The Royal Pharmaceutical Society (RPS) has published a guide to medicines optimisation for primary care professionals.

Medicines Optimisation: helping patients make the most of medicines places emphasis on safe and evidence-based medicine use to reduce wastage and improve patient outcomes.

The guide, endorsed by the ABPI and the Royal College of General Practitioners, reflects the growing role of community pharmacists in medicines management and the care of people with long-term conditions.

Sir Bruce Keogh, Medical Director of NHS England, said the guide “could revolutionise medicines use and outcomes”. It outlines four basic principles:

• Aim to understand the patient’s experience.

• Make sure the choice of medicine is made on the best available evidence.

• Ensure that medicines use is as safe as possible.

• Make medicines optimisation part of routine practice.

“I would encourage everyone to adopt these principles whether prescribing, dispensing, administering or taking medicines,” Keogh concluded.

The RPS guide is partly a response to evidence that 30–50% of patients are not compliant with prescribed medication, and £300m worth of NHS medicines are wasted each year.

Shilpa Gohil, Chair of RPS England, commented: “As care shifts towards primary care prevention, unprecedented economic challenges combined with problems around medicines waste, adherence and safety mean that medicines optimisation is now essential to good patient care and the effective use of NHS resources.

“Medicines optimisation will require health professionals to work across boundaries to individualise care and work in partnership with each other and patients to secure better outcomes and drive improved adherence.”

The chair of the Royal College of General Practitioners (RCGP) has hit back at claims by Health Secretary Jeremy Hunt that doctors are to blame for the increased pressure put on A&E services.

Dr Clare Gerada (pictured) issued a statement claiming Mr Hunt was wrong to blame GPs for a lack of out-of-hours provision and said doctors were being used as a “scapegoat” by the Health Secretary.

She said it is “not acceptable” to point the finger of blame at GPs for rising levels of A&E use and there is “no evidence” to prove this increase is down to the 2004 GP contract – as some ministers have claimed.

Hunt first made the accusation in the House of Commons when he was discussing the 2004 GP contract introduced under the former Labour government. A DH spokesperson subsequently insisted the Health Secretary was “clearly not blaming GPs.”

However, Hunt reiterated that doctors were to blame during a speech at Age UK where he outlined plans to “rethink the role of primary care” and said that “inaccessible primary care” had resulted in increased pressure on A&E services.

Dr Gerard insists “it is not true that the rise in demand on A&E services is due to a reduction in out-of-hours provision by GPs” and that there are “numerous reasons why our colleagues working in A&E departments are under pressure.”

She highlighted a shortage of consultants and a lack of integration between community and social care which has caused a “myriad of problems, including unnecessary admissions.”

The chair added that assumptions that the NHS “starts and ends with hospitals” should be ended and called upon the Health Secretary to consider the wider picture before pointing the finger of blame. “We are one NHS with patients accessing different services at different times,” she said.

“These are tough times for us all and one of the issues Mr Hunt should be addressing is the shortage of 10,000+ GPs across all services, not just out-of-hours. As a national health service we should all be working together with Government to improve patient care, not blaming GPs for perceived ‘inadequacies’ in patient care.”

Several leading charities, including Marie Curie Cancer Care, have said the new provider competition rules will prevent their having a role in NHS care.

The requirement to open up services to competition will make it more difficult for specialist non-profit care providers to be involved, the charities warned.

The voluntary sector statement, made in a briefing paper to peers, precedes a House of Lords debate on the hew NHS competition regulations.

The regulations, already described by a London GP as a blueprint for “lawyer-led commissioning”, will make it possible for private health providers to challenge any commissioning decision that does not follow UK competition law.

Charities including Sue Ryder, Marie Curie Cancer Care, the health and social care coalition National Voices and a number of hospice charities have said they are not able to compete with commercial providers.

One particular concern is that, in order to keep the administration of tendering manageable, CCGs will need to ‘bundle’ related services, shutting out specialist providers such as many charities.

The briefing paper said: “Wholesale competition... could lead to a diminishing of voluntary sector participation. We fear this will lead to a loss of specialist services and skills that will ultimately lead to poorer care for patients and their families.”

The reaction from the voluntary sector follows demands from the BMA and the Royal College of General Practitioners to scrap the competition regulations, which form section 75 of the Health and Social Care Act.

The new statutory regulations for CCG commissioning will mean that lawyers can overrule clinicians, doctors and legal experts have warned.

While a debate and vote on the new regulations in the House of Lords are scheduled for 24 April, campaigners have warned that they will lead inevitably to a full privatisation of the NHS.

Explicitly intended to ensure that CCGs obey the principles of the Health and Social Care Act, the new regulations make it possible for private providers to challenge commissioning decisions on the basis of business law.

The Department of Health, which revised the regulations following protests from the medical professions, insists that CCGs will have the authority to decide which services are put out to tender.

However, legal experts have stated that the decisions of CCGs will be vulnerable to legal challenges from private providers, since the ‘any qualified provider’ concept places commissioning within a business law framework.

Lord Hunt (pictured), Deputy Leader of the Opposition in the House of Lords, has tabled a ‘fatal motion’ against the new commissioning regulations that could temporarily block its passage into law.

Crossbench peer Lord Owen accused the Government of using “specious grounds of urgency” to drive through legislation that contradicts its own principle of ensuring ‘clinically led commissioning’.

According to Dr Kambiz Boomla, a GP in East London, “These regulations are likely to be the death of clinically led commissioning, and the birth of lawyer led commissioning.”

Clare Gerada, Chair of the Royal College of GPs, similarly warned that the new regulations will “remove the legal framework” for a “universal” and “democratically accountable” NHS.

The Government has revised its proposed regulations governing competition between NHS providers, following widespread protest from doctors.

The regulations, published a month ago, were criticised as removing the right of clinical commissioners to make decisions based on patient interests rather than the business rights of competing providers.

The amended version broadens the freedom of commissioners, stating that “integration” and “quality” are both valid reasons for not putting a service out to competitive tender.

However, the Royal College of General Practitioners (RCGP) has expressed concern that the new regulations, by virtue of their statutory nature, are imposing too many conditions on commissioners.

The aim of the new regulations was stated by the Government to be a replacement for the Secretary of State control abolished by the NHS reforms. In other words, having emphasised the “autonomy” of the new CCGs, the Government is imposing strict controls to defend the interests of the private sector.

The original secondary legislation, published in February, appeared to create a legal basis for the forced tendering of nearly all NHS services, enforced by Monitor.

A letter to the Daily Telegraph signed by more than 1,000 doctors urged MPs to force a debate on the new regulations, while the Academy of Medical Royal Colleges expressed concern that services would be disrupted by legal disputes.

Health Minister Lord Howe said: “It has never been and is absolutely not the Government’s intention to make all NHS services subject to competitive tendering or to force competition for services.”

New amendments to the regulations include:

• Commissioners are required to record how their decisions support the integration of services.

• Exceptions to competitive tendering include cases where avoiding competition leads to better quality or integration of services.

• Monitor no longer has the power to enforce competitive tendering.

The underlying purpose remains the same: to protect “patient choice” by ensuring that NHS commissioners have to put services out to tender unless they can justify not doing so in terms of better clinical outcomes.

The publication of the new secondary legislation coincides with that of a BMJ study stating that 40% of CCG board members have financial ties to private healthcare providers.

Clare Gerada, Chair of the RCGP, commented: “The revised regulations do not go far enough in ensuring that commissioners are genuinely free to decide whether or not to expose services to competition. Despite the revisions, they will still be required to show that there is only one capable provider in order to avoid having to put a service out to tender.”

The Department of Health has published a ‘pledge’ to improve health outcomes for children and young people through co-ordinated activity across the NHS.

Stated aims include a reduction in the child mortality rate, improved care for children with long-term conditions, and better mental health care for the young.

A new Children and Young People’s Health Outcomes Board, led by the Chief Medical Officer, will focus on improving outcomes across paediatric care.

The DH is responding to a report from the Children and Young People’s Health Outcomes Forum, warning that child mortality rates in England are among the worst in Europe and that 26% of children’s deaths are linked to failures in direct care.

The Forum calls for attention to obesity, maintenance of long-term conditions, earlier diagnosis of mental health disorders, and better attention to the health needs of looked-after children.

GPs will be offered specialised training or support in paediatric health, and provided with new colour-coded health maps showing trends in conditions such as asthma and diabetes.

The CCGs will be asked to review their provision of services for children and investigate poor outcomes.

The DH also said it would investigate proposals by the Royal College of General Practitioners to extend GP training for a fourth year to include child health and mental health.

Health Minister Dan Poulter said: “It is a shocking fact that child mortality in Britain is the worst when compared to other similar European countries. There is unacceptable variation across the country in the quality of care for children – for example in the treatment of long-term conditions.

“Our pledge demonstrates how all parts of the system will play their part and work together to improve children’s health.”

Hilary Cass, President of the Royal College of Paediatrics and Child Health, commented: “It’s crucial that this momentum is maintained and that outcomes are regularly measured to drive improvements.

“We will be directly involved in a number of areas, which include enhancing the use of medicines in children and working with GPs to ensure paediatrics is part of their training.”

Signatories to the pledge include the DH, Healthwatch, the NHS Commissioning Board, NICE, MHRA and Public Health England.

A key principle of the pledge is that improving children’s health outcomes will not only reduce child mortality but lay the foundations for healthier adult lives.

The new chairs of the National Institute for Health and Clinical Excellence (NICE) and the Care Quality Commission (CQC) have been confirmed.

Following the announcement of David Haslam and David Prior as the Government’s preferred candidates for the two roles, both have been approved by the Health Select Committee.

New NICE chair David Haslam (pictured) is currently National Clinical Adviser to the CQC and chair of NICE’s Evidence Accreditation Advisory Board.

Haslam is a former GP, BMA president and chair of the Royal College of General Practitioners. His appointment can be seen as an attempt to give the GP profession a clearer voice in the NHS.

He will replace Sir Michael Rawlins, chair of NICE since its inception in 2000, in April 2013 – when NICE will extend its remit to social care.

Health Secretary Jeremy Hunt said that Haslam “will bring to this important role a wealth of skills and experience from his distinguished career as both a front line GP and a respected clinical leader.”

David Prior, who will take up the post of CQC chair at the end of January, is currently chair of Norfolk and Norwich University Hospitals NHS Foundation Trust.

He is a former Conservative MP for North Norfolk, and his appointment represents a consolidation of the NHS reform agenda.

Hunt commented: “David brings a wealth of experience to this significant position, as the chair of a foundation trust, a large comprehensive school, and experience in the private sector.”

Prior said: “I do not underestimate the scale of the challenge ahead but look forward to working with the chief executive, David Behan, and the whole of the organisation to ensure CQC is absolutely clear to the general public about the quality of services it inspects: when services are good and when they are not.”

NHS Chief Executive Sir David Nicholson has warned that the Government’s controversial health service reforms may end in “misery and failure”.

Sir David said that politically driven changes to any public sector body usually ends in disaster.

Speaking to doctors at the Royal College of General Practitioners conference, Nicholson said that “carpet bombing” the health service with private sector competition was not the right way to tackle rising costs.

The NHS’ leader said that the reforms would benefit patients by offering them increased choice and improved standards of care through competition. But he added that GPs would only benefit from the reforms if they are free from negotiating new services.

“If we are creating a system where general practitioners feel it is their job to do all that, then I think we have a massive problem,” he told delegates. “We need to create the right kind of people with the right kind of skills, which we are trying to do at the moment through commissioning support, to enable people to focus their attention on clinical decision-making.

“My advice to anyone – and I have been involved in the last five or six years with the national programme for IT, and I have, as they say, the scars on the back around all of that – is that big, high-profile, politically driven objectives and changes like this almost always end in misery and failure.”

Shadow Health Secretary Andy Burnham said Nicholson’s comments were a concern. “David Nicholson is a man who has the NHS at heart, so it is worrying to hear him talk in these terms,” he said. “He has put on a brave face in public, but clearly has private concerns about the real damage this reorganisation is doing.

“His open acknowledgment of the possibility of it ending in failure will send shock waves through the NHS and provide a stark illustration of the sheer scale of the gamble the Government is taking.”

NHS rationing is affecting the relationship between doctors and their patients, a new survey has found.

The survey by Pulse Magazine revealed that three quarters of GPs believe the doctor-patient relationship has been tainted by cut backs to certain treatments.

Dr Clare Gerada, Royal College of General Practitioners, said the problems of the Health and Social Care Act have resulted in patients holding GPs responsible.

Typical treatments which have been affected by a rationing include GP referrals for bariatric, hip and knee and cataract surgery.

Out of the 237 doctors questioned, nine out of 10 reported pressure to ration treatments or services over the past twelve months. Two-thirds of respondents admitted local rationing was adversely affecting standards of patient care.

More than 40% of doctors said they had changed the therapy of patients to less effective options due to rationing guidelines in the past twelve months. A third also raised issues with getting patients to guideline-directed targets.

GPs also exposed other forms of rationing with 89% finding patients had been referred back to them after missed hospital appointments and 31% claimed hospitals were overemphasising the risks of surgery in an attempt to off put individuals.

A spokesperson for the Department of Health said they would be writing to the NHS to remind them that rationing on the grounds of cost was wrong.

A ‘commissioning champion’ at the Royal College of General Practitioners (RCGP) has resigned in protest at the rationing of NHS referrals.

Senior GP Helena McKeown, a member of the RCGP’s council, said she could not continue working as an advocate for GP commissioning because she was “too disillusioned” with NHS reform.

GPs were being “set up to fail” in budgetary terms and forced to move “too close to breaching good medical practice” by the new system, she argued.

The RCGP’s Centre for Commissioning was launched in December 2010 with a £1.7m grant from the DH to help the new GP consortia (now called CCGs) develop the skills and expertise needed for commissioning.

Dr McKeown insisted her resignation was not due to any disagreement with the RCGP – rather, she was “a GP-commissioner advocate who has become too disillusioned to be associated with the reality”.

GPs will not be able to “commission to make best use of resources”, she argued, when they are financially rewarded for reducing referrals and CCGs impose on them systems requiring third-party approval.

“I am happy to discuss referrals and peer review and share learning, I am not happy to put my patients at risk, at the limits of my clinical competencies, nor to be seen as a supporter of such schemes,” she said.

In the long term, Dr McKeown concluded, the new system was designed to “undermine” the role of the GP as “patient advocate”.

RCGP Chairwoman Clare Gerada said McKeown’s resignation reflected the fact that GPs were being required to participate in “rationing care” against the interests of their patients.