Reports/papers

Guide for World Class Commissioners

Posted on January 8, 2010. Filed under: Reports/papers | Tags: |

Promoting Health and Well-Being: Reducing Inequalities

Royal Society for Public Health | accessed 8 January 2010

To improve the health of local populations requires World Class Commissioning that is relevant, sensitive and accessible. This Guide has been developed by the Royal Society for Public Health in partnership with the National Social Marketing Centre, with funding from the English Department of Health. It will assist Commissioners to make the most of the best methods of promoting health, using the latest understanding of how we can support people to make healthy choices as individuals within the social and environmental contexts in which they live. The Guide will also be of value to Providers in giving insight into the Commissioning process.

“This Guide will help people do good work more efficiently and will prevent a waste of resources, I strongly recommend Primary Care Trusts should not take action without reading the Guide first.”

Sir Muir Gray, Director of the National Knowledge Service.

To download click here

If  you have any questions please don’t hestitate to contact Richard Shircore atinfo@rsph.org.uk or call 020 3177 1622

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Number of patients in GP-led health centres and walk-in centres, walk-in activity, funding per patient

Posted on January 4, 2010. Filed under: GP-led health centres, Reports/papers | Tags: |

NHS Calderdale | Disclosure Log Item | FOI request 09/148 | accessed 4 January 2010

You asked for the information related to GP-led health centres, walk-in activity and funding. In response to your request, please find details below.

The number of patients on the registered list of all GP-led health centres and new practices that have been procured by the PCT under the Equitable Access to Primary Medical Care initiative, and the number of patients on the registered list of any walk-in centres in the PCT.

  • NHS Calderdale does not have any walk in centres. However we have two GP Led walk in services which are also Equitable Access practices. The number of patients on the list is as follows:
  1. Calder Community Practice 1645
  2. Park Community Practice 146

The level of walk-in activity at the GP-let health centres and any walk-in centre in the PCT, measured on a monthly basis if this is available

  • NHS Calderdale does not at this stage have monthly figures relating to activity.

The figure for the funding to each GP-led health centre and any walk-in centre in terms of pounds per patient registered in that centre

  • We are unable to give a pound per patient as the NHS Calderdale is still in a live procurement for the scheme.
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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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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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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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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 Westminster: GP-led Health Centres & Polyclinics

Posted on December 15, 2009. Filed under: GP-led health centres, Polyclinics, Providers, Reports/papers | Tags: , |

NHS Westminster | Committee Report | Health Consultations and Service Development | 15 December 2009 [word]

GP-led Health Centres

The introduction of GP-Led Health Centres is a nationally driven initiative to extend access to primary care services in response to the findings of Lord Darzi’s review that notes access as a significant concern for patients and service users.

The minimum services specified by the Department of Health for the GP led health centres were as follows:

  • Core GP services
  • Open 8am to 8pm 7 days a week
  • Bookable GP appointments and walk-in services
  • Registered and non-registered patients.

London PCT’s were asked to commission at least one GP-Led Health Centre by March 31st 2009.

In 2008, NHS Westminster initiated a programme of work to procure 2 GP-Led Health Centres for the north and south of the borough in areas of highest health need.  Unfortunately in the Victoria/Pimlico area difficulties were encountered in finding suitable premises for this new service and therefore we have not been able to proceed. We remain committed to providing extra GP services in the south of the borough and are currently exploring all available options to ensure that we deliver the best services possible for local people.

The contract for the GP-Led Health Centre in the north of the borough was awarded to Malling Health LLP and premises for the service have been identified in Queens Park.

A temporary premises solution has been secured while the permanent location is being made fit for purpose.  The GP led health centre opened in this temporary location on 26 October 2009.  The service is called Malling Health at Westminster.  The practice is open for patients 8am – 8pm, 7 days a week at Woodchester Square, W2.  The practice is adequately staffed with clinical and administrative personnel.  The Practice is expected to move into the permanent premises by June 2010.

Whilst in the temporary location, Malling Health will be operating under the same contractual arrangements as they will in the permanent location, including the provision of the full range of services within their contract.

Polyclinics

NHS Westminster is consulting with residents in two areas on the development of new Polysystems for the provision of out-of-hospital and primary care services. The two areas have been designated as Queen’s Park and Paddington – which covers Queen’s Park, Harrow Road, Westbourne, Bayswater, Lancaster gate and Hyde Park – and Central Westminster – which covers Bryanston & Dorset Square, Marylebone High Street, The West End, Abbey Road, Maida Vale, Little Venice, Regent’s Park, Church Street.

A polysystem is simply a network of community health services – clinics, health centres and GP surgeries – which all work together to care for patients.  It can organise for patients to get the care they need more efficiently, support patients in getting more care nearer to home and reduce the number of trips patients have to make into hospital.

GPs will be able to offer tests, appointments and treatment more quickly and conveniently.  It will also be easier to get an urgent appointment or go to a walk-in service near to home or work.  It can offer more health services in a community setting.  Examples include:

  • urgent care and walk-in services
  • diagnostics such as blood tests, x-rays and ultrasounds
  • community nursing
  • physiotherapy, occupational therapy and podiatry
  • minor surgery
  • hearing tests and hearing aid fitting
  • obstetric and maternity appointments
  • support to help with a long term condition
  • outpatient clinics
  • mental health clinics
  • sexual health clinics.

It will offer these services alongside the traditional community health services (GPs, NHS dentistry and pharmacies) and well-being services from the local authority from housing and benefits advice to debt counselling or support in getting back to work.  When a GP surgery becomes part of a polysystem, patients will still see their own GP as before.  In addition, they will also be able to see the other GPs and healthcare professionals that are part of the network.

NHS Westminster is running two separate consultations, one in each proposed polysystem area.  The proposals have been developed by local Practice-Based Commissioning Clusters in partnership with NHS Westminster to reflect local needs and experience.  Although the NHS London policy of developing polysystems is being implemented by NHS Westminster, it is important that each one is tailored to the needs and views of local residents, patients, stakeholders, GPs and other professional clinical staff.

All stakeholders on the NHS Westminster database will be contacted in the relevant areas and invited to contribute to the consultation.  NHS Westminster will also be offering stakeholders the opportunity to attend meetings to discuss and listen to local views.  Online questionnaires and response mechanisms are also being made available and consultation materials will also be available online, in GP practices and other NHS facilities as well as in libraries.

Feedback from the consultations will be collated and analysed.  Separate reports will be created for consideration by the NHS Westminster Board and will be made available online and in a feedback document to stakeholders and respondees to the consultation.

The NHS Westminster Board will then consider the responses to the consultations in developing the service specification and implementation plan.

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NHS Westminster – Update on GP Led Health Centre, Polysystems and Dental Practices

Posted on November 24, 2009. Filed under: GP-led health centres, Providers, Reports/papers | Tags: , |

NHS Westminster | Board Meeting | 24 November 2009 [pdf]

Introduction
Following the discussions at the last Board, this paper provides an update on key developments within primary and community care in Westminster.
Queens Park GP Led Health Centre Summary Update

Karen Clinton, Assistant Director, Primary Care Commissioning | 3 November 2009

Temporary solution

The GP Led Health Centre opened on 26 October 2009. The service is called Malling Health at Westminster. The practice is open for patients 8.00am – 8.00pm, 7 days a week, from temporary premises situated at Woodchester Square. The practice is adequately staffed with clinical and administrative personnel. NHS Westminster met the Department of Health target to open the GP Led Health Centre by 31 October 2009.

Permanent solution
  • Malling Health and their agents, GPI, have agreed the Heads of Terms (HoT) with Genesis Housing.
  • The rent has been agreed between NHS Westminster and GPI and the rental level is supported by the District Valuer.
  • The planning application for the permanent premises was submitted on 1 October 2009. The process will take 8 – 12 weeks in total. Taking into account the planning process and the work required to make the premises operational, the contractors have advised that the building will be ready for occupation in April 2010. A project plan for delivery of the permanent solution is in development.
  • Dr Thomas Reichhelm, Medical Director for Malling, has met with Dr Srikrishnamurthy, who is located directly opposite the Genesis building.
  • Progress is now being made by Malling Health to integrate into one of Westminster’s PBC clusters.

Significant Risks
  • The planning cycle for “change of use”, from retail to clinical, may take longer than the estimated 8 weeks and could impact upon the building work required to make the premises habitable.
  • The building work may hit unforeseen problems that could delay the opening in April 2010.

Polysystems Update

Simon Hope, Assistant Director, Strategic Commissioning | 3 November 2009

Context

The PCT is progressing development of 3 Polysystems across Westminster. Polysystem boundaries are broadly aligned with the 3 largest PbC clusters and design of Polysystem service models is being led by PbC clusters, supported by the Polysystem Programme Team.

Detail regarding development of each Polysystem is detailed below including the latest position in terms of cost and timescale for implementation:

South

The project is at implementation stage and work is underway to develop the South Westminster Centre, which is the identified system hub. A programme of minor refurbishment is due to begin, and discussions are underway with a range of service providers which will be commencing provision of new clinics in the Centre during the coming months. These include; Improving Access to Psychological Therapies (IAPT), Dermatology, Musculoskeletal services and Diabetes.

A marketing and communications plan is being drafted to include engagement with key stakeholders including clinicians and local residents, regarding the further development of the polysystem.

Discussions with the Victoria Commissioning Collaborative Cluster, regarding arrangements for management of the Polysystem, associated resources and governance arrangements between the Polysystem and the PCT are at an advanced stage.

To date, there has been new investment in the Polysystem of £280,000, to fund minor refurbishment and IT infrastructure costs. Further significant investment will be required in order to facilitate extended hub opening hours, building management, and commissioning of an on-site Urgent Care Centre. Specific detail of costs will depend on the respective service models and procurement routes selected. Savings to be accrued from the Polysystem, linked to development of redesigned community-based services, are being calculated using the Commissioning Support for London (CSL) framework, which is being relaunched in November. Detail will be included in the next Board update.

Central

Following a workshop with the Central London Healthcare Cluster, a design report has been produced which highlights a significant range of areas where further work is required in order to finalise the service model.

The Cluster’s preference is for a largely federated system, with services provided in a range of locations and integration achieved via its planned Clinical Co-ordination Centre.

The major focus to date has been in relation to the model for commissioning community-based Urgent Care services. The model put forward by the Cluster proposes multiple practice-based sites, providing integrated planned and urgent care by current primary care providers, 12 hours a day, 7 days a week. The PCT is assessing the affordability of this option and whether it meets Healthcare for London requirements.

In addition to scoping the potential for development of a number of practice-based sites for urgent care provision, the project has PCT Management Team approval to work with Central London Community Healthcare (CLCH) to develop an integrated planned and urgent care service at the Soho Centre for Health, by integrating the PMS practice and the Walk-In service already commissioned there.

Work is ongoing to identify potential locations for other Polysystem services. The cluster is keen that, as far as possible, services are hosted by GP practices and is developing criteria which potential host sites will be required to meet.

An engagement process with local stakeholders is due to commence during November, the findings of which will be incorporated into the final service model which should be complete by February 2010. The timescale for implementation will be dependent on the model, as will the requisite investment and planned savings over time.

North West

Following a workshop with the Queens Park and Paddington Cluster, a design report has been produced which highlights a significant range of areas where further work is required in order to finalise the service model.

The Cluster’s proposal is for development of the Queens Park Medical Centre (QPMC) as a polysystem hub, working with the GPs in the centre to deliver an integrated model of planned and urgent care services. The Project Team is assessing the affordability of the urgent care element of this model, linked to the likely footfall of patients through the service and the close proximity of other urgent care services at the planned GP-led Health Centre on Harrow Road, and also at St Charles Hospital in NHS Kensington and Chelsea. If affordability and return on investment of the urgent care element of the model cannot be demonstrated, work to develop the QPMC as the hub will continue, with a range of other services being located there.

An engagement process with local stakeholders is due to commence during November, the findings of which will be incorporated into the final service model which should be complete by February 2010. The timescale for implementation will be dependent on the model, as will the requisite investment and planned savings over time.

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The future of West Essex Community Health Services

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

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

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

What is a social enterprise?

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

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

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

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

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

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

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

An alternative to a social enterprise

• PCT provider unit (current arrangement) 

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

• Community foundation trust (CFT)

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

• Horizontal integration with other community care services

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

• Vertical integration with an acute trust 

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

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

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

• Managed dispersal

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

• Integration with primary care forming a social enterprise model

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

• An integrated organisational model led by local GPs

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

Big Changes For Staff And Patients At Saffron Walden Community Hospital

Saffron Walden Reporter | 23 October 2009

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

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

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

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

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

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

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

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

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

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

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

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

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

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Integrated Care Network – An Introductory Guide

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

Department of Health | accessed 26 October 2009 (pdf)

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

help drive improvements in local health and wellbeing.

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

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

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

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

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

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World class commissioning – an introduction

Posted on October 15, 2009. Filed under: Reports/papers | Tags: |

Department of Health | Guidance | 15 October 2009

World class commissioning is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice based commissioners and others, Primary Care Trusts (PCTs),supported by Strategic Health Authorities (SHAs), will lead the NHS in turning the world class commissioning vision into a reality, adding life to years and years to life.

This guide provides a brief introduction to world class commissioning.

Download World class commissioning an introduction (PDF, 303K)

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The NHS as preferred provider

Posted on October 13, 2009. Filed under: Reports/papers | Tags: , |

Department of Health | Dear Colleague Letter | 13 October 2009 

The Secretary of State’s recent speech at the King’s Fund focused on putting quality at the core of the NHS. He assured ‘the NHS is our preferred provider’. The attached letter shares with NHS Chief Executives how we propose to move this policy forward through the development of future guidance.

SHA Chief Executives
PCT Chief Executives

Gateway Reference Number: 12774
 
On the 17th September, the Secretary of State made a speech at the King’s Fund which focused on putting quality at the core of the NHS. He stated: With quality at its core, I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision. Let me begin with where I stand on this debate, and that is that the NHS is our preferred provider. But it is the important job of the commissioner to test whether these services provide best value and real quality.

Where a provider is not delivering quality – and the new accountability information will more readily demonstrate that – we will set out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers. This is fair to all as it means everyone knows where they stand and services stand or fall on the quality they provide.”

The purpose of this letter is to share with you how we propose to take this policy forward and highlight the potential implications for commissioners.

“The NHS as the preferred provider” is about getting the best care for patients and looking after the NHS staff who care for them. Our aim is to ensure that NHS staff are treated fairly and engaged in decisions, so that they know what is happening and when, what changes are being sought and why, and have a full opportunity to contribute to improving and re-designing the services that
they provide. Service improvement and re-design should not be something which is imposed on NHS staff but something which they own and lead.

We propose to do this – as the Secretary of State announced at the King’s Fund – “by setting out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers”. This will ensure “everyone knows where they stand and services stand or fall on the quality they provide”. In practical terms, we will provide guidance to PCTs on the processes we expect them to follow, which includes engaging with NHS organisations and their staff and trade union representatives, coupled with strengthened assurance processes.

“The NHS as the preferred provider” does not have implications for current or future ‘Right to Request’ proposals to set up social enterprises. We remain committed to supporting those PCT staff who wish to set up social enterprises, and neither Secretary of State’s letter, nor future guidance, should preclude the establishment of successful ‘Right to Request’ schemes. Application and assurance processes remain unchanged.

The Secretary of State has written to Brendan Barber, the General Secretary of the TUC, outlining the core principles he expects commissioners to follow from now when engaging with NHS providers. To illustrate these principles and how they might be developed in practice, we have developed six draft scenarios which set out the processes we expect PCTs to follow henceforth as commissioning needs arise (these are shown as an annex to the letter). These scenarios will inform the development of further guidance.

We will approach the development of guidance in two stages. Firstly we will publish guidance which will supersede Necessity – Not Nicety. Secondly, we will issue a revised PCT Procurement Guide and refined Principles and Rules of Co-operation and Competition. All key stakeholders will be invited to help shape these documents. Whilst we are preparing and publishing new guidance that will supersede Necessity – Not Nicety, we remain committed to the establishment of regional Commercial Support Units and the national Strategic Market Development Unit, which have important roles to play in supporting the development of World Class Commissioning (WCC).

In addition to the revised guidance, there will be implications for assurance processes, including for WCC and Transforming Community Services. It is too early to tell what these are likely to be but the WCC and TCS teams will work closely with the service, the SPF and stakeholders to identify and develop appropriate proposals that are robust and aligned existing assurance mechanisms. Our over-riding principle is to provide high quality care for patients delivered by providers who offer the best care. We remain committed to the participation of independent and third sector providers where this is the right model for patients – for example, where we need new services/service models, or substantial increases in capacity, or to offer increased choice to patients or to stimulate innovation.

We are committed to treating NHS staff fairly; giving NHS providers the opportunity to meet commissioner’s needs and thereby doing the best thing for NHS patients. For new or substantially redesigned services, PCTs would be expected to engage fully with the existing provider(s) and staff at an early stage, as well as other potential providers, enabling them to contribute to service specifications. Only after this would a decision on whether or not to openly tender take place. When competition is used it should be transparent, equal, fair and proportionate to deliver the best care to meet the needs of the local population.

I hope this helps to explain the concept of “the NHS as the preferred provider”, in advance of the proposed revised guidance. If you would like any further information, or clarification of the above, please do not hesitate to contact your SHA system management or commissioning director, or Claire Whittington (0113 254 5619), Sebastian Habibi (0207 633 7458) or Bob Ricketts (0207 633 4209/4210) at the Department.

David Nicholson CBE
NHS Chief Executive

Enclosed
1. Letter from SofS to Brendan Barber, General Secretary of the TUC

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Independent sector treatment centres

Posted on October 9, 2009. Filed under: ISTC, Reports/papers | Tags: |

The King’s Fund | Author: Chris Naylor, Sarah Gregory | Published 1 October 2009 | accessed 9 October 2009

Independent sector treatment centres (ISTCs) provide services to NHS patients but are owned and run by organisations outside the NHS. This briefing paper explains why ISTCs were introduced, and how they are funded, staffed and regulated. It assesses their impact so far, including the quality of their services and whether they provide good value for money. Finally, it examines what their future may be now that the contracts ISTC providers hold with the Department of Health are beginning to expire.

2441_ISTC_Briefing-1 Independent Sector Treatment Centre (pdf)

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NHS Plymouth provider arm

Posted on October 6, 2009. Filed under: Arm's length providers, Reports/papers |

NHS Plymouth | FOIA 671 | 6 October 2009

Item 1: Has your provider arm achieved Autonomous Provider Organisation (APO) status?

No.

Item 2: If not, when will you reach this stage?

NHS Plymouth does not hold this information because no date is set.

Item 3: What is your decision for the future organisational form of your provider arm?

NHS Plymouth has a signed memorandum of understanding with the Local Authority to develop a more integrated approach to the delivery of care.

Item 4: Are you taking part in a Department of Health pilot scheme?

No.

Item 5: Please can you provide a list of the services your provider arm offers?

Please see file entitled ‘Business Plan 2008-09’, attached below.

Item 6: Please can I have a copy of your Provider Arm Annual Report 2008/09?

Please see file entitled ‘Business Plan 2008-09’, attached below.

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Integrated care pilots: An introductory guide

Posted on September 30, 2009. Filed under: Integrated care, Reports/papers |

Department of Health | 30 September 2009

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

Integrated care is an important building block within the strategic plan for improving the health and wellbeing of the population of England, as highlighted in both the NHS Next Stage Review report High Quality Care for All and the concordat Putting People First. Both documents stress the importance of improving local health and care services by offering personalised, flexible and high quality services, where the individual is at the centre and engaged in service organisation. Integration may refer to partnerships, systems and models as well as organisations; crossing boundaries between primary, community, secondary and social care.
Each of the 16 pilot sites participating in the national programme has developed an integrated model of
care to help respond to particular local needs. Using their in-depth knowledge of the local population, the pilots are

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

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

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

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

Download Integrated care pilots: an introductory guide (PDF, 2456K)

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A year of progress towards High Quality Care for All

Posted on September 10, 2009. Filed under: GP-led health centres, Reports/papers |

Department of Health | Publications | Published 30 June 2009 | accessed 10 September 2009

Lord Darzi has today published his report High Quality Care for All: Our Journey So Far, which examines the progress that has been made since High Quality Care for All was published a year ago. Across each dimension of quality – patient experience, patient safety and clinical effectiveness – Lord Darzi has found that there has been real progress with patients already seeing the difference.

Major improvements highlighted in the report include the opening of 50 new GP led Health Centres, the introduction of personal care plan for 9.3 million patients with long term conditions and the growth in keyhole surgery. The focus on quality has moved up the agenda for staff and organisations, supported by the promotion of innovation through the introduction of tools and funds such as NHS Evidence, the Innovation Fund and the Challenge Prizes.

The report also outlines plans to drive up the quality agenda even further and free up clinicians time to do this.  Proposals include:

  • Refining of targets based on evidence – we want to free up front line staff so they can focus on delivering high quality care. We will remove the obsolete 13 week outpatient and 26 week inpatient performance targets, as well as reviewing data collections across the board in order to reduce the burden on front line staff;
  • Clinician budget ownership – we will look at giving clinical teams in the acute sector ownership of their budget. Allowing clinical teams to manage their budgets will promote entrepreneurship and innovative delivery of services built around the needs of the patient.
  • Peer review accreditation system – we will create a new voluntary peer review system in which clinicians will judge the standard of their peers in order to drive up quality and achieve a ‘gold standard’ of care. The system will be developed through close collaboration and consultation with the relevant partners and stakeholders.

 This document is for print only, a tagged and accessible version will be available shortly

Download High Quality Care for All: Our journey so far (PDF, 1069K)

 

Letter introducing High Quality Care for All, our journey so far

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GP-led health centres and polyclinics

Posted on August 5, 2009. Filed under: GP-led health centres, Polyclinics, Reports/papers |

The Chartered Society of Physiotherapy | accessed 5 August 2009

Published: 10 Jun 2009
Author: Gary Robjent – Head of Public Affairs and Policy Development

The terms “polyclinic” and “GP-led health centres” have been applied to a number of different models aimed at improving access to primary care services. This briefing sets out the background to these initiatives.

Definitions and development

Whilst not a specific recommendation, the White Paper Our Health, Our Care, Our Say (DH 2006) set out the principle to shift care from hospitals to more community-based settings. This approach was reaffirmed by Lord Darzi in Our NHS, Our Future (DH 2007), perhaps best summarised by the principle to ‘localise where possible, centralise where necessary’.

The term ‘polyclinic’ has been applied to a number of different models. In some, the defining feature is the co-location of a range of specialties. In others, the polyclinic is an organising principle in which services on several sites work together.

The co-located model in Healthcare for London (NHS London 2007) includes two significant proposals for the delivery of health care:

  • a major concentration of current GP practices into larger facilities, with 70 per cent of GP practices to be sited in polyclinics
  • a significant shift of some specialist services from hospital to community settings, with 40 per cent of all outpatient activity to be delivered in polyclinics.

One of the options in the original Healthcare for London report, for example, was a hub-and-spoke model in which the polyclinic was more of a referral centre for a number of practices that worked together but remained in their separate locations. In the main, though, the polyclinic is perceived as a building to co-locate GPs alongside specialists and a range of other services. NHS London has proposed the development of polyclinics serving populations of around 50,000 and housing a variety of primary, community and secondary care professionals.

The plan for the GP-led health centres was a development of the recommendation Lord Darzi made in A Framework for London (NHS London 2007) that polyclinics should be established in each PCT in NHS London – the first seven opened in April 2009. GP-led health centres were a response to two developments in primary care: changing patient expectations and the desire where possible to move services out of hospitals closer to where patients live.

The centres have several objectives:

  • to increase the capacity of primary community services and thereby improve access;
  • to provide more choice for patients;
  • to tackle some of the inequalities in healthcare; and
  • to encourage team working between a range of health care professionals located in one building.

Subsequently, the Royal College of GPs proposed a ‘federated model’ (RCGP, February 2008) and this has become an accepted alternative means of delivering the centres. In a federated model a network of GP practices remain in their existing buildings but are linked to what the Royal College of GPs called a local referral centre, which provides diagnostic tests and outpatient clinics, either housed in a separate building or in a GP practice.

The NHS Next Stage Review Interim Report (DH, October 2007) identified that more than 80% of NHS patient contact takes place in primary care. Most secondary and tertiary care is accessed through primary care, with millions of people receiving community-based care, for example for the 15 million people in England with long term conditions.

The report states,

‘We should invest new resources to enable PCTs to develop 150 GP-led health centres, situated in easily accessible locations and offering a range of services to all members of the local population (whether or not they choose to be registered with these centres), including pre-bookable appointments, walk-in services and other services. 

The guiding principle will be to ensure that any member of the public can access GP services at any time between 8am and 8pm, seven days a week. These centres will reflect local need and circumstance and maximise the scope for co-location with other community-based services such as diagnostic, therapeutic (eg physiotherapy), pharmacy and social care services. PCTs will be expected to commission these new health centres on a level playing field from existing GP groups or other providers.’

This was supported in the 2007 Pre-Budget Report and Comprehensive Spending Review which stipulated that health care should be ‘personalised – with a maximum of 18 weeks from referral to treatment by next year, new services for people with long term conditions and new measures to increase GP access, including additional resources for over 100 new GP practices in areas with low provision and 150 new health centres open 7 days a week;’

In the subsequent Statement to Parliament (Hansard, 10 Oct 2007 : Column 297. ‘Health and Social Care’) The Sec. of State for Health, Alan Johnson said,

‘Lord Darzi’s interim report drew out four overarching themes for the NHS over the next 10 years: fairness, personalisation, innovation and safety. First, an NHS which is fair: no single institution has made a greater contribution to social equity in this country than the NHS, yet 60 years on, whilst the health of all income groups has improved dramatically, stubborn health inequalities remain. We will begin to address one important element of this problem with a new £250 million access fund ….. 

‘The new access fund will also establish at least 150 new GP-run health centres in easily accessible locations, open seven days a week from 8 am to 8 pm. These will offer bookable appointments, walk-in services and, in some cases, access to physiotherapy, diagnostics and social care services. There will be at least one in each PCT area.

In response to the Statement the CSP issued a comment. Sarah Bazin, CSP Chair of Council, said:

“The CSP welcomes the recognition by the Secretary of State of the value of ready access to physiotherapy services. The provision of physiotherapy in the proposed GP-run health centres is good news for patients, especially for those with musculoskeletal and long-term conditions, seeking greater control of their condition. Prompt intervention by physiotherapists can achieve savings for the public purse, for example with the 500,000 plus people with musculoskeletal disorders claiming incapacity benefit.

“With up to 2,000 unemployed graduate physiotherapists waiting to treat and care for patients, there should be no delay by PCTs in taking advantage of this resource.”

The NHS Operating Framework for 2008-09 (DH 2008) made it a key priority for PCTs to complete their procurements for these new services by 31 March 2009, reflected in Annex C the ‘Vital Signs’ for inclusion in the local operational plans. It was expected that around 21 centres would be open to the public by then, with the great majority of the remaining centres opening during the rest of 2009.

The DH has avoided a prescriptive national approach; it is for SHAs and PCTs to design the service on the basis of local health needs assessments. Keeping requirements to a minimum is designed to allow PCTs to develop services which best meet locally identified need and to encourage innovation. However, the Department has set a small number of core requirements that PCTs should include in their specifications to ensure consistency across the country.

The centres should be:

  • in an easily accessible location
  • open 8am-8pm, seven days a week
  • offer bookable GP appointments and walk-in services
  • provide services for both registered and non-registered patients; and
  • maximising opportunities to integrate and co-locate with other community based services.

The only requirement on staffing is that health centres must have at their core the provision of GP services and staffing to enable patients to see a GP from 8am to 8pm, seven days a week.

The DH stipulated that the centres would be provided under the Alternative Provider of Medical Services (APMS) contract so that healthcare professionals other than GPs or commercial providers of healthcare could bid to run the centres.

The Health Committee inquiry into the Next Stage Review concluded that, ‘while polyclinics and GP-led health centres can bring benefits, we are disappointed that the Department is introducing them without prior pilots and evaluation.’ It also noted that, ‘GP-led health centres offer the potential for closer collaborative working between GPs, pharmacists and other clinicians. This should benefit patients by providing them with more integrated care. However, simply bringing health professionals under the same roof does not necessarily mean that they will work better or that they will start working together.’ (HC 53-I, 2008-2009).

Consultation

As part of the Next Stage Review, the DH published Leading Local Change (DH, May 2008). This provides the context for the publication of the 9 SHA strategic ‘visions’ which provide the framework for service development locally over the following ten years. It makes five pledges that PCTs should have regard to, to ensure that ‘the right changes happen for the right reasons, based on what is clinically best for patients.’

  1. Change will always be to the benefit of patients. This means that they will improve the quality of care that patients receive – whether in terms of clinical outcomes, experience, or safety.
  2. Change will be clinically driven. We will ensure that change is to the benefit of patients by making sure that it is always led by clinicians and based on the best available clinical evidence
  3. All change will be locally-led. Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs – and local needs are best met by local solutions.
  4. You will be involved. The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.
  5. You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.

The SHA ‘vision’ statements whilst all adopting an approach around the same 8 or 9 clinical pathways, do reflect the varying needs and aspirations within their region. These aspirations are ‘localised’ within the planning and commissioning process by each PCT.

Furthermore, the NHS Constitution (DH 2009) – currently subject to legislation – does also include the right to staff consultation. Section 3a states, ‘The NHS commits to engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements.

All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.’ It also advises that in the same way that the national Social Partnership Forum offers an opportunity to discuss, debate and involve partners in the development and implementation of the workforce implications of policy similar arrangements are being developed at SHA level and other employers’

This briefing has been prepared in response to ARC motion 36 (2009) on Polyclinics.

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