NHS needs more – and more specialist – GPs

by JoelLane 24. June 2013 16:18

Claire Gerada, RCGP  (resized) The NHS needs 10,000 more GPs by 2022 to meet the growing need for primary care, according to the Royal College of General Practitioners.

In addition, the college’s report said, primary care needs more GPs with specialist training in care of elderly people and care integration.

Echoing NHS Confederation leader Mike Farrar, the RCGP said that the vision of a system of integrated and ‘patient-centred’ care could not be realised without major investment in primary care.

Clare Gerada, President of the RCGP, said it was essential to shift funding from secondary care to improve the premises and capacity of GP practices.

“Innovation and reform are vital but must be underpinned by investment,” she warned. “The Government must recognise that general practice is the most cost-effective way of providing care and act accordingly, by urgently reversing the real-terms decline in the amount of money that general practice receives.”

The RCGP report noted that demand for GP services is changing due to long-term trends: more elderly patients, more patients with multiple long-term conditions, and a growing need for better-integrated care.

General practice needs to adapt by providing longer consultations and more health information, sharing decisions with patients, and assisting self-management of chronic illness.

The report proposed a four-year specialty training programme to equip GPs with specialist skills, including management of elderly patients with multiple long-term conditions, and co-ordinating systems of care.

In addition, it said, GP training in mental health and paediatric health needed to improve.

For these changes to be feasible, however, another 10,000 GPs would be needed within a decade, and the tendency for secondary care to monopolise resources had to be “must be halted and reversed.”

DH plans to raise number of GPs by 400

by JoelLane 30. May 2013 15:24

female GP The number of GPs in England will rise by 400 over the next two years, according to the Government’s mandate for Health Education England (HEE).

The 14% increase in the number of GP training posts seeks to address the growing need to reduce the pressure on secondary care by improving and extending primary care.

In addition, the ‘task force’ recently set up to increase the number of doctors in emergency care will be maintained until 2015.

The new mandate for HEE requires it to ensure that 50% of medical students are training to become GPs by 2015. This requires the number of GP training posts to increase from 2,850 to 3,250 by 2015.

The new body responsible for healthcare education and workforce planning will need to develop and implement a plan by this summer to draw more doctors into emergency care.

HEE will also need to:

• ensure and demonstrate that selection for training programmes is based on values and behaviours as well as technical and academic skills

• ensure that trainee doctors have enough time with patients

• ensure that at least 50% of student nurses have community placements as part of their training by March 2015

• develop a postgraduate training programme for nurses who care for older people with complex needs

• provide dementia awareness training – including early symptom recognition and effective interaction with patients – to 100,000 healthcare staff by March 2014.

13 Proves Lucky Number as Pf Awards Byrne Brightly

by IainBate 25. April 2013 17:14

The great and the good of planet pharma converged on the Lancaster Hotel in London for, quite simply, the greatest award ceremony in the galaxy (that’s unbiased journalism, right there, folks!) John Pinching reflects on a delightful evening.

During 13 glorious years the Pf Awards has been an increasingly-important fixture on the pharma industry’s hectic calendar. It’s a chance to reflect on the high points of the last 12 months, reward the supreme efforts of pharma’s finest and meet up with vaguely recognisable faces on the dance floor!   This year’s shindig was perhaps the most exciting so far with new categories, inspirational performances and, in Ed Byrne, a compelling host.

The evening got underway with the dulcet Black Country tones of Melanie Hamer who – in her capacity as Events Director for Pf Awards and a Director of Events 4 Healthcare – has overseen every ceremony to date. She was keen to point out how the Pf Awards have evolved in accordance with the demands of the industry, and why they continue to set a benchmark for the most passionate people in the business.

It was my very first Pf Awards and I was most honoured when asked to present the award for best company (the most notoriously unpronounceable organisation in the history of pharma, naturally). The night before I had dreamt that my pilgrimage to the stage was greeted with a chorus of abuse, but in reality the crowd were consummately professional and, as a result, the words ‘Boehringer Ingelheim’ tripped off the tongue effortlessly!

As the names of other winners resonated around the venue, it was very clear from the spectacularly wild celebrations that these endorsements are treasured acknowledgments of a job well done.

Now enjoy our photo album which commits those unforgettable moments to the hallowed pages of the very magazine that gave the awards their name.

Adding a Pf Award to the mantelpiece will be used to inspire several companies as they aim to reach even greater heights. Here’s how one of the winners will be celebrating.

Lundbeck: Working in partnership

The Pf 2013 Joint Working award was won by Jo Livingston, Lundbeck’s Parkinson’s disease specialist.

Jo Livingston worked with partners in primary and secondary care across the Sunderland NHS to develop an integrated care pathway for local people suffering from Parkinson’s disease. An account of the project’s goals and outcomes appeared in an HSP Partnership in Practice supplement in 2012.

A medium-sized pharmaceutical company, Lundbeck specialises in treatments for mental health and neurological disorders. The company has devised a strategy for 2013 that builds on the stability the organisation has achieved and focuses on its three main pillars of strength: delivering excellent results, giving value to customers and being a great place to work. The company’s strategic priorities are complemented by its four operating principles: to be ambitious and take action; to own the future; to be better for less; and to create results together.

In recent years, Lundbeck UK has focused strongly on working in partnership with the NHS to improve the care of people with Alzheimer’s disease and Parkinson’s disease. Jo Livingston’s project is a good example. According to Andrew Jackson, Sales & Marketing Manager for Azilect, there are two reasons for this strategic focus: “The changing NHS and the relationship that the pharmaceutical industry has with it means we need to work jointly, rather than simply promoting drugs. Services for neurological disorders are very varied across the UK, so it’s important that we partner with the NHS to make them better for mutual benefit.”

What made Jo Livingston’s project stand out among the finalists? “It was a true partnership project,” Jackson explains. “She got buy-in from various stakeholders within the NHS and she worked in partnership with them, which is rare. We’ve evolved over time to a model where we’re jointly sharing projects, as opposed to the traditional model where pharma gives money and the NHS goes and does something.”

While joint working is a team achievement, that doesn’t mean good leadership isn’t crucial. Jackson comments: “Clinicians and stakeholders in the NHS are very, very busy, and for the project to actually be seen through and implemented correctly, Jo needed to be the one who was spearheading that and who was driving the meetings, their content and their output, to get towards the end result.”

As well as winning in the Joint Working category, Lundbeck had five other finalists in the Pf Awards 2013. Jackson puts that success in context: “Eighteen months ago Lundbeck restructured to align to the changing needs of the NHS. We developed a team of regional account directors to tailor Lundbeck’s offering to the needs of the local health economy.” That dynamic response to NHS reform has boosted their reputation both with customers and within the industry.

Friends with benefits

by IainBate 24. January 2013 12:14

The ABPI sets out to deliver tailored support and advice to healthcare providers on the medicines its member companies produce. Kevin Blakemore, NHS Partnerships Manager at the Association of the British Pharmaceutical Industry, discusses the advantage of partnerships in healthcare.

Kevin Blackmoor - web The pharmaceutical industry has experienced tremendous change and, as part of that evolution, forming successful partnerships in healthcare has become integral to our way of working. The NHS delivers outstanding care to patients – utilising the innovative medicines the pharmaceutical industry produces – so it makes perfect sense for us to work together, ensuring the best possible outcomes for patients. There are some points, however, to consider when embarking on ‘joint working’ ventures – these partnerships must be managed and guided to ensure that the process is efficient, seamless and offers patients maximum benefit.

Often these partnerships can result in patients spending less time in secondary care settings, and can deliver significant savings. Patients benefit most when those with a stake in their care work effectively, enthusiastically and efficiently together.

Joint working describes situations where, for the benefit of patients, NHS and industry, organisations pool skills, experiences and resources for the joint development and implementation of patient centred projects and a shared commitment to creating a streamlined, joined-up care pathway, where patients are kept at the heart.

Flexible joints
Joint working has already benefited thousands of patients across the UK and to help achieve greater outcomes, the Association of the British Pharmaceutical Industry (ABPI) has developed the ‘NHS Partnerships Team’. My dedicated team work with healthcare providers up and down the country, providing specialist advice and support, while facilitating successful working relationships.

The NHS Partnerships team is made up of eight individuals, each responsible for a different area of England. Their knowledge and expertise includes experience of working within the pharmaceutical industry and the NHS. They also bring their knowledge of innovative and effective medicines created by the industry, and this can be utilised for the benefit of patients. The central focus of the team is improving the healthcare environment in order to increase access to and uptake of innovative products. The team consists of Diana Vegh, Karen Thomas, Carol Blount, Harriet Lewis, Andy Riley, Mike Ringe, Angela Logun and myself.

Diana Vegh started her career in the pharmaceutical industry within regulatory affairs in AstraZeneca, working in scientific roles of increasing seniority. She then moved to the NHS where she held senior positions in the Strategic Health Authority, two PCTs and a Foundation Trust in the South West.
Diana returned to industry in a commercial capacity at UCB Pharma, working in market access for products. She has extensive networks across the industry and the NHS, and a wealth of practical, positive experience.

Veteran’s parade
Karen Thomas – a recent addition to the NHS Partnerships Team – has extensive experience of working in the pharmaceutical industry, and for the past 12 years Karen has worked for Bristol Myers Squibb, where her roles spanned finances, sales, commercial and market access, covering several therapeutic disease areas. Karen joined the ABPI in November 2012 as the Regional Partnership Manager for London.

Harriet Lewis has been a pharmacist for over 20 years. She has worked in a wide range of healthcare sectors including industry, community, hospital and primary care. Before joining the ABPI, Harriet’s most recent role was Associate Director for Medicines Advice with the National Institute for Health and Clinical Excellence (NICE). Harriet has led on a number of NHS support programmes, including local formularies, local decision making, controlled drugs, accountable officers and ‘specials’. She has authored several key documents for NPC and NICE. Harriet is the Regional Partnership Manager for the North.

Most recent additions to the team are Andy Riley and Mike Ringe. Andy joins us as the ABPI Regional NHS Partnership Manager for Midlands and East. He qualified as a pharmacist in 1987 and has held posts in hospitals, community pharmacies and health authorities in London, the North West and the West Midlands. Mike joins us as the ABPI Group Therapy Manager directly from the NHS, and previously held the position of Chief Operating Officer at Luton Clinical Commissioning Group.

My role is the NHS Partnerships Manager and I manage the team. Previously, I have worked in the pharmaceutical industry for over 25 years – at UCB and GlaxoSmithKline (GSK) – and I have been responsible for developing national level methodologies and frameworks to support patient and market access programmes.

Bonded by blood
The ABPI recently undertook a joint working project at a hospital trust in the North of England looking at epistaxis – one of the most common ENT emergencies in England, with over 27,000 patients presented to secondary care between 2008 and 2011. In 2009/10 the trust admitted 250 patients presenting the condition, with the average length of stay at over two days, costing a minimum of £400 per patient per day.

Like many other hospitals, the trust had limited specialist ENT experience in their emergency departments, and as a consequence nasal packing was frequently used as a first line treatment – even for small volume bleeding – when a more conservative or targeted approach would have been safe and effective. There was a clear opportunity here for the patient pathway to be revised and a different approach taken.

Through the ABPI, a joint working project was instigated between a local pharmaceutical company and the trust. They jointly agreed – through a joint working agreement – to truly address the challenges within the current treatment regime and completely redesign the service. Consequently, it addressed the training requirements within A&E and junior doctors.

The new treatment pathway encouraged clinicians to identify the bleeding point, if possible, and in cases of continued bleeding, to consider the use of a product manufactured by the local company – thereby avoiding unnecessary hospital admissions. The company and trust continued to work in partnership to develop training materials in order to develop the new treatment pathway and introduce the use of the medicine where possible.

This venture resulted in a number of positive outcomes, which included a reduction in hospital stays, improving productivity and cost savings. But most importantly, when compared with the three preceding years, the audit of the venture showed that the total number of bed days due to epistaxis, was reduced by 30 per cent and length of stay was reduced by 21 per cent. Additionally, staff were motivated to consider an alternative to immediate nasal packing/admission, which also resulted in a reduction in the length of stay.

QIPP while ahead
Working with the Department of Health and the NHS, we have developed a toolkit on successful joint working. Joint working is a relatively new concept for many, but has already shown tangible benefits to patients, the NHS and industry. For example:

East Lincolnshire Primary Care Trust (PCT) reduced hospital admissions for Chronic Obstructive Pulmonary Disease (COPD) by 23%, through working with three companies to target and screen patients, train clinicians and set up specific COPD clinics.

In Ashton Leigh and Wigan the PCT is tackling low life expectancy, high rates of heart disease and diabetes by working with industry on a ‘Find and Treat’ strategy.

The innovative approach to patient care adopted by that trust was aligned with the Quality, Innovation, Productivity and Prevention (QIPP) programme. QIPP is an NHS initiative to improve the quality of care it delivers, while at the same time making savings that can be reinvested into the service. It engages with staff from across the NHS, at local and regional level, and is supported by QIPP plans and work streams that provide guidance and tools.

The NHS also works with a range of partners to deliver QIPP, one of which is the pharmaceutical industry. Apart from supplying medicines that improve the quality of patients’ lives and outcomes, the industry can contribute business skills and expertise, as well as extensive knowledge of the therapy areas relevant to its medicines.

Joint working is the foundation for creating, developing and implementing innovative healthcare solutions which can lead to better health outcomes. We believe this is the way forward in healthcare and both the NHS and industry must seek out more opportunities to work together.

Innovation Scorecard makes uncertain start

by JoelLane 10. January 2013 17:19

waiting_room_hospital A limited ‘experimental’ version of the Government’s Innovation Scorecard points to variation and low overall levels in patients’ access to new NICE-approved medicines across England.

The spreadsheet and report published by the Health and Social Care Information Centre summarise the existing data on the availability of 76 medicines and 6 medical technologies recommended by NICE through NHS organisations.

While the initial ‘scorecard’ cannot be used to assess the performance of individual organisations, it will stimulate discussion on how to develop a fuller and more accurate version.

The goal of the Innovation Scorecard is to support the uptake of innovative therapies by the NHS, in line with the Government’s ‘Innovation, Health and Wealth’ strategy.

More information is needed to address the causes of the variation in availability of these treatments, since patient demographics and local purchasing arrangements may influence the data.

The report includes: estimates of actual and expected use of medicines; volumes of medicines used in primary care (daily dose per 100,000 of CCG population); and volumes of medicines used in secondary care (mg of drug purchased by hospital trust per 100,000 bed days).

The ABPI has expressed concern that the initial ‘scorecard’ not only reveals widespread variation but also shows the uptake of new medicines to be generally well below the expected level.

Stephen Whitehead, ABPI Chief Executive, commented: “This first Scorecard is less detailed than ABPI hoped for and we envisage future scorecards offering more details on how the NHS is complying with NICE guidance. But we welcome its publication as a first step on a transparency journey in the new NHS.

“I believe the Government understands the challenges, but it must act quickly and decisively to drive the adoption and diffusion of the newest and most innovative medicines across England.”

Hunt aims for global telehealth domination

by IainBate 14. November 2012 17:11

Jeremy Hunt - Web A new telehealth scheme has been launched by the DH to help an initial 100,000 patients with long-term conditions gain control over their own care.

Patients will get access to the use of electronic information and technology to help manage their health independently reducing the need to visit primary or secondary care facilities.

The scheme complements the NHS Mandate, which aims to provide telehealth access to three million people by 2017.

Health Secretary Jeremy Hunt said it was “logical” that the NHS should use technology to help patients “manage their condition at home, free up a lot of time and save the NHS money.”

The initial roll out of the project will see seven NHS ‘pathfinders’ across the country agreeing contracts with telehealth suppliers. The project is like no other witnessed in the UK before and is the largest outside the US.

The DH aims to make England the world leader in telehealth in coming years.

“In a world where technology increasingly helps us manage our social and professional lives, it seems logical that it should also help people manage their health,” said Jeremy Hunt. “With our industry partners, we will make England a world leader on telehealth.

“Getting another 100,000 people to benefit from this technology is a very important step and I congratulate all involved on their hard work. I hope it will be the first of many steps towards our overall goal of getting three million people to benefit in the years to come.”

David Nicholson, Chief Executive of the NHS Commissioning Board, said the introduction of the scheme had the potential to transform the lives of people with long-term conditions. “Telehealth not only saves lives, it transforms them, so that people with a long-term condition can feel in control of their life,” he said.

“The seven pathfinders that are offering this new technology to patients will give the NHS Commissioning Board important insight into how best to extend this option to any patient managing prolonged ill health or a chronic condition. 

“Working closely with the local commissioners involved and informed by their experience, we plan to promote vigorously the use of telehealth across England from next April.”

Bridge over troubled healthcare

by IainBate 28. September 2012 12:20

How will Public Health England bring together the NHS and local government?

Bridge - Web Public Health England (PHE) is the national executive agency of the new public health system, which will be driven by local government. PHE will be responsible for improving public health and reducing health inequalities through a range of local policies aimed at reducing health risks to individuals and communities.

From 1 April 2013, when PHE becomes a statutory body, public health services will shift from the NHS to local government. PHE will take £4 billion (5%) of the annual NHS budget with it, and will form an economic and organisational bridge between health and social care.

Like the NHS Commissioning Board, PHE will provide national leadership and guidance for local organisations but will not control them. According to Duncan Selbie, its Chief Executive designate, PHE will combine “a national voice with local action”. It will bring together experts from newly-dissolved public health bodies such as the Health Protection Agency and the National Treatment Agency.

Local authorities will commission public health services, employing local Directors of Public Health as ‘health ambassadors’ to lead discussions on public health spending. To engage with this locally-controlled system, PHE will develop public health outcome indicators and a ‘public health premium’ incentive system.

PHE’s broad function has been defined as “helping people to lead healthier lives”. That covers a wide range of interventions, from driving health awareness campaigns to a more practical role in vaccination programmes. In terms of impact on behavior, PHE will follow the Nuffield ‘ladder of interventions’ model, which relies on using evidence-based arguments rather than regulatory controls.

Leaders, not bosses
PHE will operate through 15 centres across the four regions identified by the NHS CB: North, Midlands and East, London, and South. This structure articulates the national role of PHE with local authorities: the regional bodies have more responsibility for national initiatives such as health emergency response, while the centres are more involved with local initiatives such as specialised commissioning.

The senior leadership team of PHE, like that of the NHS CB, will combine medical and commercial expertise. The medical leadership will consist of a Director for Health Protection, a Director for Health Improvement and Population Health, and a Chief Knowledge Officer. These will be supported by a Chief Operating Officer and Directors for Strategy, Programmes, Finance and Corporate Services, and Human Resources.

Chief Executive designate Duncan Selbie promises that PHE will offer the new public health system “leadership without hierarchy”. Selbie is an experienced NHS leader who was recently Chief Executive of Brighton and Sussex University Hospitals NHS Trust. He has been described as ‘popular’ and ‘likeable’, despite being a man of relatively few words. Notably, he survived the 2005 crisis of NHS governance under Sir Nigel Crisp with his professional credibility intact.

PHE is currently engaged in setting up its board and management team, and in matching roles between the old and new public health systems.

Health of the nation
The underlying medical goals of the new system are defined by the Public Health Outcomes Framework (January 2012), which groups outcome indicators into four domains:

  1. Improving the wider determinants of health – improving against wider factors that affect health and well-being.
  2. Health improvement – helping people to live healthy lifestyles, make healthy choices and reduce health inequalities.
  3. Health protection – protecting the population from major incidents and other threats.
  4. Public health and preventing premature mortality – reducing the numbers of people living with preventable ill-health and people dying prematurely.  

Selbie’s document My vision for Public Health England (July 2012) states that the agency “will lead nationally and enable locally a transformation in the health expectations and, in time, outcomes of all people in England”. He promises a focus on “collaboration” to provide a national voice for local public health expertise in councils, and says PHE will achieve “transformation” by changing people’s behaviour.

PHE’s three directorates, described in a separate factsheet, indicate the agency’s chief responsibilities:

  • Health protection – concerned with reducing infectious disease and environmental harm. PHE will lead the field epidemiology service, the national immunisation programme, and emergency preparedness, resilience and response. It will also be responsible for investigating and managing environmental hazards such as radiation and chemical exposures.
  • Health improvement and population health – concerned with reducing health inequalities and improving preventative healthcare. PHE will advise NHS commissioners on policies for disease screening and specialised commissioning, and will use social marketing to achieve behaviour change. It will promote innovation in this area of public health, reaching out to all providers and commissioners of health and social care, with the long-term goal of achieving improvement across the first, second and fourth domains (see above) of the Public Health Outcomes Framework.
  • Knowledge and intelligence – concerned with delivering “a new national evidence and intelligence service” to support assessment of public health need and track performance against key outcomes. PHE will seek to raise the national standard of disease registration, and will work in partnership with NICE to assess the effectiveness of treatments in improving public health. Notably, cancer registration will migrate from the NHS to PHE by April 2013, when PHE will launch a new Cancer Registration Service to “collect consistent high quality, near real-time data” on all cancers diagnosed in England.

Making communities safe
The health protection functions of PHE bear a complex relationship to the NHS. The agency will investigate risks to public health including infectious disease outbreaks, and assess the availability and effectiveness of drug treatments for these threats. PHE will take over the functions of the Health Protection Agency, which will impact on the health protection activities of CCGs, the NHS CB and local authorities.

For example, PHE will have a strategic role in immunisation. The NHS CB will commission vaccination services, but PHE will set their quality standards, assess their performance, fund and manage the development of new programmes and the extension of existing ones, and even purchase, store and distribute the vaccines; while CCGs will commission treatment of infectious disease and work with PHE and local authorities on outbreak control.

It is not surprising, therefore, that the Faculty of Public Health has expressed concern about the “complex new arrangements” for disease control and warned that the system will require “excellent communication and very close collaboration between GPs and their teams, public health staff and hospital services”. This, rather than changes in people’s lifestyles, is most likely to be the area on which the effectiveness of the new public health system is judged.

Pharma and public health
Public Health England may only have 5% of the NHS budget, but its impact on prescribing and other NHS services should not be disregarded. The agency will act as a communication network and body of expertise to guide the new public health system within local government – which in turn will influence and work collaboratively with CCGs and primary and secondary care providers.

PHE’s impact on immunisation and disease control is likely to be particularly important. However, in keeping with the Government’s ‘nudge’ approach to unhealthy lifestyles, it is unlikely to intervene decisively in ‘lifestyle’ and ‘wellness’ issues.

Where the pharmaceutical industry can contribute in concrete terms to PHE’s agenda – for example, by providing better immunisation solutions or affordable drugs that help to prevent serious illness – it may find the agency a willing ally that can impact on GP and hospital prescribing.

At other times, it may find PHE inclined to promote non-drug solutions to public health issues, especially in terms of behaviour change; the industry needs to engage constructively with these issues.

As well as public health outcomes, PHE will be concerned at all times with helping the NHS and local government to save money. Pharma will thus have opportunities to align itself with PHE’s agenda by offering solutions that reduce the cost of public health improvements.

GPs must be involved in Scotland redesign, says BMA Scotland

by IainBate 28. August 2012 15:34

BMA - web GPs must be involved in the reconfiguration of the NHS in Scotland if the new system is to be a success, BMA Scotland has warned.

The Scottish Government has proposed to replace community health partnerships (CHPs) with new health and social care partnerships in order to deliver care through shared budgets and targets.

BMA Scotland welcomes the switch but has said that clinicians should be at the “very heart of implementing changes” to ensure they are not “doomed to failure”.

The Association has called for GPs to take on a central role on the new partnership boards and wants reassurances the reforms will not result in the shift of work from secondary care to GPs in primary care.

“We have always advised a review of CHPs,” said a BMA spokesperson. “We are very concerned about the failure of these locally and a lot of GPs have walked away from them. If this gives us an opportunity for improvement, then we welcome it.

“But we want ensure GPs are involved in the new boards and that clinicians are also at the very heart of implementing changes. We need to ensure it will not lead to any further shift of work to primary care. That shift is not resourced either in terms of staff, premises or funding.”

Nicola Sturgeon, Cabinet Secretary for Health, said the changes are part of the Scottish Government’s commitment to creating a system of health and social care that is “robust, effective and efficient”.

Breaking the mould of primary care

by IainBate 25. July 2012 10:48

What does the ‘single operating model’ for primary care commissioning mean for GPs?

Dame Barbara Hakin - web The NHS Commissioning Board Authority’s ‘single operating model’ for primary care commissioning represents a major step in defining the relationship between GPs and the new NHS. As such, it is essential reading for anyone with a stake in prescribing behaviours and, more widely, in patient pathways.

A major question posed by the Lansley reforms is: who should commission the commissioners? If GP-led groups are responsible for commissioning secondary care, who can commission primary care? The answer, the NHS Commissioning Board, was greeted with mistrust by many GPs who asked why they needed some Big Brother watching over the job they had always done.

In addition, the passage of the Health and Social Care Act left a lot of broken glass scattered through primary care. The relationship between clinical outcomes and money, the involvement of the private sector in the NHS and the apparent fragmentation of the health service are issues that divided
the GP profession.

So the single operating model has the task not only of outlining new clinical and business relationships, but of building professional bridges. The Board tackles this challenge by saying up front that it seeks to
achieve “the right balance between national consistency and local decision making”.

Unlike earlier documents describing the infrastructure of the new NHS, Securing excellence in commissioning primary care does not list concrete developments to be in place by April 2013. Rather, it outlines a pattern of relationships that will develop from that date, when the new single operating model
for primary care commissioning becomes operative. It represents the parts of the new
NHS working together with a clear goal of outcome improvement.

The commissioning challenge
According to Dame Barbara Hakin, National Director for Commissioning Development, the new system aims to “tackle unwarranted variation and take positive steps towards raising the overall standard of primary care”. The document notes that primary care, while accounting for only 15% of the NHS budget, has a
profound role in making “preventative interventions” and influencing all the care patients receive.

The challenge of replacing “many different systems” for primary care commissioning with “a single national
operating model” without losing “vital local responsiveness”, the Board says, depends on “establishing relationships and arrangements across the new organisations” – including CCGs, whose health strategies
will set the context for primary care.

The NHSCB will be responsible for planning, securing and monitoring primary care services. Its local area teams will manage the performance of GPs and other primary care providers (dentists, community pharmacists and opticians), and will help to support providers in difficulty and deal with major emergencies.

The local area teams will support patient “choice and control in designing services that respond to their needs”, focusing on “the basic service offer” (such as early diagnosis) to reduce variations and health inequalities. Likewise, they will support the development of “local area clinical leadership teams” that draw on the expertise of all types of primary care clinicians. Finally, their focus on patient outcomes means they will look for “improvement strategies” at all times.

All together now
Most primary care commissioning will take place through the Board’s local area teams working with CCGs, local authorities and health and wellbeing boards. The Board as a central authority will “ensure consistency” and provide the framework for performance management and quality assurance. Crucially, this system involves “fewer managerial resources” and “larger geographical footprints” than the previous system. It does not remove local initiative: it just removes the SHA and PCT management layer.

At the heart of the model are the common operating procedures for local area teams, of which the most important is “to standardise the performance management frameworks and processes at practice, provider and individual levels”. Managing variability and the healthcare market are also key priorities.

Commissioning support services may also assist local area teams: emphasis is placed on the value of
business intelligence in providing “a single flow of standardised information”, and the potential for CCGs to share support for primary care development and redesign with local area teams.

Micro commissioning
CCGs themselves will work closely with the NHSCB to review the “micro commissioning decisions” made by
GPs in “each referral and prescription”. The Board says that its work with CCGs has shown they can progress effectively together towards “quality improvement” through benchmarking, data sharing and peer review. It notes further that CCGs will be able to commission integrated “wrap-around” community-based services in which GP practices can participate, with care taken to manage conflicts of interest.

The local area teams will establish relationships with a range of partners, including CCGs, Local Healthwatch, health and wellbeing boards, local authorities, Public Health England local units and the CQC. Clinical networks will feed into the primary care system “with a particular focus on early diagnosis and timely treatment”. Public health commissioners will advise local area teams on priorities for the local
population, and work with them to develop health improvement initiatives that may include primary care.

The Board concludes: “During the next three to six months, we will fully explore all the interdependent relationships critical for the operating model and take any action necessary to ensure that they will work effectively.” It encourages discussion of the model within PCT clusters and feedback on
potential improvements.

A business network
The single operating model for primary care commissioning is not so much a ‘one size fits all’ as an ‘all things to all people’. It shows the old hierarchical NHS giving way to something much closer to a business network, with shared rules and goals but different cultures. The imprecision of the arrangements described displays the will to promote clinical innovation and business
development.

The emerging structure is designed to give GPs more confidence that they will be neither isolated nor controlled. Those who need guidance and support will receive it, while others will have the freedom to change treatment pathways and business models. This will help to defuse opposition to reform in the
profession, while setting the stage for further changes.

For pharma, the new model points to the development of a complex and flexible customer network with many points of contact. Key account managers are much concerned with how primary care operates and the factors influencing it. This model shows primary care in a dynamic field of NHS and other stakeholders, responding to ideas from all sides: an exciting prospect for suppliers.

Public health recommendations issued to CCGs

by IainBate 28. June 2012 14:21

CCG News Clinical commissioning groups will be given free specialist expertise and advice from April 2013 to maintain high standards of public health.

A series of recommendations have been issued by the DH to support CCGs in delivering public health objectives through its Healthcare Public Health Advice Service.

Guidance to support the Provision of Healthcare Public Advice to Clinical Commissioning Groups outlines how local authorities should support and work alongside commissioners in tasks such as making Joint Strategic Needs Assessments and identifying areas for disinvestment.

Recommendations that the service should offer at various stages of the commissioning cycle are suggested in the document, such as interpreting and understanding primary and secondary care clinical data and advising CCGs on prioritisation and processes.

The document replaces the draft guidance published by the DH back in February 2012. As a result of the NHS reforms and the “shift of local leadership on public health to local authorities”, the report says, “it is critical that NHS commissioning continues to benefit from public health advice”.

The service, which will be provided by local authorities, will be the only means available to commissioners in obtaining public health expertise.

As part of the Health and Social Care Act 2012, CCGs will have access to public health advice, information and expertise in relation to the healthcare services that they commission and will be provided by local public health teams based in local authorities.

CCGs will have the freedom to determine how to organise public health arrangements depending on local requirements.

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