems with telephone triage featured in 19 complaints. In one case, a GP assessed a patient with abdominal pain and prescribed medication without visiting the patient, who later developed appendicitis.

– 13 complaints and claims in the study were referred to the General Medical Council (GMC). Four followed the death of a patient; two were sexual allegations and the majority of the rest related to poor performance.

Source: The Medical Defence Union

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Health bosses come under fire over polyclinic plan

Posted on January 25, 2010. Filed under: News stories, Polyclinics |

Ilford Recorder | ZJAN SHIRINIAN | 25 January 2010

THE Redbridge health roadmap was torn apart by an angry councillor who warned the borough would be lumbered with five run down polyclinics if it pressed ahead with plans to build more of the super surgeries.

Fairlop Polyclinic is one of four new health centres set to be built over the next four years to go alongside the existing Loxford Polyclinic, Ilford Lane, Ilford.

But the centres – housing GPs and a host of other specialist health services – are sparking unease.

At a coffee morning hosted by campaign group Barkingside 21 on Thursday, residents had the chance to grill Rob Meaker, chief officer for the Fairlop Polysystem, and Adrienne Noon, head of communications and marketing for NHS Redbridge.

In an angry outburst, Conservative Cllr Loraine Sladden – who was at the meeting in Fullwell Cross Library, High Street, Barkingside – warned building more polyclinics would be a mistake.

She said: “If you’re hell bent on polyclinics, at least get Loxford right first of all.

“A good business wouldn’t open another company if they have problems with the first one.

“Do it over three years and then come back if it works.

“Otherwise we will be left with five run-down polyclinics.”

Mrs Noon said: “Loxford has teething problems like any new entity.

“There are issues with the walk-in side of things and we are addressing those.”

She also told residents Fairlop Polyclinic, which would also serve Fullwell, Barkingside, Clayhall and Hainault, would be unable to house every health service, meaning some may have to travel further for medical care.

She said: “What we’re trying to do is say if there is a prevalence for this thing or that, lets provide for that in the closest polyclinic.”

She also denied suggestions doctors would be forced to close and move into the new super surgery.

The proposed closure of King George Hospital’s A&E was another topic at the meeting.

People raised concerns about the “complexity” of the public consultation’s questions and appointment waiting times.

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New surgery in Kingstanding

Posted on January 22, 2010. Filed under: GP-led health centres, News stories | Tags: |

HEALTHCARE in Kingstanding has been given a boost after a doctors’ partnership signed up to run a new GP practice.

The new practice, based at the Warren Farm Health Centre, will be served by doctors from Assura Vertis, a group of 23 GP practices based in the Redditch and Bromsgrove area.

National investment has been provided to an area which has suffered a greater level of ill health and had access to a lower number of GPs than elsewhere in the country.

Jonathan Tringham, NHS Birmingham East and North director of resources, said: “I am delighted we are working in partnership to produce a new GP practice with high-quality services for patients.

“We have taken into account what our patients wanted from a GP practice and have incorporated views put forward through the public consultation.”

The initiative in Warren Farm Road follows extra funding as part of the Government’s Equitable Access to Primary Medical Care programme, which has enabled NHS Birmingham East and North to commission the new GP-led health centre.

The Warren Farm practice will work with the local community to develop an increased range of health facilities relevant to the local community and will provide extended access to health advice until 8pm two days a week and also on Saturday mornings.

Dr Ian Morrey, a local GP and Assura chairman, said: “We are pleased to have this opportunity to work with NHS Birmingham East and North to provide this additional access to a GP or nurse for the local community.

“We look forward to providing the patients of Kingstanding with high-quality, easy and convenient access to a GP or nurse.”

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New wave of APMS tenders announced

Posted on January 22, 2010. Filed under: News stories | Tags: , |

Pulse | By Yvette Martyn | NHS South West Essex | 22 January 2010

A PCT has announced plans to farm out 10 GP practices under a new wave of APMS tenders, in a move raising questions over the Government’s new-found commitment to ensure the NHS is the ‘preferred provider’.

NHS South West Essex will tender the contracts for the practices, which it currently runs, over the next 18 months as part of the process of splitting commissioning and providing roles.

Private companies and social enterprises will be allowed to bid for the contracts, even though health secretary Andy Burnham recently said alternative providers should only be sought to run services as a last resort.

In a sign of the confusion within Government policy, the PCT said the tenders were going ahead to satisfy a parallel drive to ensure PCTs only managed practices directly for short periods or in emergencies.

The first phase of tenders will see three practices transferring management with contracts to be awarded in Autumn 2010 and the remaining seven tenders to follow.

The trust insisted the move would not affect the services available or put the jobs of staff at risk. It said patients would be involved in the process and invited to give feedback on the plans, with a representative having input in the selection process.

Marc Davis, director of primary care for NHS South West Essex, says: ‘There are no plans to close or move any of the 10 GP surgeries, or reduce the range of NHS services available. The practices will still be NHS services, but like most other practices they’ll be managed by an independent contractor appointed by us.’

Dr Brian Balmer, chief executive of Essex LMCs, said: ‘The PCT has encouraged the GPs to bid for them and we are hopeful current employees will have a fair chance of getting a contract. We have organised training for GPs and practice managers in tendering and winning tenders.’

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OOH providers to be named and shamed in new benchmarking drive

Posted on January 22, 2010. Filed under: News stories | Tags: |

Pulse | By Gareth Iacobucci | 22 January 2010

PCTs and out-of-hours providers who fall short of national benchmarking standards are to be named and shamed under new plans to drive up standards of care.

The Primary Care Foundation is planning to publish names of trusts and out-of-hours providers, and patient feedback, as part of the next phase of its NHS-funded national benchmarking scheme.

The plan is outlined in the group’s latest report, which analyses the lessons learned from the first phases of its benchmarking scheme.

It comes as the inquest into the death of a patient given a fatal overdose by German locum GP Dr Daniel Ubani has prompted renewed calls from the Conservatives for GPs to take back ‘collective responsibility’ for out-of-hours care.

Although benchmarking information has so far been anonymised, it has exposed huge variations in the cost and quality of out-of-hours services.

The latest report warns many providers are missing ‘potentially urgent’ cases and suggests there is an ‘adverse impact’ where out-of-hours services are split between providers: ‘The next benchmark, planned for mid 2010, we expect to be open rather than anonymous. We are confident greater openness will help both commissioners and providers improve their services.’

Henry Clay, director of the Primary Care Foundation, said: ‘[At the moment] you have a PCT and provider doing X, Y and Z but can’t tell who they are. That feels daft.’

GPC chair Dr Laurence Buckman warned the mounting criticism over out-of-hours did not mean GPs should take back responsibility for cover, saying that would be ‘dangerous to patients’.

‘The BMA wants to see PCTs commission out-of-hours care with the involvement of local GPs. There also needs to be better investment and more rigorous monitoring, but there must not be a return to the system we had before the new contract.’

‘That would just mean replacing the current, poor system with a potentially dangerous one.’

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MPs told to ‘free’ PCTs of acute commissioning

Posted on January 21, 2010. Filed under: News stories | Tags: |

Health Service Journal | 21 JANUARY 2010 | BY NICK GOLDING

Primary care trusts should be “released” from commissioning acute care and left to concentrate on improving primary and community services, MPs have been told.

York University professor of health economics Andrew Street suggested that the Department of Health should fund hospitals directly, as part of his evidence to the Commons health select committee inquiry into commissioning last Thursday.

He said it was “difficult” for PCTs to control costs, a task made harder since the introduction of the payment by results tariff system.

Professor Street warned: “They are at financial risk.”

In his written evidence he said: “Either PCTs should be given the means to negotiate on an equal basis with hospitals or – more radically – they should be released from having to deal with hospitals altogether.”

He told the MPs: “This role could be undertaken centrally and PCTs would focus on the more neglected areas of primary and community care where there’s a considerable need for action.”

His written evidence added: “The transfer of responsibility would allow the DH to sharpen the incentives of payment by results, using the tariff more effectively to control volume, and it would better facilitate free patient choice of hospital.

PCTs that successfully kept patients out of hospital would receive a proportionately larger budget from primary and community care, he suggested, with the proportion increasing over time if strategies to reduce referrals proved successful.

But NHS North Yorkshire and York director of public health Peter Brambleby told the committee that he disagreed with the proposal.

“It’s important that someone is tasked with ensuring that the deployment of resources for that community genuinely reflects its needs,” Dr Brambleby said.

PCT Network director David Stout told HSJ commissioning was about improving patient pathways, not simply about payments between different organisations.

He said there were numerous attempts to invest in community based services, including community matrons and telemedicine to reduce the length of hospital stays or avoid unnecessary admissions.

However, he admitted PCTs had struggled to reduce acute activity and would need to do so in order to invest in community based services in the leaner years of public spending to come.

“The DH would have less means of influencing acute demand than PCTs,” he said.

Westminster PCT chief executive Michael Scott also disagreed with Professor Street’s proposal. “Controlling acute activity is undoubtedly challenging. But this isn’t the answer.

“The answer is to aggregate the scale to get the leverage you need.”

Mr Scott heads the North West London commissioning partnership, which aggregates commissioning across eight PCTs, with an acute commissioning budget of £1.4bn.

He said Professor Street was proposing the “ultimate aggregation” by centralising all of acute commissioning, but that took aggregation too far.

“You would lose local control and flavour and you wouldn’t be able to incentivise shifting care from the acute to community sector,” he said.

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Care UK chief hits out at renewal process as ITC contracts expire

Posted on January 21, 2010. Filed under: ISTC, News stories, Providers | Tags: , , , , |

Health Service Journal | 21 JANUARY 2010 | BY ALISON MOORE

The process for renewing contracts for the first independent treatment centres has been described as a “pig’s ear” by the chief executive of the largest independent provider in that sector.

Ten of the “first wave” contracts are due to expire in the next six months – with the general election expected midway through that period – and the future of many of the centres is uncertain.

At least one, the Kidderminster treatment centre in Worcestershire, is likely to close its doors. The centre will return to NHS use from next month, although the team running it plans to continue doing NHS work at a local independent hospital.

The future of the Greater Manchester surgical centre hangs on whether owner Trafford Healthcare Trust decides to use the site itself or to rent it out.

Many of the others are likely to continue but will offer treatment at tariff through patient choice, rather than through a block contract.

The firms running the centres have been told they have to go through a tender process to rent the buildings from the NHS – leading to uncertainty for staff and patients.

Mike Parish, chief executive of Care UK, which operates two sites coming up for renewal, said this had led to a “pig’s ear of a process”, with firms being offered short term contract extensions at the last minute because primary care trusts still had the contracts out to tender.

At the Barlborough centre in Chesterfield, run by Care UK, staff had to be formally told they were at risk of redundancy – only for managers to hear the next day that its contract had been extended.

“We have gone absolutely to the precipice with Barlborough,” said Mr Parish. “We have now agreed a short term tenancy with the PCT to give them an extra three or six months to sort out the lease.”

Several PCTs are at an early stage in inviting tenders for their sites. Lincolnshire PCT does not expect a new contract to come into force at its Gainsborough site until next year, according to tender documents. Many new leases will be for only three years, so PCTs and centre operators may have to repeat the process in 2013.

Mr Parish said independent centre operators had expected to switch to payment at tariff for any patients they could attract at the end of the original five year contracts, which offered guaranteed payments regardless of the number of patients treated.

But they learnt a few months ago that if their premises were owned by the NHS, as most are, they would have to go through a tendering process in order to continue to use them. Operators will pay market rent for the sites in future.

“The Department of Health, in its wisdom, decided that there would be some sort of procurement process for the leases,” he said. “It does seem odd that we have to go through a tender process to continue operating hospitals that we have operated for the last five years while NHS hospitals don’t.”

Care UK hit the headlines last week after reports its chairman had made a £21,000 donation to shadow health secretary Andrew Lansley’s office.

Health secretary Andy Burnham wrote to Mr Lansley questioning whether it was acceptable for a shadow minister

to “accept private donations from companies that have a vested interest in their policy areas”.

A Conservative spokesman said the donation was “fully within the rules”.

Independent provider Ramsay said it “understands the need” for a tendering process but some contracts may have extensions to allow this to be concluded.

The Department of Health said it announced in July that there would be a competitive tendering process where the NHS had identified a continuing need for services. It added there has been “an ongoing dialogue” between providers, the local NHS and the DH in each area.

Care UK and Ramsay may apply to run centres they do not operate at present, and Netcare – which runs the Greater Manchester centre – says it will consider case-by-case bidding.

NHS Partners Network director David Worskett was critical of the delay in resolving the contracts.

In some cases, operators will be paid at tariff but are being given “activity plans” by PCTs – an indication of the level of work they will be doing, which should help manage cash flow.

In others, PCTs say they now have sufficient capacity in the local healthcare system but they are willing to lease premises if the independent contractors take the risk of attracting sufficient patients.

The centres will also no longer be bound by “additionality” rules, which prevented NHS clinicians working in them and often forced them to recruit clinical staff from abroad.

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