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Private firms snap up PCT-run GP practices

Posted on August 24, 2011. Filed under: Uncategorized |

Exclusive Private companies are taking advantage of the scheduled closure of PCTs to snap up a series of GP practices previously run by trusts and increase the proportion of primary care they run to record levels.

Firms are to take over the contracts of seven GP practices formerly run by PCTs after they were put out to tender over the last year, as trusts wind down and prepare to hand over to clinical commissioning groups.

Pulse revealed last week that 41 practices in England have either been retendered under APMS or are due to be, and at least two are due to close, while only six have been converted to GMS or PMS.

Now an analysis of the tendering process suggests it will drive up the proportion of practices run by the private sector, with companies dominating the award of contracts. Click here to look at a map of those practices.

A total of 11 practices previously run under PCTMS have gone through APMS tenders over the past year, with seven going to the private sector, four to the acute sector and just one to local GPs. Assura has taken over two practices in Northamptonshire and one in south-west Essex. The Practice has taken over a practice in mid-Essex, and One Medicare won tenders to run two practices in Bradford.

Latest NHS Information Centre figures show the number of APMS contracts increased from 173 in 2009 to 262 in 2010, partly through the rollout of Darzi centres, with around a quarter of equitable access contracts going to private firms.

Our analysis examined 71 practices run under PCTMS – of 84 listed by the NHS Information Centre.

Two practices, the Globe Surgery in south-east Essex and the Manzoori Clinic in west Kent, are due to close, with their patients distributed among neighbouring practices.

Consultations are being run on the future of eight practices – three in Lincolnshire, two in east Lancashire and three in the North East. Six practices have reverted to GMS or PMS contracts, 11 have been transferred to social enterprises and 41 have been retendered or are due to be.

Dr Nigel Watson, a GP in the New Forest and chair of the GPC’s commissioning and service development subcommittee, said: ‘If you go to procurement, inevitably big companies benefit. There remains concern about whether contracts are just given to the lowest bidder.’

Dr Louise Irvine, a GP in Lewisham, south-east London, said the news was of ‘great concern’: ‘It advances the damaging commercialisation begun under the last government. Commercial practices typically have a high turnover of doctors, undermining continuity.’

Dr Mark Stott, a GP in Westcliff-on-Sea, Essex, said: ‘We’re a practice for vulnerable patients. The plan is to force these people into surrounding practices. I’m sure it will have an adverse impact upon their care.’

A Department of Health spokesperson said PCT-run practices would have to be retendered, but there was no directive to close them.

CLICK HERE TO VIEW A MAP OF THE PRACTICES AFFECTED

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Commuter walk-in centre closures

Posted on May 25, 2011. Filed under: Uncategorized |

Bureau of Investigative Journalism | May 25th, 2011 | by Emma Slater

Four of six commuter walk-in centres created in a £50m Labour government scheme to give busy workers better access to healthcare have closed, the Bureau of Investigative Journalism can reveal.

The walk-in clinics were created as a part of the Independent Sector Treatment Centre (ISTC) scheme, which outsourced procedures to private providers to reduce NHS waiting times.

The table below details how much was spent on the six centres.

Commuter walk-in centres Name Provider Contract Start Date Contract End Date Contract Value (£m) Status
Manchester Manchester Piccadilly NHS Walk in Centre Atos Healthcare 11/17/05 9/30/10 7.5 CLOSED
Liverpool Street Liverpool Street NHS Walk in Cetnre Walk in Health 12/19/05 12/19/10 8.3 CLOSED
Canary Wharf Canary Wharf NHS Walk in Centre Atos Healthcare 4/21/06 3/31/11 8.2 CLOSED
Newcastle Newcastle Central NHS Walk in Centre Care UK 5/17/06 4/30/11 7.0 CLOSED
Victoria Victoria NHS Walk in Centre Care UK 12/11/06 5/31/11 8.2 OPEN
Leeds Headrow NHS Walk in Centre Netcare UK Limited 2/1/07 11/30/11 8.4 OPEN
TOTAL 47.6

Source: Department of Health

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Contract threats are no way to do business

Posted on May 25, 2011. Filed under: Uncategorized |

Pulse

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Trusts write termination clauses into PMS contracts

Posted on May 25, 2011. Filed under: Uncategorized |

Pulse | 25 May 11

By Gareth Iacobucci

Exclusive: NHS managers are writing potentially unlawful ‘variations’ into PMS contracts allowing them to be unilaterally terminated or tying GP payments to controversial efficiency measures, Pulse can reveal.

Almost two-thirds of trusts across England are writing in tough new ‘variations’ that in many cases allow them to unilaterally terminate PMS contracts if GPs don’t agree to reductions in funding or tough new requirements for payment.

The practice of writing in variations that allow unilateral termination could be declared illegal next month when a landmark case brought by GPs in London challenges attempts to force through 40% cuts in funding under the threat of closure.

The case was brought after the Department of Health inserted a new clause into PMS contract regulations last year that appeared to give the green light for terminations ‘without grounds’.

Our investigation reveals trusts across England have written variations into practice contracts or are in the process of doing so, with many specifically inserting clauses allowing unilateral termination.

PCTs are also requiring GPs to hit tough new performance targets, with one tying funding to GPs’ ‘use of resources’ by requiring them to adhere to specific care pathways.

NHS Sandwell has written in a host of new indicators to PMS contracts, including ‘adherence to local clinical pathways for diabetes and orthopaedics’ and achieving ‘a minimum number of appointments per 1,000 registered patients’.

NHS Sandwell would not comment on whether its targets amounted to payments for restrictions to referral.

A manager close to the PMS negotiations told Pulse the changes ‘were implemented in a very messy fashion’.

Click here to find out more!

NHS Wolverhampton City has written in new indicators requiring PMS practices to operate Choose and Book and extended opening, carry out in-house surveys with 25 patients per GP, and develop an action plan for practice improvement.

Of 35 PCTs providing information to Pulse, 21 have written variations into PMS contracts in the past year, or are in the process of discussing variations.

At least one-third of PCTs, including three trusts in the North East, and nine across London, have written in variations allowing termination, leaving their actions open to legal challenge.

In some cases, such as NHS Sunderland and NHS North East Essex, this was the only clause inserted, although it leaves PMS practices open to the imposition of further performance management measures in future.

GPC negotiator Dr Chaand Nagpaul, a PMS GP in Stanmore, Middlesex, said: ‘What is important is to ensure reviews are being carried out for the right reason, to ensure there is a fair contract in place, that promotes quality care and allows for innovation. Lamentably, many PCTs are misusing the contract to vary terms for the purposes of cost efficiencies.’

Dr Jane Lothian, a PMS GP in Ashington and chair of Northumberland LMC, fought a battle against her PCT over the imposition of variations to PMS deals back in 2008.

She told Pulse some of the measures being pursued by trusts were ‘ludicrous’: ‘My fear is that [reviews] will be used to impose non clinically-sensible clauses. You’d be into very dangerous ground if you started restricting for referrals contractually.

‘Measuring the number of appointments is ludicrous and an extremely crude measure which shouldn’t be used.’

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GPs to challenge PMS contract ruling in High Court

Posted on May 4, 2011. Filed under: Uncategorized |

Pulse | 04 May 11

By Amy Fallon

Exclusive: A group of GPs has launched a landmark legal case against PCTs’ right to unilaterally axe PMS contracts and will challenge health secretary Andrew Lansley in the High Court next month.

A judicial review on whether the secretary of state was entitled to introduce regulations permitting PCTs to terminate PMS agreements without cause has been set for June. The hearings have been brought by around 30 practices from Havering and Greenwich in London, a source told Pulse.

The case has been tabled as PCTs across London begin moves to write in ‘variations’ to PMS contracts that will reduce the payment per patient and impose a raft of additional performance management measures.

Pulse understands that some trusts are threatening to terminate contracts in cases where GPs do not agree to the terms, after the Department of Healthinserted a new clause into PMS contract regulations last year effectively allowing ‘without grounds’ terminations.

The change to PMS regulations, brought in under the previous health secretary Andy Burnham, came after the test case of dentist Eddie Crouch in 2008, who established it was then illegal for PCTs to terminate the dentists’ equivalent of a PMS contract without cause.

The DH revisions last year prompted a separate legal challenge by a PMS GP last June against NHS Havering, after it attempted to revise its PMS contracts to allow unilateral termination as a means of forcing through income cuts of up to 40%.

At the time, NHS Havering withdrew the proposed changes, saying it would reissue them to comply with due process.

Click here to find out more!

Barrister Simon Butler, from Ely Place Chambers – who secured victory for the dentists in 2008 and worked on the Havering case – told Pulse he has now been instructed on behalf of a GP in Havering.

Dr Karim Jan-Mohamed, a GP in Greenwich, is also named as a claimant, according to court officials.

‘The short answer is that there’s going to be a judicial review on PMS and the termination clauses currently used by some practices,’ Dr Jan-Mohamed confirmed.

Another GP in south-east London involved in the case, who asked not to be named, told Pulse: ‘Our variation contains numerous targets and policing, with ever-increasing performance management pressures. I am in favour of transparency and good standards, but I think general practice is in danger of suffocation. If the PCTs get away with these variations, it won’t be long before the Government does the same with any national GP contract.’

Both NHS South East London and the Department of Health said they could not comment while court proceedings were ongoing.

GPC negotiator Dr Chaand Nagpaul said: ‘Threats of terminations can only be disruptive and reduce morale.’

Dr Surendra Dhariwal, a PMS GP in Newham, east London, said he ‘strongly supported’ the legal challenge: ‘This law is not only be against natural justice, but also against the human rights of a doctor.’

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UnitedHealth quits primary care and sells off surgeries to The Practice

Posted on April 20, 2011. Filed under: Uncategorized | Tags: , |

Pulse – UnitedHealth quits primary care and sells off surgeries to The Practice.

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Assura Medical – Case studies123

Posted on March 14, 2011. Filed under: Providers, Uncategorized |

Assura Medical – Case studies123.

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Protected: Links

Posted on November 16, 2010. Filed under: Uncategorized |

This content is password protected. To view it please enter your password below:

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Virgin Group Enters Healthcare Sector With Majority Shareholding in Assura Medical

Posted on March 6, 2010. Filed under: Uncategorized | Tags: |

Assura Medical – Virgin Group Enters Healthcare Sector With Majority Shareholding in Assura Medical.

Highlights

  • Assura Group (“Assura”) has sold a 75.1% stake in its medical services business to Virgin Healthcare
  • In addition to retaining a 24.9% stake, Assura has received a £4 million Loan Note
  • Virgin Group will provide further funding to develop the medical services business
  • Assura will focus on its core property and pharmacy activities


London, March 1st 2010:


Virgin Group (“Virgin” or “The Group”) is today pleased to announce that it has realised a long-held ambition to enter the healthcare sector with the acquisition of a 75.1% share-holding in Assura Medical, a provider of primary healthcare services. Assura will retain a significant minority shareholding in this new partnership. Richard Burrell, Chief Executive of Assura, will join the Board of Virgin Healthcare alongside Patrick McCall and Gaurav Batra from Virgin Group.


The new partnership between Virgin Group and Assura, initially under the Assura Medical brand, aims to become one of the leading companies providing primary healthcare services to the NHS and its patients. Assura will invest £4 million of the proceeds to retain a 24.9% stake in Assura Medical.


Assura Medical forms collaborative joint venture partnerships with NHS GP practices to provide primary care, urgent care and outpatient services, diagnostics and day case procedures outside of hospitals, in the community. This approach demands new ways of delivering services, putting the patient at the heart of the healthcare experience.


Sir Richard Branson, Founder of the Virgin Group, commented:


“Healthcare is a sector that the Virgin Group has been extremely interested in entering for some time but we have always said that the partner and the timing had to be right – with Assura we believe we have found the perfect partner. The Assura Medical business is underpinned by a passion for patients, a strong focus for delivering quality and safe health outcomes and a commitment to work in partnership with those who deliver healthcare.  I am excited that Virgin and Assura will continue to develop this business, working alongside our NHS partners, to bring excellent, high-quality services right to the heart of patients’ communities.”


Richard Burrell, Chief Executive Officer of Assura, commented:


“Virgin is the ideal organisation to enable the Assura Medical business to fulfil its potential. We have developed a strong business model to assist GPs and the NHS and an established platform which, with Virgin’s help, will flourish and be much stronger in the long term. Virgin is a consumer brand synonymous with quality and service and is well placed to serve a patient-led NHS. Assura benefits from the upside of the business through its 25 percent stake and looks forward to a long term partnership with Virgin.”


The management team of Assura Medical will be led by Bart Johnson and Dr Vivienne McVey, both of whom will remain with the business under Virgin’s ownership, providing continuity of existing services and relationships with the NHS, GP partners and patients. The management team remain committed to the original vision of improving the patient experience of healthcare, and are pleased with this significant investment in future opportunities and growth.


Editors notes:


GPCos:


Assura Medical’s GPCos are healthcare provider organisations formed in partnership with groups of GPs. In total, the 30 GPCos represent partnerships with over 1500 GPs servicing more than 3 million patients in England.  They provide a range of high quality primary and intermediate community-based NHS services, including outpatient services, diagnostic procedures, day care surgery and GP-led health centres.  The services provided aim to give choice to patients, often outside of normal working hours, and have strict quality assurance mechanisms in place.


Virgin Group:

Virgin is a leading branded venture capital organization and is one of the world’s most recognised and respected brands. Conceived in 1970 by Sir Richard Branson, the Virgin Group has gone on to grow very successful businesses in sectors ranging from mobile telephony to transportation, travel, financial services, media, music and fitness.  Virgin has ten years experience in wellness through our successful chain of Virgin Active health clubs we now have over 1,000,000 members around the world after starting with one club in Preston 10 years ago.  
Virgin has created more than 200 branded companies worldwide, employing approximately 50,000 people, in 29 countries. Global branded revenues in 2009 exceeded £11.5 billion.


Assura Group


Assura Group, which was established in November 2003, is listed on the London Stock Exchange and is one of the leading healthcare companies in the UK. Assura’s property business develops and retains for long term investment GP surgeries and primary care property. Assura also operates a network of health centre based pharmacies. At 30 September 2009, Assura’s property portfolio comprised 117 investment properties, 3 investment properties under construction and investments in 6 Local Improvement Finance Trusts (LIFT) companies. In addition Assura had 32 pharmacies trading, the majority of which are located within health centres.


For information contact:


Jackie McQuillan or Nick Fox:
Virgin Group Press Office:  + 44 207 229 4738

 

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West Yorkshire Urgent Care services

Posted on January 4, 2010. Filed under: Uncategorized |

West Yorkshire Urgent Care Services | accessed 4 January 2010

From April 2009, there is now one local number to get the right NHS services when you need them urgently.

Using the service

Urgent Care is for when you have minor accidents or unexpected health problems and need help within the next few hours.

One number – 0345 605 99 99

This is a new number for West Yorkshire.

You can call day or night. Lines are open 24-hours each day, including bank holidays. And if you call your doctor out of hours, your call will be automatically transferred to us.

The new number will help you get the right treatment when you need it. The number is 0345 605 99 99. This number does not replace any existing health service.

The right treatment

If you have called 0345 605 99 99 and we think you need emergency treatment, we can arrange that directly.
Urgent care services are not for life threatening problems or emergencies. If you have an emergency, always call 999.

Service funding

West Yorkshire Urgent Care services are commissioned and funded by NHS Bradford and Airedale, NHS Calderdale, NHS Kirklees, NHS Leeds and NHS Wakefield District.

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Competition panel rules in GPs’ favour in branch surgery battle

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

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

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

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

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

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

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

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

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

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

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

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

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Company struggling to find site for new health centre

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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High cost of new Blackburn health centre

Posted on September 28, 2009. Filed under: Uncategorized | Tags: |

Lancashire Telegraph | By Chris Hopper | NHS Blackburn with Darwen | 28 September 2009

A NEW health centre due to be built for £21million will cost taxpayers more than £50million, it has emerged.

Health bosses last month secured private finance for the facility, in Alma Street, off Barbara Castle Way, Blackburn, with a deal to lease the building back.

But now the Lancashire Telegraph has learned that under the terms of the deal, NHS Blackburn with Darwen will pay around £2million a year for 25 years, with annual instalments adjusted for inflation.

And the trust must then make a further payment if it wants to buy the site at market value in 2034.

Yesterday, Roy Davies, Blackburn with Darwen’s health watchdog, criticised the deal and similar public finance initiative (PFI) schemes.

He said: “I don’t think this is a good way to built public buildings at all. I think it is disgusting that we have so much money to pay back.

“I am trying to discourage NHS officers from going down the PFI route.”

Coun Davies said he believed cash for the build of the health centre should have been found within NHS Blackburn with Darwen’s budget.

Burnley General Hospital’s new £29million maternity unit has been paid for from East Lancashire Hospitals’ capital fund, although the Royal Blackburn Hospital extension was bankrolled by PFI at huge cost to taxpayers.

The new health centre, which is expected to open in September 2011, will replace the outdated Montague Health Centre.

Paul Hinnigan, NHS Blackburn with Darwen’s finance director, said: “A replacement for Montague Health Centre has been a priority for some time.

“We have an option to purchase the new health centre at the end of the lease which will be linked to its market value.

“It is not a commitment to buy and we can decide whether or not to take up the option at that time.”

The Lancashire Telegraph has previously revealed that East Lancashire Hospitals NHS Trust will pay £680million over 35 years for the Royal Blackburn Hospital extension, which opened in 2006.

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Firm chosen to build new health centre for Forres

Posted on September 5, 2009. Filed under: Uncategorized | Tags: |

The Press & Journal | By Ryan Crighton | 5 September 2009

GALLIFORD TRY WINS £22.3M DEAL FOR THREE PROJECTS

A construction firm has landed a £22million contract to design and build three new healthcare centres in the north-east.

The deal, which will finally mean work starting on the long-awaited new hospital at Forres, will also see four ageing health centres in Aberdeen replaced with two modern facilities.

Galliford Try announced to investors yesterday that NHS Grampian will pay them £22.3million to deliver the three properties.

The first project to be completed is likely to be the £12million hospital and health centre off Grantown Road at Forres.

The building would replace the 117-year-old Leanchoil Hospital and incorporate two GP practices, allowing 15,500 patients to be treated at one facility.

The health board is in negotiations with Aberdeen City Council to take over a site on Great Southern Road which would become the multimillion-pound Whinhill Health Centre. The facility would replace both the Ferryhill Medical Practice and the Belmont Medical Practice, which health bosses say are “no longer ideal” for providing modern care.

Plans will also be drawn up for a new facility on the western edge of the Foresterhill site, which will offer GP services as well as a dentist and a chemist.

The facility will become the new home of both the Elmbank Medical Practice and Westburn Medical Group.

Last night an NHS Grampian spokesman said: “We are very pleased to have Galliford Try, known locally as Morrison Construction, on board for these projects.

“A considerable amount of work has already been carried out by health staff and the practices, but it would be premature to speculate about start dates so early on.”

He added: “NHS Grampian is now completing approvals for the development of a new hospital and health centre in Forres. The development has been in the pipeline for many years and will provide much needed new facilities and improved services. An application has been lodged with Moray Council and, if approved, would enable us to determine when a start could be made.”

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Out-of-Hours

Posted on July 28, 2009. Filed under: Uncategorized | Tags: , |

NHS Choices | accessed on 28 July 2009

Since 2004, GPs have been able to choose whether or not to provide 24-hour care for their patients.

The out-of-hours (OOH) period is from 6.30pm to 8.00am on weekdays and all day at weekends and bank holidays.

Currently, some GP surgeries deal with OOH services themselves as well as having normal surgery hours. Some surgeries work together so that the GPs from more than one surgery can take turns to provide care. Other surgeries pay private companies to give care on their behalf at certain times. This may be for OOH treatment or when surgeries are closed for another reason.

Primary care trusts (PCTs) are local healthcare organisations that are responsible for making sure that all patients get OOH care. Some PCTs may decide to provide the care themselves, while others might hire other organisations to do it. This means that each area may have a slightly different service.

You can contact your local PCT to find out how you can access OOH care in your area.

Since January 2005, all providers of OOH care have had to comply with national OOH quality requirements. These state that details of all OOH care must be sent to the surgery where the patient is registered by 8.00am on the next working day. OOH providers must have a complaints procedure consistent with the NHS complaints procedure.

Types of out-of-hours care

OOH cover may include some or all of the options below:

  • GPs working in A&E departments, NHS walk-in centres or minor injury units (MIUs),
  • teams of healthcare professionals working in places such as primary care centres, A&E, MIUs or NHS walk-in centres,
  • healthcare professionals (other than doctors) giving home visits after a detailed clinical assessment, and
  • ambulance services moving patients to places where they can be seen by a doctor or a nurse in order to reduce the need for home visits.

Telephone consultations and triage (assessment of how urgent your medical problem is) are an important part of all OOH care. NHS Direct is the national 24-hour phone service, on 0845 4647, giving health information and professional healthcare advice.

For the Department of Health’s Comprehensive information on a range of out-of-hours topics including categorised policy documents, non-clinical guidance, links, and other resources click here

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BMA warns of ‘backdoor privatisation’ of Hull’s GP services

Posted on July 24, 2009. Filed under: Uncategorized | Tags: , |

Healthcare Republic | 24 July 2009

Primary care services in Hull are being ‘privatised through the back door’, the BMA has warned. A863D298-FADD-92C3-B8E1A849E705D51D

NHS Hull is converting its provider arm into a commercial company, provisionally known as the City Health Care Partnership Community Interest Company (CIC).

The company will be owned by its staff, and will ‘re-invest’ any profits in health services or in the wider community. It will run services including several local GP practices and the local out-of-hours service.

But, despite the fact that staff will be shareholders, a trade union survey found that 90% of staff had no idea that the move was happening.

A BMA spokesman said the PCT had been ‘very unclear’ about what would happen to the company’s profits. ‘Its intention is to put that profit back into the community, but it’s not given us any detail on how that’ll work.’

He added that the trust had ‘misled its staff into thinking it’s just another NHS merger, when what’s happening is the services are moving out of the NHS’.

The PCT says that all staff that transfer over to the new company will retain their NHS pension.

But current rules mean that new staff will not be eligible for it, raising the spectre of a two-tier workforce. 

A PCT spokeswoman said: ‘City Health Care Partnership will be an independent organisation that is underpinned by strong social purpose and organisational values.’

She added that the trade union that conducted the survey had only asked its own members. ‘This is not 90% of the total staff,’ she added.

jonn.elledge@haymarket.com

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Alternative Providers of Medical Services (APMS)

Posted on July 15, 2009. Filed under: Uncategorized | Tags: , |

Department of Health – last accessed on 15 July 2009

Alternative Provider Medical Services (APMS) is a contractual route through which PCTs can contract with a wide range of providers to deliver services tailored to local needs.

It offers substantial opportunities for the restructuring of services to offer greater patient choice, improved access and greater responsiveness to the specific needs of the community. It will provide a valuable tool to address need in areas of historic under-provision, enable re-provision of services where practices opt out, and improve access in areas with problems with GP recruitment and retention.

What is APMS and why was it introduced?

Why was APMS introduced?

Alternative Provider Medical Services (APMS) is a contractual route through which PCTs can contract with a wide range of providers to deliver services tailored to local needs. It was introduced to allow PCTs to make arrangements outside of the established contracting routes with additional providers.

What services can be provided under APMS?

APMS can be used to provide essential services, additional services where GMS/PMS practices opt out, enhanced services, out-of-hours services or any one element or combination of these services.

How does APMS differ from the other routes?

Under APMS, PCTs are able to contract for primary medical services with commercial providers, voluntary sector providers, mutual sector providers, social enterprises, public service bodies, GMS and PMS practices (through a separate APMS contract) and NHS Trusts and NHS Foundation Trusts.

Does APMS mean privatisation of the NHS?

No. APMS is just a contractual route to deliver NHS services. Regardless of the type of provider, the NHS remains free at the point of delivery.

Can APMS be used for children’s services/drug or alcohol services/mental health services/sexual health services/complementary health services?

It is for PCTs to determine the health needs of their populations and to commission or provide services. Services such as those described can be provided using any of the contracting routes, including APMS, as long as the services are primary medical services.

How is an APMS contract regulated?

The APMS Directions 2006 set out mandatory requirements, but also allow extensive flexibility. APMS gives PCTs considerable discretion to shape locally appropriate services responsive to the needs of the community. A ‘model’ APMS contract is available through the link to EAPMC below and can be used as a guide for local APMS contracts.

Equitable Access to Primary Medical Care (EAPMC)

 

Standards, regulations and pensions

What factors apply to APMS contracts?

  •  The APMS Directions place a duty on the PCT to set out various clauses in each APMS contract.  These apply to:
  1. basic requirements: who can be patients, the services to be provided, circumstances in which the contract can be terminated or sanctioned;
  2. common standards with PMS: provisions equivalent to the PMS regulations, including premises, GP appraisal and assessment, clinical governance, confidentiality, inspection by the Healthcare Commission;
  3. extra requirements: covering dispute resolution, additional restraints on prescribing, qualification of staff;
  4. requirements applicable to essential services (where these are provided under the APMS contract)
  • Why is APMS regulated at all?

The APMS Directions have been designed to ensure quality standards across all contracting routes, and so that minimum statutory requirements apply across the board.

What standards do APMS providers have to meet and how are these enforced?

PCT service specifications should include requirements across all dimensions of performance, and state what performance standards will be applied, including NHS and local performance management standards. These should be incorporated into the contract between the PCT and provider.

What is the difference between APMS and a Service Level Agreement (SLA)?

An SLA is not an enforceable contract. Under an SLA, where the two bodies involved in the agreement are health service bodies, the contract will be an NHS contract which is not enforceable at law, and where disputes will be dealt with via the NHS Dispute Resolution Procedure. APMS contracts with private and voluntary organisations which are not health service bodies set out legally enforceable provisions, including safeguards for patients, and, since the contract is not an NHS contract, appropriate mechanisms for resolving disputes and breaches of contracts.

How are APMS contracts paid for?

This is for PCTs to determine, using the PCT’s unified budget.

How much will APMS contracts cost?

This is for agreement between the PCT and provider. As with all contracts, APMS contracts should seek to balance outputs against value for money.

Can GMS and PMS practices provide APMS services?

Yes. PCTs can contract with GMS and PMS practices through the APMS route. The practice would hold a separate APMS contract alongside their existing GMS/PMS contract.

Are APMS arrangements pensionable under the NHS Pension Scheme?

The NHS Pensions Regulations enable APMS contactors and their staff to be eligible to remain in, or join, the main NHS Pension Scheme providing the APMS contractor also meets the eligibility criteria for the provision of GMS or PMS. For pension purposes, staff will be treated as practice staff. As members of the main NHS Pension Scheme, practice staff are entitled to retirement benefits. However, they are not entitled to the separate but related benefits in respect of injury, early payment or extra service on the redundancy or Voluntary Early Retirement with the employer’s consent (where the employer agrees to meet the cost so the pension is not reduced).

If the APMS Provider is a NHS Trust or a Foundation Trust then the staff will have the same pension rights as other NHS Trust or Foundation Trust employees.

The eligibility criteria for providing GMS are section 28S of the NHS Act 1977. The eligibility criteria for PMS are in section 28D of the Act – set out in the Annex to this note.

APMS contractors who do not meet the eligibility criteria for the provision of GMS or PMS will not be eligible to remain in, or join, the NHS Pension Scheme.

How many PCTs are currently using APMS?

The Department does not collect or hold this information. We do know that many PCTs in England are contracting for out-of-hours services under the APMS route and there is much interest in the wider opportunities presented by APMS.

The Department has been supporting six PCTs with the procurement of alternative providers.

Do PCTs need to tender for APMS contract?

Any decision to place a tender for primary medical services provision is a matter for the commissioning PCT. In reaching a decision the PCT will need to meet DH procurement guidelines and would also be expected to seek its own legal advice.

While PCTs will be aware that health services are not covered in full by the EC Directive on the procurement of services they may, as good practice to ensure delivery of high clinical standards and good value for money services, seek to test the market via the procurement process.

Can pharmacy, dental or optometry services be provided under an APMS contract?

No. APMS is for the provision of primary medical services.

What is the difference between APMS and SPMS?

Specialist PMS (SPMS) is a PMS model of delivery that does not require the provider to have a registered list of patients, the involvement of a GP or the provision of essential primary care services. What makes SPMS different is that it can only be provided by those who would otherwise qualify to hold a PMS agreement, as in Section 28D of the 1977 Act and Part 2 of the PMS Regulations.

How do PCTs procure services using APMS?

NHS PASA have produced an APMS Procurement Toolkit  to support PCTs in the procurement process, available on NHS PASA’s website. The toolkit gives advice on developing service specifications, advertising, tendering, evaluating applications, project managing contracts, and monitoring outputs.

NHS Purchasing and Supply Agency (opens new window)

 

What other help is available to support APMS development?

The Department of Health has issued Directions and guidance. For general guidance on contracting and commissioning, see links below.

The National Primary Care Collaborative (NPCC) supports PCTs in 28 pilot sites to develop an integrated approach to primary care commissioning, using all contracting routes. Further details are on the Improvement Foundation website

Commissioning Friend (opens new window)

 

Primary care contracting (opens new window)

 

Improvement Foundation: Practice-based commissioning development programme (opens new window)

 

Eligibility of contractors

This is an extract from the Health and Social Care (Community and Health Standards Act) 2003. Anyone entering into a contract for the provision of primary medical services is advised to take legal advice.

‘(1) A Primary Care Trust or Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with:

(a) a medical practitioner;

(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied; or

(c) a company limited by shares where the conditions in subsection (3) are satisfied

(2) The conditions referred to in subsection (1)(b) in relation to a partnership are that-

(a) at least one partner is a medical practitioner; and

(b) any partner who is not a medical practitioner is either-

    (i) an  NHS employee;

    (ii) a section 28C employee, section 17C employee or Article 15B employee;

    (iii) a health care professional who is engaged in the  provision of services under this Act; or

    (iv) an individual falling within section 28D(1)(bc) above.

(3) The conditions referred to in subsection (1) (c) in relation to a company are that-

    (a) at least one share in the company is legally and beneficially owned by a medical practitioner; and

    (b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2) (b) (i) to (iv).

(4) Regulations may make provision as to the effect, in  relation to ageneral medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.

(5) In this section:

       ‘health care professional’ has the same meaning as in section 28M above; ‘NHS employee’, section 28C employee’, ‘section 17C employee’ have the same meaning as in section 28D above.

 

Section 28D of the 1977 Act  (Persons with whom PMS agreements may be made)

This is an extract from the Health and Social Care (Community and Health Standards Act) 2003 and is provided for information. Anyone entering into a contract for the provision of primary medical services is advised to take legal advice.

‘(1)   A Strategic Health Authority or a Health Authority may make an agreement under section 28C (personal medical or dental services) only with one or more of the following:

    (a)    an NHS trust or NHS foundation trust;

    (b)   a medical practitioner who meets the prescribed conditions;

    (ba)    a dental practitioner who meets the prescribed conditions;

    (bb)    a health care professional who meets the prescribed conditions;

    (bc)    an individual who is providing services:

        (i)   under a general medical services contract  
        (ii)   in accordance with section 28C arrangements, section 17C arrangements or Article 15B arrangements; or 
        (iii) under section 35 of this Act, section 17J or 25 of the 1978 Act or Article 56 or 61 of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No 1256 (NI 14)); or has so                provided them within such period as may be  prescribed;

(d)  an NHS employee, a section 28C employee, a section 17C employee or an Article 15B employee;

(e)  a qualifying body;

(f)   a Primary Care Trust or Local Health Board.

(1A)   The power under subsection (1) to make an agreement with a person falling within paragraph (bc) or (d) of that subsection is subject to such conditions as may be prescribed.

(2)   In this section –

‘the 1978 Act’ means the National Health Service (Scotland) Act 1978;

‘Article 15B arrangements’ means arrangements for the provision of services made under Article 15B of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No 1256 (NI 14));

“Article 15B employee’ means an individual who, in connection with the provision of services in accordance with Article 15B arrangements, is employed by a person providing or performing those services;

‘health care professional’ means a person who is a member of a profession regulated by a body mentioned (at the time the agreement in question is made) in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002;

‘NHS employee’ means an individual who, in connection with the provision of services in the health service in England and Wales, Scotland or Northern Ireland, is employed by

(a)   an NHS trust, an NHS foundation trust or (in Northern Ireland) a Health and Social Services Trust;

(b)   a Primary Care Trust or Local Health Board;

(c)   a person who is providing services under a general medical services contract;

(cc)   a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 36(1)(a);

(d) an individual who is providing services as specified in subsection (1)(bc)(iii) above;

‘qualifying body’ means:

(a)   a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (ba), (bb), (bc), (d) or (f) of subsection (1); and also

(b)   in the case of an agreement under which primary dental services are provided, a body corporate which, in accordance with the provisions of Part IV of the Dentists Act 1984, is entitled to carry on the business of dentistry;

‘section 17C arrangements’ means arrangements for the provision of services made under section 17C of the 1978 Act;

‘section 17C employee’ means an individual who, in connection with the provision of services in accordance with section 17C arrangements, is employed by a person providing or performing those services;

‘section 28C arrangements’ means arrangements for the provision of services made under section 28C; and

‘section 28C employee’ means an individual who, in connection with the provision of services in accordance with section 28C arrangements, is employed by a person providing or performing those services.

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GPs given contract for walk-in centre

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

Sunderland Echo | By Julie Wilson | Sunderland tPCT | 10 February 2009

Doctors who took over their own GP practice have been awarded the contract to run Wearside’s new walk-in centre.

Patients at Encompass Healthcare fought for two years to keep family doctors Ashley Liston and Tracey Lucas, amid fears that they could be forced out after the contract to run the surgery was put out to tender.

They were delighted when the GPs were chosen to run the practice at Washington’s Galleries Health Centre.

Now Encompass has won the contract for the new Washington Primary Care Centre, which will be open seven days a week, from 8am to 8pm.

It will provide a doctors’ surgery alongside a range of other mixed healthcare services, including a minor injuries walk-in centre.

Dr Liston, of Encompass Healthcare, said: “We are very happy and very enthusiastic about it. We are very committed to developing services for our patients.

“It’s going to be a huge asset for the local community.”

The walk-in service at the new Washington Primary Care Centre, in the town centre, will start from May 1, with additional GP services at Washington Galleries Health Centre from April 1.

Jan Forster, director of primary care commissioning for NHS South of Tyne and Wear, said: “We would again like to reassure patients that this is not about replacing current GP providers, but offering greater choice should patients wish to take up this opportunity.”

Sunderland Teaching Primary Care Trust has also announced that two new GP practices in Riverview Health Centre in Hendon and Pennywell Health Centre will be run by Peterlee-based Intrahealth from April 1.

The GP surgeries in Pennywell and Hendon will be open to new patients and will have a wider range of services and longer opening hours – 8am to 6.30pm and Saturday mornings – with a possibility that opening times will be extended even further.

Greg Moorhouse, managing director of Intrahealth, said: “We are extremely pleased and honoured to be given this opportunity. It’s something we are looking forward to.

“I’m a Sunderland resident and it’s a chance to make a difference in our own community.”

Mr Moorhouse, a pharmacist, said the shareholders of Intrahealth were from an NHS background. 

No suitable application was received to run a new doctors’ practice in the Coalfields area, so the trust is reconsidering its options.


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Atos Healthcare: NHS Walk-in Centres

Posted on April 23, 2009. Filed under: Uncategorized | Tags: , |

Atos Healthcare 

Flexible access to primary care is the key to delivering health services that meet the needs of modern society.

The NHS introduced seven new Walk-in Centres (WiCs) in England, run by independent sector providers. These complement existing primary care services such as GPs and hospital accident and emergency departments. They provide patients with a range of services, without requiring an appointment.

Contracts for two of the WiCs were awarded to Atos Healthcare. The first was opened in Manchester on 17 November 2005, and the Canary Wharf WiC opened on 21 April 2006.

The services offer treatment for a range of conditions such as:

  • Coughs, colds and flu-like symptoms
  • Emergency contraception and advice
  • Hay fever, bites and stings
  • Minor cuts and wounds
  • Muscle and joint injuries
  • Skin complaints – e.g., rashes, sunburn and head lice
  • Stomach ache, indigestion, constipation, vomiting and diarrhoea.

Patients can simply turn up at any time from 7am to 7pm, Monday to Friday. If more convenient, they can also make an appointment.

Treatment and advice is provided in purpose-designed medical centres staffed by dedicated teams of nurse practitioners and doctors.

Continuity of care is important so, with the patient’s consent, details of key aspects of the consultation are sent to their GP.

The performance and quality of the service provided by Atos Healthcare is monitored by the Department of Health and the host Primary Care Trust using reports generated by the centre’s bespoke IT system. The centre operates under a robust clinical governance framework with clear lines of responsibility to Atos Healthcare’s Chief Medical Officer.

The Atos Healthcare run NHS Walk-in Centres in Manchester Piccadilly and Canary Wharf were recently awarded the Grand Prix: Best Operational Project across all sectors at the Public: Private Finance Awards 2007. The awards recognise the improvement in public services that the Walk-In Centres have delivered and the benefits that they have brought to the local community.

According to Andrew Ridley, Director of Primary and Community Care Commissioning, Tower Hamlets PCT, Atos Healthcare demonstrated “a strong focus on collaborative working with local stakeholders”.

To learn more about how we are helping the NHS provide primary care, contact Atos Healthcare.

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Understanding healthcare markets: A PCT guide to market analysis and market management

Posted on April 21, 2009. Filed under: Uncategorized | Tags: |

Ernst & Young | 8 April 2009

This guide is intended as a short introduction for PCTs to market analysis and market management

Section 1 sets out a framework for defining healthcare markets and considering the sate of competition in these markets.

Section 2 sets out a framework for analysis markets and understanding their current and future ‘dynamism’.

Section 3 describes a systematic process by which PCTs can prioritise and understake their market analysis.

Section 4 sets out the market management levers available to PCTs to shape markets.

A worked example of how the processes set out in the guide could be applied in practice is given at Appendix 1.

Click here for the full report.

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