Practices not funded for nurse work in extended hours

Posted on August 24, 2009. Filed under: News stories | Tags: |

Healthcare Republic | News | 24 August 2009

More than a fifth of GP practices employ practice nurses in extended hours, but just 8% receive funds to pay for it.

poll by GP newspaper found practices are losing up to £30,000 a year from extended opening hours.

The survey, of 301 GPs, also found 27% felt relationships between partners, staff and managers had become strained since the introduction of extended hours last year.

In England, the extended hours directed enhanced service only pays practices for GPs’ time, while the Welsh and Scottish governments provide extra funding for nurses.

The BMA has always argued that practice nurses and receptionists are vital for a ‘meaningful’ extended hours service.

Many practices have agreed more flexible local deals with their PCTs, but the poll found just 8% have negotiated funding for practice nurse time.

Sara Richards, former chair of the RCN practice nurse association, said the government risks making practice nurse shortages worse with under-funded, ‘wearying’ initiatives.

‘Any new work takes so long to negotiate and the government never seems to realise this. As soon as you get organised with one initiative, another comes along, she said.

‘There is a lack of practice nurses anyway, and in the future it will be considerably worse. We may get more nurses simply leaving practices if they feel they are being made to work long hours. This will certainly cause problems, especially for single-handed GPs.’

tom.ireland@haymarket.com

  • Read the full version of this story in this week’s Independent Nurse dated 24 August.
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Out of hours care must be reviewed, says Royal College of GPs chair

Posted on August 24, 2009. Filed under: Journals | Tags: |

Health Service Journal | By Steve Ford | 24 August 2009

The use of overseas doctors to cover out of hours and weekend care must be reviewed due to potential safety issues, according to GP leaders.  

Professor Steve Field, chair of the Royal College of GPs, said the college was worried about the quality of out of hours care provided for patients in some parts of the country.

He said: “It is the responsibility of primary careorganisations to ensure that patients receive good quality care by commissioning appropriate services. This is obviously not working and something needs to be done.

“We believe a radical review of out of hours and weekend care is needed,” he said.

His comments follow the recent case of a 70 year old man in Cambridgeshire who was accidentally killed by an overdose of painkillers delivered by a GP from Germany on his first shift in the UK.

Professor Field added: “I am particularly worried about the use of doctors from Europe flying in to provide out of hours care and then flying back to their home countries to provide services there.

“Doctors from Europe who come to the UK to work in out of hours services must prove they are of the same quality as our home-grown doctors. We are not convinced there are appropriate checks in place to ensure they are,” he said.

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Exclusive: Practices lose £30,000 on extended hours

Posted on August 20, 2009. Filed under: News stories | Tags: |

Healthcare Republic | By Tom Ireland | 20 August 2009

Practices are losing up to £30,000 a year because extended hours funding does not cover the cost of providing the service, a GP newspaper survey reveals.

Only a quarter of GPs said extended hours funding covers their costs. Many ran the service at a loss because not doing it would be even more costly.

One GP said providing extended hours cost his practice £22,000, but not opening longer would cost £28,000.

The extra hours, as predicted by the GPC, are creating stress within practices. The poll, of 301 GPs, found that more than a quarter felt relationships between partners, managers and staff had become strained as a result of extended hours.

It found evening and weekend clinics are generally well used, with 77% of GPs reporting that over three quarters of appointments are used.

But one in 10 GPs said less than a quarter of their extended hours appointments were used.

Respondents also reported more patients missing appointments, especially on weekends.

Just 17% of GPs said longer opening had improved the care at their practice. 

GPC negotiator Dr Beth McCarron-Nash said: ‘I’d like to see the government read the results of your survey and decide how to make access better in a way that can really meet the needs of patients. 

‘The funding for the DES (directed enhanced service) was always inadequate.’

A DoH spokeswoman said 1.1 million people had expressed a desire for extended hours in the latest GP patient survey.

‘Making these additional slots available to patients reduces pressures on general practice during other routine opening times,’ she said.

‘Additional opening is therefore a core part of what patients want their practices to do and not simply an additional activity to be funded at premium cost.’

tom.ireland@haymarket.com

  • Read this week’s GP dated 21 August for the full version of this story and a two-page analysis of the issue.
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Take Care Now

Posted on August 6, 2009. Filed under: Press/News Releases, Providers | Tags: , |

Take Care Now | accessed 6 August 2009

Take Care Now is one of the UK’s leading independent healthcare providers.  TCN currently provides health services to over 2.1 million people living, or resident, in the UK. We work in partnership with the NHS to provide:

•    Out of Hours services (healthcare when GP surgeries are closed)
•    Integrated sexual health services
•    Minor Injuries Unit (MIU)
•    GP practices
•    Emergency dentistry

TCN is passionate about providing good quality healthcare. Clinicians (doctors and nurses) are at the heart of TCN and help ensure that the services you receive will be timely and right for you, given your circumstances.  You can make the best use of our “unscheduled” care services, such as Out of Hours, by recognising that these operate to deal only with those problems that are worsening to the extent that you do not feel they can wait until your own GP surgery is open.

If you are looking for medical help when your GP surgery is closed, or you have a minor injury, you can use this website to put you in touch with local services. If you require advice about the best place to get the right treatment, please telephone NHS Direct on 0845 4647 or visit the website www.nhsdirect.nhs.uk.

In case of emergencies, hospital A&E departments assess and treat patients who have serious injuries or illnesses. Generally, you should visit A&E or call 999 for emergencies, such as loss of consciousness, pain that is not relieved by simple analgesia, acute confused state, persistent and severe chest pain, or breathing difficulties.

 

Click here for the news on TCN
Click here for Frequently Asked Questions
Click here for patient leaflets

GP Practices

TCN manages two GP practices serving over 8,000 patients. 

We have a practice of two surgeries in Lowestoft, Suffolk and a practice in Waltham Abbey, Essex:

Lowestoft – Marine Parade and Oulton Surgeries
Waltham Abbey – Greenyard Practice

Through our energetic and experienced staff, we pride ourselves on the quality of our service. These practices achieve a year-on-year improvement to quality (QOF) scores, with extended opening hours and improved access to specialist clinics. Each of the teams is continually looking for ways to improve our approach and develop their practice and its services.

Out of Hours

Out of Hours is the period of time when your GP surgery is closed – at night, at weekends and on bank holidays.

The Out of Hours service is for those medical problems that are urgent.

TCN, alone or with partner organisations, provides Out of Hours services in: 
•    East Cambridgeshire & Fenland
•    Great Yarmouth & Waveney
•    Essex
•    Suffolk
•    Worcestershire

Use this link to find answers to Frequently Asked Questions (FAQ) about the Out of Hours services

For directions to all our Out of Hours bases click here.

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Primecare to run the UK’s first ‘8 to 8’ GP service

Posted on August 3, 2009. Filed under: GP-led health centres, Press/News Releases | Tags: , , |

Nestor | News | accessed 3 August 2009

Today an innovative GP service, believed to be the first of its type in the country, is being launched in Middlesborough.

The service will be available from 8am to 8pm, 7 days a week, and will be provided by Primecare and run from the PCT’s premises. Appointments will be booked through Primecare and referrals made from existing GP practices.

The service will also allow for self-referral (‘walk-in’) patients. Patients are requested to book appointments, but patients who ‘walk-in’ will be seen as soon as there is a free appointment. The scheme offers all GP services, but is not a minor injury unit.

This service, although administered by Primecare, is in addition to, and separate from, the existing ‘Out of Hours – Urgent Care Service’ also run by the Primecare team.

Colin McLeod, chief executive of Middlesbrough PCT and Redcar and Cleveland PCT, said: “Patients have told us that one of their main concerns is getting fast access to a GP. This is our response to this concern.”

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New drop-in health centre to open 365 days a year

Posted on August 3, 2009. Filed under: News stories, Providers | Tags: , , |

Messenger | Trafford PCT | 3 August 2009

TRAFFORD residents will soon have access to a ‘drop-in’ health centre that is open 365 days a year.

The facility will be launched on October 1 at Trafford General Hospital.

People will be able to see a GP between 8am and 8pm, seven days a week, including bank holidays.

When it opens the health centre will also be looking after registered patients from Flixton’s Crescent Medical Practice at Woodsend Clinic, while the service at Woodsend Clinic will become a branch surgery that will be open for two hours a day, Monday to Friday.

Both the new centre and Crescent Medical Practice will be managed on behalf of Trafford Primary Care Trust (TPCT) by Mastercall Healthcare, the organisation that looks after the borough’s ‘out-of-hours’ emergency service.

Gina Lawrence, executive director of commissioning at TPCT, said: “This new health centre will provide a really convenient service for people across Trafford, not only in terms of the extensive hours during which GPs will be accessible, but also because they will be able to turn up without an appointment.”

Registered patients at Crescent Medical Practice are currently in the process of being consulted about how they would like their new branch surgery and health centre to be run in the lead up to October.

Michaela Buck, managing director of Mastercall, added: “We are looking forward to working with the PCT to provide an enhanced and more flexible access to GP services for all Trafford residents.”

Mastercall Healthcare is a not-for-profit healthcare provider managed by local NHS professionals. The organisation was formed in 1996 to provide urgent unscheduled care within Greater Manchester and has been the provider of out-of-hours GP services in Trafford since 2004.

For further information got to trafford.nhs.uk or mastercall.org.uk

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Extended hours: best thing for general practice?

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

Healthcare Republic | By Neil Durham | Editors’ Blog | 29 July 2009

I had a GP appointment at 7.25am yesterday. It’s the first time I’ve used extended hours and what an interesting experience it was.

I arrived at 7.15am half expecting to be kicking my heels in the car park but was buzzed through a locked door via a receptionist at the end of an intercom. Mr 7.35am arrived five minutes later. 

At 7.25am sharp the consultation began. Whilst having my BP taken, there was a chance to talk extended hours and my GP loves them: ‘I drive into work at 7.10am and I see all the commuters on the roads or going to the station, so I know people work hard.’ He thought the practice should extend them further but his partners, who have young families, were less keen.

The downside is that his PCT isn’t keen to lose any appointments during the day, so there are workload issues. (Trust me, I’ve done weird shifts and know they mess with your mind. I once went to bed with a mobile in caseShakespeare In Love director John Madden called in the early hours for a post-Oscar victory chat. Clue: he did.)

For me as a patient, extended hours are fantastically convenient. But I guess working them is another matter. Before their introduction I visited the walk-in centre near work because my practice wasn’t open before I left for work or when I got home. And though the concept of immediate walk-in access appeals, the reality of waiting indefinitely to see a random nurse who knows nothing about you is less enticing.

Of course the way extended hours were introduced by the government was too bullying. But there’s so much to commend my practice this is easy to forget: I get on with my GP, he knows my history and I like to think we’ve established a rapport.

My grandparents are still alive and it seems to me that the more we age the more vital continuity of care becomes.

The key to this – and, probably, the future of general practice – must be protecting the registered list. Surely no government would dare threaten this as popular practices become even more accessible to their patients?

Are extended hours an urban solution to an urban problem? I live in south-east London, a 60-minute commute from where I work in south-west London. I’m sure there are less urban locations where there’s just no demand for extended hours. I can’t think of anything more annoying than kicking my heels at work with nothing to do early in the morning or late in the day because the PMinsists needlessly I do so.

We’re keen to know what you think and today launch an extended hours survey about your experience and views.

Are extended hours really the best thing that’s happened to general practice? Or am I, and my GP, alone on that one?

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Out-of-Hours in Manchester

Posted on July 28, 2009. Filed under: Press/News Releases, Providers | Tags: , |

Go to Doc | accessed on 28 July 2009

From the 1st April 2009, GO To DOC have been commissioned by NHS Manchester to provide out of hours urgent primary care services for North, South and Central Manchester. patient

The Manchester service will be provided in partnership with Harmoni, a national out of hours organisation based in Hertfordshire that delivers care across the South East, South West and the Midlands. Across NHS Manchester the operational and clinical services will be provided by GO To DOC, with Harmoni providing substantial expertise in ensuring resilience and offering innovation from elsewhere in the country.

The service will be delivered by local staff based at a call centre in Denton, at three primary care treatment centres (North Manchester General Hospital, Manchester Royal Infirmary and Wythenshawe Forum) and by visiting doctors for patients who are unable to travel.

If you need immediate and necessary medical advice or attention and cannot wait until your GP surgery is open, you can ring your own GP’s surgery telephone number and you will then be directed to GO To DOC. Alternatively you can contact GO To DOC directly on 0161 336 3252.

If you are advised that you need to see a doctor during the Out of Hours period then you will normally be asked to attend one of the following centres:

North Manchester General Hospital (Outpatient Department)
Delaunays Road
Crumpsall
Manchester
M8 5RB

Forum Health Centre
Simonsway
Wythenshawe
M22 5RX
Primary Care Emergency Centre (PCEC)
Manchester Royal Infirmary
Oxford Road
M13 9WL

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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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Out of Hours

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

BMJ Careers | Authors: Kathy Oxtoby | freelance journalist London | Publication date:  22 Jul 2009

There are increasing mutterings that the experiment of taking out of hours work away from GPs may have failed. Kathy Oxtoby investigates 

For some general practitioners, out of hours work was the bane of their lives. Often it meant getting up in the middle of the night to see a patient and then having to face a busy surgery the following day. Being expected to visit patients any time of day or night meant general practitioners often felt exhausted, not to mention worried that they might make mistakes. Working regular weekends also made it hard to have a family life.

In 2004 all that changed. The new general practitioner contract allowed practices to hand over responsibility for providing out of hours (OOH) coverage to their local primary care organisation in return for giving up an average of £6000 (€7000; $9700) per year. And many were only too happy to do so.

But some patients were less than pleased. Research carried out among more than 3000 patients on behalf of Pulse magazine by the online market research company Opinion Health in 2007 showed that patients were increasingly unhappy with the quality of OOH coverage and many feared for their safety.

Poor provision

That same year a public accounts committee report found preparations to introduce the new system of OOH coverage were “shambolic” and that only general practitioners had benefited from the arrangements.

In April this year, the standard of OOH provision was again called into question after an analysis of more than 70 primary care trusts in England by the Primary Care Foundation found the proportion of OOH cases classified as in need of urgent attention varies by as much as 30-fold across primary care trusts.

Then there are the individual stories, such as that of David Gray, a Cambridgeshire man and father of a general practitioner who died last year after a diamorphine prescribing error by German locum Daniel Ubani. In response to the case, the Care Quality Commission is conducting an inquiry into the OOH provider involved, Take Care Now, and is also looking at the way in which the services were commissioned by local primary care trusts.

So once again OOH coverage is under scrutiny, with some ministers calling for a review of the way the system works. The case of David Gray has also caused many to question whether private providers should be using foreign doctors to treat patients.

“Problems can occur when these providers use doctors who don’t have the same qualifications as general practitioners in this country and who aren’t well acquainted with our systems,” says Mike Dixon, chairman of the NHS Alliance. Critics of OOH coverage post-2004 are concerned about how much the cost and quality of services vary in different parts of the country.

“It is clear that provision is extremely patchy in terms of quality of service,” says shadow health minister Mark Simmonds. “People also tell me there are enormous disparities in terms of cost per person.”

Accident and emergency

Since the change to OOH provision, accident and emergency services have been under extra pressure. Don MacKechnie, vice president of the College of Emergency Medicine, says there has been a “steady increase” in the number of patients attending accident and emergency departments.

General practitioners made a “big mistake” when they voted to give away the responsibility for OOH coverage, believes Roger Chapman, a general practitioner in Bedfordshire. “I thought it was wrong to stop being responsible for OOH, but I respected that was where majority opinion lay. It was not in our interest because it undermined our claim to offer continuity of care. It was bad for patients, and it undermined our negotiating position.”

Although the current system has its problems, Chaand Nagpaul, General Practitioners Committee negotiator with responsibility for OOH coverage, stresses these are “more to do with the failings in PCT [primary care trust] commissioning and PCT behaviour—not the contract.

“PCTs in many areas have developed OOH policies without adequate input of clinicians, who are best placed to understand patients’ needs.

“The funding of OOH care varies considerably between PCTs, and we are concerned that decisions may be influenced by financial drivers, rather than ensuring the best quality OOH provision,” Dr Nagpaul says.

Relieving general practitioners of the responsibility of providing OOH coverage has been “a successful move” he believes. “It has transformed the professional lives of many general practitioners, allowing them to control their work load and maintain a work-life balance.”

Dr Dixon believes that on the whole, current OOH services are probably “clinically safer” because they are manned by clinicians employed to give their time and attention specifically to providing such care.

Career choice

Many general practitioners are choosing to make OOH provision a career choice, combining it with part time care. For Lancashire general practitioner Zahir Mohammed, who does a session a week for Bury and Rochdale Doctors on Call, a not for profit organisation, OOH work “is a way to keep up with developments and there is also the monetary reward.”

Current OOH services are in keeping with a society where people will search the internet or pick up a phone for health information or advice. Where once patients wouldn’t dream of calling their general practitioner outside surgery hours unless they had a serious illness, now they phone private providers, such as Harmoni, to get advice on all manner of ailments.

“Roughly 45 per cent of calls to Harmoni are completed over the phone,” says the organisation’s marketing director Mike Barradell-Smith. Such services can increase access to health advice and ease pressure on day time surgeries.

As these services are well established and general practitioners are now used to working without the responsibility of providing OOH services, it is hard to imagine a return to the old days of being on call, or indeed that the profession would even consider it.

That said, many feel there is room for improvement. The David Gray tragedy has prompted calls for primary care trusts to be more vigorous in the way they vet potential providers of OOH services and for those providers to be more rigorous in their recruitment methods. And some believe that OOH services should only employ local general practitioners.

Others question the use of private providers, suggesting their focus is profit not quality. But Mr Barradell-Smith, who stresses that Harmoni recruits its clinicians using a “rigorous assessment process,” believes the issue is “not about whether you’re an NHS provider or a private provider. It’s about being a quality provider.”

Monitoring quality

In the future, monitoring the quality of all OOH providers will be the task of the Care Quality Commission. Later this year, general practitioner practices and other primary care services, including OOH services, will be under the direct scope of independent regulation for the first time. These services will need to register with the organisation and must meet a set of essential standards of quality and safety in order to maintain registration.

One way of raising the quality of services would be for general practitioners to be involved in commissioning, says Professor Steve Field, chairman of the Royal College of General Practitioners.

“OOH should be led by those who really understand the system, so we should be putting the emphasis back on the general practitioners to commission OOH care,” he says.

General practitioners could well be back in the driving seat for OOH care come a change of government. “GPs should be responsible for commissioning—though not necessarily providing—OOH care,” says Mark Simmonds. “They are the best people to do this because they are much closer to patients’ requirements and needs. GPs should also be given control of hard budgets so they can commission on behalf of patients,” he says.

A new government

The likelihood of a change of government prompted general practitioners at this year’s local medical committee conference to pass the motion that in the event that the profession takes back responsibility for the commissioning of OOH cover, the General Practitioners Committee would agree and publish a minimum set of criteria. Attendees at the conference also passed the motion that primary care organisations would allocate reasonable funding levels to OOH providers to enable them to provide good quality care.

Dr Nagpaul says that although the BMA welcomes general practitioners being more closely involved in commissioning OOH services, “We don’t want to go back to general practitioners being responsible for its provision.”

Making general practitioners responsible for real commissioning budgets is another concern he says. “If these services are underfunded and budgets are inadequate, and general practitioners are responsible for providing them, this could open up a whole can of worms,” he says. “We must keep OOH budgets separate from GMS [general medical services] budgets.”

For Dr Dixon, the future of OOH coverage lies with practice based commissioning, with more primary care trusts handing groups of general practitioners “the reins” to drive services. Dr Chapman urges general practitioners to “grab” any chance to get back in the driving seat and take back responsibility for OOH coverage to safeguard the future of OOH care.

“That doesn’t mean going back to doing on call. It means taking control over what is happening with OOH. It’s in the interest of patients and the NHS. And it’s in the interest of the profession, for without that responsibility we’re undermining our ability to offer patients continuity of care, which is selling ourselves short.”

Competing interests: None declared.

Case study

Tony Davies is a general practitioner at the Lodge Surgery, St Albans and clinical director of Herts Urgent Care, a general practitioner led out of hours provider. He says: “When PCTs [primary care trusts] in Hertfordshire decided they wanted one OOH provider for the area, local general practitioners felt strongly that they didn’t want it to be a private one. They were keen to control the quality of services and for money for OOH to go to ensuring quality of patient care, not to shareholders’ pockets. It was also important to have local general practitioners who know the area and understand how services work.

“Herts Urgent Care was awarded the contract. The company was set up on social enterprise principles and is an amalgamation of some of the organisations that were part of St Albans and Region Doctors On-call (STARDOC), a general practitioner coop that had previously provided OOH to the community.

“The service went live in September 2008 and covers around 1.2 million patients across the county. Since then we’ve had positive feedback about the standard of care we offer. We tend to use only local GPs and there are more than 250 on our books.

“Many do shifts not just for the money, but so they can make sure the quality of care they provide continues through the night as well as the day time.

“I believe those GPs who don’t do OOH miss out on something very special to general practice.”

kathyoxtoby@blueyonder.co.uk

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Patients may have legal right to GP access in extended hours

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

Healthcare Republic | 29 June 2009

Patients could be handed a legal right to access a GP in extended hours, under plans set out by prime minister Gordon Brown. Brown

Building Britain’s Future, published on Monday as Mr Brown sought to outline his vision for the country, sets out plans to give patients a series of legal rights.

The document says: ‘We will give patients enforceable rights to high standards of care, including hospital treatment within 18 weeks, access to a cancer specialist within two weeks and free health-checks on the NHS for people aged 40 to 74.’

But it adds that several other areas could also be made subject to legal rights: ‘At the same time we will look closely at where we can go further to establish new rights, for example to NHS dentistry, to evening and weekend access to GPs, to an individual budget for those with long-term or chronic conditions and whether we can create a right to choose to die at home as further progress is made in implementing the end-of-life care strategy.’

nick.bostock@haymarket.com

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The ‘patchwork privatisation’ of our health service: a users’ guide

Posted on June 10, 2009. Filed under: GP-led health centres, ISTC, LIFT, Reports/papers, Social enterprise | Tags: , , |

NHS Support Federation

Executive summary

• The government is carrying out the ‘patchwork privatisation’ of the NHS. For the first time, this report presents a comprehensive picture of the many kinds of privatisation occurring in the health service. It provides indisputable evidence that a process of privatisation is in train.

• This is happening on such a scale and in so coordinated a way as to make it a unique phenomenon – the ‘patchwork privatisation’ of a major public concern.

• Unlike the Thatcher privatisations of the 1980s, the entire NHS is not being put up for auction – but historically this is only one manifestation of privatisation. The deregulation of state monopolies, the outsourcing of state responsibilities and the cessation of services are the forms of privatisation we see in the NHS today.

• The government is transforming the NHS from a comprehensive, equitable provider of healthcare into a tax-funded insurer, paying for care provided by others. What emerges will still be called the NHS, but it will take the form of a kite-mark attached to selected services.

• The government argues that while the health service remains free at the point of need, funded from taxation, it is still public. However, access does not determine whether a service is public. ITV is free for all to watch, but is clearly different from the BBC. Neither does public funding automatically translate into public service status. There are examples of private ventures that are publicly funded.

• The ‘patchwork privatisation’ of the NHS is deeply worrying because privatised healthcare tends to cost more; accountability suffers; the fog of ‘commercial confidentiality’ makes scrutinising public spending impossible; the profit motive encourages ‘cherry-picking’ of the lucrative work, ultimately leading to NHS services being cut.

• The report presents an anatomy of NHS privatisation:

Creating a market
o ‘Patchwork privatisation’ is only possible because of the creation of a market. This process began with the purchaser/provider split introduced by the Conservatives, but has been greatly accelerated under Labour with the introduction of ‘choose and book’ and a new financial system – ‘payment by results’. The latter has been rolled out faster and further than in any comparable country, creating powerful incentives that will have unpredictable consequences.

Privatisation in primary care
o Privatising GP services – Huge multinational corporations are taking over GP surgeries. This process will have profound implications. There are already examples of continuity of care suffering where companies are unable to retain doctors.

o Privatising the commissioning function of Primary Care Trusts – Takes privatisation into the heart of the NHS by giving the private sector a role in the decisions on what care patients can receive, determining to some extent how the NHS budget should be spent.

o Practice-based commissioning – Transfers the buying power for purchasing many treatments from a public body with responsibility for the whole local population to practices accountable only for their registered patients. Increasingly these will be run by corporations that could dominate the market in any region and gain huge power over what kind of care patients receive and who provides it.

o Outsourcing PCT care – The government wishes to see PCTs stop providing health care directly, instead contracting the private sector and social enterprises to provide services. This will increase administration costs and reduce flexibility.

o Unbundling of primary care services – Primary care services are being broken up into saleable commodities in a process known as unbundling. The most high profile instance is out-of-hours GP care, where the private sector has performed poorly.

Privatisation in secondary care
o Independent Sector Treatment Centres (ISTCs) – ISTCs (private sector clinics usually specialising in straightforward procedures like cataract surgery) have not provided value for money, have made only a very modest contribution to cutting waiting lists and in many areas have seriously destabilised NHS hospitals causing service closures.

o Privately run NHS hospitals – The fullest extension of the ISTC policy is the handing over of an entire hospital to the private sector as has happened at the Lymington New Forest Hospital. This is the first time a whole NHS hospital, including urgent care, is to be run by a private company, meaning local patients will have little choice but to use the private facility.

o Off-shoring medical secretaries – NHS trusts are cutting trained medical secretaries in favour of cheaper services abroad, raising fears for safety.

o Private ambulance services – Non-emergency ambulance services are being put out to tender. There are examples of serious problems where contracts have been awarded to the private sector.

Privatisation in diagnostics
o ICATS and CATS – Diagnostic and treatment centres that raise the prospect of conflicts of interest because of their ability to refer patients on for further care. One company, Netcare UK, has contracts for an ICATS and an ISTC in Manchester meaning it could refer patients to its own facilities.

o Privatisation of pathology services – The government has signed large contracts with private sector companies for pathology and diagnostic tests, despite warnings of the dangers involved in fragmenting pathology services through privatisation

Privatisation of NHS facilities
o PFI – A vastly expensive way of building hospitals that is taking money away from frontline care. PFI has a direct effect on patient services, as the fixed costs are borne by the local NHS trust and have first call on the available money.

o LIFT – Often referred to as the primary care version of PFI, LIFT projects are costing up to eight times more than traditional ways of building.

o Subsidising private sector infrastructure – Department of Health guidance advises that the NHS could pay a “supplement… to cover the set-up or development costs faced by a new provider,” to “reduce the capital investment required” – i.e., supply the buildings.

Privatisation in NHS supplies
o Privatisation of NHS Logistics – The government outsourced NHS supplies to delivery firm DHL and its sub-contractor Novation, which will control over £4 billion of NHS money. Novation is being investigated in the US over bribery and defrauding American public health schemes.

o Privatisation of oxygen supplies – The service supplying oxygen to patients with breathing difficulties was privatised in February 2006, resulting in chaos. One woman, Alice Broderick, died while waiting for an emergency delivery of oxygen that took nine hours to arrive.

For full report click here

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East Leeds super surgery ‘shot in arm for patients’

Posted on June 8, 2009. Filed under: LIFT, News stories | Tags: , , , |

Cross Gates Today | Published Date: 04 February 2009 | Last Updated: 03 March 2009 7:34 AM

A long-awaited super surgery in east Leeds has finally opened, with bosses vowing to make it a success.

The doors to the new 365-days a year Shakespeare Medical Practice in Burmantofts opened on Monday, March 2, with the first patient being welcomed at 9am.

The development of the medical multiplex in Cromwell Mount – on the site of the former Burmantofts Health Centre – has seen much drama with months of discussions both private and public about its viability and its impact on existing surgeries. 

However healthcare chiefs insist it will offer a convenient and flexible healthcare service in an area where need is high. 

Burmantofts is one of the most deprived areas of the city and bosses say the location of the walk-in surgery fits well with NHS Leeds’ strategy for addressing health inequalities in the city and improving access for patients. 

Dr Damian Riley, Director of Primary Care for NHS Leeds said: “Having the flexibility to provide GP appointments and a walk-in service in one centre is really good news for people in Leeds. 

“It means that those who work in the city but are registered with a GP elsewhere can see a doctor or nurse conveniently, and near to their place of work. 

“It also gives greater access to GP services out of normal hours for local people and the flexibility to make doctors’ appointments early in the morning or later in the evening.” 

The new centre offers an extended walk-in surgery which will provide all the traditional GP services for registered patients. 

But vitally, people not registered with the practice will also be able to walk in off the street and get treatment for anything from sprains, coughs and headaches to burns, bites and rashes. 

The practice, run by Care UK Clinical Services Limited, will be open from 8am to 8pm every day. 

Plans for the new super surgery have not been without controversy and concern.

Last month, councillors on the city’s healthcare scrutiny panel vowed 
to monitor it and demanded an update a month after its opening to see how the service is working. 

And last year, 100 Leeds GPs wrote to the Yorkshire Evening Post, saying the new super surgeries formula could “destabilise” existing practices. 

Burmantofts is the third walk-in health centre in Leeds, joining the existing services at The Light and Leeds General Infirmary. 

Mark Hunt, managing director of Care UK Primary Care, said: “We are delighted to be opening a new Care UK health centre at Burmantofts. We are looking forward to providing a high standard of health and care to local people, which will be easy to access and tailored to their needs.”

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Hampshire Health – Local GPs set to win super-surgery contract

Posted on June 8, 2009. Filed under: LIFT, News stories | Tags: , , |

Basingstoke Gazette | NHS Hampshire | Wednesday 27th May 2009

A SUPER-SURGERY offering GP and dental service to unregistered patients 365 days a year is set to open in Basingstoke.

The new Hampshire Health Care Centre in the grounds of Basingstoke hospital, scheduled to open this autumn, is being commissioned to increase out-of-hours access and it will open from 8am to 8pm seven days a week.

Health chiefs also hope to relieve pressure from the accident and emergency department by treating minor illnesses and injuries.

Hampshire Health – a team of 13 North Hampshire GP practices – has joined with a private healthcare firm Assura and Basingstoke dentist Dr Anushika Sharma to run the new centre.

Dr Christian Chilcott, a board member of Hampshire Health and partner from Oakley and Overton Surgery, said the doctors came together to make the bid so the new surgery could be run by locally based GPs.

He said: “This way we could ensure continuity of care for our patients and that their interests are put first.”

The value of the contract they will sign with NHS Hampshire was not disclosed because of “commercial confidentiality”.

Helen Clanchy, director of primary care for NHS Hampshire, said: “We are very pleased to announce plans for these services with Hampshire Health and Dr Sharma, who have each shown that they will provide a high quality service.”

Patients will still be able to see their regular GP and dentist even if they use the new centre.

It will also house a raft of other services, including vaccinations and immunisations, contraceptive services, cervical screening, maternity medical services, minor surgery and stop smoking services.

Under reforms led by health minister Lord Ara Darzi, each NHS primary healthcare trust (PCT) has to have one super-surgery.

NHS Hampshire, the commissioning branch of Hampshire PCT, chose Basingstoke because of the number of people commuting to and from the town.

It was thought that they would benefit most from a service open 12 hours a day, seven days a week, although the service is open to anyone.

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Super-surgery just what the doctor ordered

Posted on June 8, 2009. Filed under: LIFT, News stories | Tags: , , |

Linconshire Echo | Monday, April 13, 2009

A brand new Lincoln super-surgery will make family doctors available to the public 24 hours a day, 365 days a year.

The proposed state-of-the-art clinic will provide a GP surgery and walk-in centre by day, and an out-of-hours GP service by night.

NHS bosses are currently looking for a suitable building in the Monks Road area of Lincoln where the facility can be launched in April 2011.

It will amalgamate the soon-to-open Lincoln NHS walk-in centre, the current Arboretum Surgery and Linmed, the out-of-hours GP service currently based at Lincoln County Hospital.

Other staff including social services workers, teams of mental health staff and physiotherapists could also work from the super-surgery.

Sue Cousland, chief operating officer for Lincolnshire Community Health Services, said that 63 Monks Road – the building from which the city’s 8am to 8pm walk-in centre will run from May 11 – will be used for other NHS purposes.

“Our preferred choice from April 2011 is to house everything under one roof and combine with the out-of-hours service,” said Mrs Cousland.

“So we’d have a building that’s open 24 hours a day, 365 days of the year.

“We will tailor the services to the needs of the population and will find the right estate in the middle of Lincoln.”

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Dental surgeries could extend opening hours

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

Health Services Journal | By Helen Crump | 30 April 2009

Primary care trusts are to begin a £150m procurement process which could see dental surgeries opening outside normal hours.

National director for GP and dentistry access Mike Warburton said contracts for new work should focus on quality and access rather than activity and consider extended hours. PCTs would decide what hours were appropriate.

He said the money would be used for “additional procurement and new services” but did not have to involve a new building as last year’s GP led health centre procurement had done. No dental walk-in centres are proposed.

Tendering process

Dr Warburton said most investment would be in southern England, where shortages were greatest. PCTs will be expected to use tendering processes.

Dr Warburton denied that the change in emphasis in the contracting arrangements was an admission the present dental contract was not working.

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London announces first seven polyclinics

Posted on April 29, 2009. Filed under: Journals, Polyclinics | Tags: |

Seven polyclinics are open or will soon be open in London.

The health centres, which incorporate extended-hours GP services, were proposed by now health minister Lord Darzi two years ago.

His report on reforming the NHS in the capital, A Framework for Action, said five to 10 polyclinics should be developed by April 2009, but the policy was vehemently opposed by some GPs.

One of the centres, the Loxford Polyclinic in Redbridge, is “purpose built” and will open in June, NHS London said today.

The others – in Hounslow, Harrow, Lambeth, Tower Hamlets and Waltham Forest – are existing health centres that are extending their services.

All will offer extended-hours GP and other services, including pharmacy, diagnostics and urgent care. GPs based at the polyclinics and those at nearby practices will refer to their services.

Improving access

NHS London, which is pursuing the Framework for Action proposals with primary care trusts and providers through arm’s-length organisation Healthcare for London, said they would improve access and help reduce accident and emergency attendances.

Tom Coffey, a GP in Wandsworth and clinical director for the polyclinics programme, said: “I believe the new polyclinics provide a major leap forward in the story of London’s healthcare.

“Polyclinics will continue to develop over time and will be evaluated to ensure they meet the needs of local people and inform the development of future polyclinics.”

Healthcare for London programme director David Sissling added: “London has the worst GP access figures in the country. Polyclinics are a vital solution in making GP and other health services more user-friendly.”

NHS London chief executive Ruth Carnall said: “Polyclinics will transform primary and community care in London for the better, delivering accessible, high-quality services which will ultimately reduce health inequalities.”

Lord Darzi’s original report said: “New facilities – polyclinics – should be developed that can offer a far greater range of services than currently offered in GP practices, whilst being more accessible and less medicalised than hospital.”

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GP-led health centres threaten OOH funding

Posted on April 29, 2009. Filed under: GP-led health centres, News stories | Tags: , |

Pulse | By Steve Nowottny | 29 April 2009

NHS managers are beginning moves to renegotiate contracts for out-of-hours services because of a fall in demand since the launch of GP-led health centres.

An evaluation at one of the first of the centres in the country to open has found large numbers of patients are choosing to use it rather than the local out-of-hours provider.

Primary care academics are predicting that the value of out-of-hours contracts could fall sharply because of the heavy overlap with GP-led health centres in the early evening and particularly at weekends.

Managers at NHS Northamptonshire reported that patients seeking care at the weekends had been flocking to the walk-in facilities at the new Darzi centre.

The PCT reported a ‘marked decrease’ in out-of-hours attendances in the town of Corby since the Lakeside Plus GP-led health centre opened in early December.

And it has wasted no time in trying to re-negotiate the levels of funding for out-of-hours care. The trust is currently tendering for a new out-of-hours provider and said it would be trying to drive down the cost of the contract.

Nicki Price, associate director, Primary Care Contracts and Market Development at NHS Northamptonshire, told Pulse: ‘We absolutely expect to see an impact in what we pay for the out-of-hours services as a result of the 8-8, because obviously there’s activity shifting around the system.

Professor Chris Ham, professor of health policy and management at the University of Birmingham, said he believed other out-of-hours providers would face similar pressures:

‘I predict two scenarios. For some patients who are not currently able to access services, these will be additional and generate more demand.

‘For other patients, it will be a diversion from services that they otherwise would have used, such as their own GP practice, out of hours and A&E taking pressure of hospitals for cases that are more appropriately dealt with by these GP services.

Walk-in numbers at the Northamptonshire centre have been far higher than expected, with a total of 1,201 patients in March compared with an estimate of just under 700.

But Ms Price said the centre had only registered around 250 patients by the end of March – compared with a projected 500 – partly because a local house-building programme had stalled due to the recession.

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