NHIS News

Superannuation deal in Northern Ireland to go ahead after three-year delay

18/05/2012 10:51:23

18/05/12

Northern Ireland GPs look set to receive a superannuation payment worth tens of thousands of pounds which has been severely delayed.

The work now begins to ensure that practices aren’t left with large accountancy bills, which the Northern Ireland GPC is trying to achieve. Chairman Dr Tom Black said that the delays had been a “huge headache” for practices and accountants. He added:

“The money involved is 6.3% of earnings so it’s a lot. But the real issue is the confusion – if this isn’t solved accounts will have to be reopened and accountancy bills will skyrocket.”

This has all come about because the GMS contract took effect in 2004, including funding for employer’s superannuation contributions at 7%. However, from April 2008 the employers’ superannuation contributions rose from 7% to 15.7%, and revised to 13.3% in 2009. This was not reflected in the funding the practices received, creating a shortfall.

The Northern Ireland GPC, along with the DH, Social Services and Public Safety (DHSSPS) has now agreed to repay the money. It has been agreed to use a formula based on a practice’s global sum, correction factor and practice nurse allocation as per 31 March 2004,

The funding for 2011/12 has also been done on this basis. A DHSSPS spokesperson said:

“In view of the difficulties which would result from funding being allocated to practices in this financial year in respect of the three years in question, talks are taking place with HMRC for the funding to be al¬located dir¬ectly to the Health and Social Care Pensions Branch.”

CCGs prefer in-house support for commissioning, rather than the CSS

17/05/2012 08:56:29

17/05/12

It appears that the clinical commissioning groups are opting to host their own commissioning support from within their organisation, rather than turning to outside sources.

This is now threatening to undermine the plan to create a marketplace for the standalone commissioning support services.

It has become apparent amid the criticism of the commissioning support services inability to engage with the leaders of the CCGs, and as the NHS Commissioning Board announces that three of the CSSs have been dissolved, as they were judged as being unfit to proceed.

North, East and West Devon CCG have given commissioners the ability to host their own commissioning support services – taking away the majority of the potential market for the Peninsula CSS.

Interim chair David Jenner said:

“We want to retain the organisational memory of skilled health service managers. In my view there is less risk in keeping a service under your own management than outsourcing to an as yet unformed and unproven organisation.”

The NHS operating framework 2012-13 set running costs as £25 per head of population – but CCGs are planning to spend significantly less with their local CSS. The expected figures in CSS South are £10 per head, £12 with Arden CSS, £9.50 with the Greater East Midlands CSS and only £8 in South London.

Nottingham City CCG chair Hugh Porter plans to spend between £5 and £10 per head with the Greater East Midlands CSS. He said:

“To make clinical commissioning work [we] need to have a cohesive team of managers and clinicians as integrated as possible. We thought we could do that best within the organisation, with a clinician in every contracting team.”

Dame Barbara Hakin, National Director of Commissioning Development, said that she believes the key factors in deciding how well the CSSs are doing, and how viable they are included seeing “how committed CCGs were to the particular business model [of each CSS], and how much the leadership of the organisation had managed to make significant inroads into customer relationships.

Almost half of the new commissioning support services have problems passing key tests

14/05/2012 03:11:12

14/05/12

Out of the 26 commissioning support service plans, 9 have been found to have only “marginally” passed, and three have failed completely.

Plans to develop a national communications service as a CSS, West Mercia CSS and Peninsula CSS have now been judged as not fit to proceed.

All 26 have been assessed on the quality of leadership, business planning and their focus on the clinical commissioning group customers.

The three which are no longer proceeding were deemed to have failed on two or three of these criteria.

The nine which have been identified as needing “rigorous management” only just passed one or two of the domains. The nine are:

Greater East Midlands
Greater Manchester
Cumbria and Lancashire
Birmingham and the Black Country
Essex
South London
Surrey and Sussex
Central Southern
Hertfordshire

These will now have a strictly controlled development plan under the commissioning board’s business development unit to help bring them up to speed. All commissioning support services will have a new plan to help them to become independent organisations.

The NHS Commissioning Board has said:

“For those CSSs that have ‘stopped’, strategic health authorities are already working closely with the CSS, primary care trust cluster and CCGs to ensure that robust plans are put in place and to provide the necessary reassurances to staff.

“This is to ensure that CCGs have confidence in their commissioning support arrangements and that they can choose the best service that meets their needs. It will be particularly important to ensure that CCGs have time to put these arrangements in place ahead of their application for authorisation.

“In these cases, it is clear that there will still be a significant need for locally-based staff to deliver support services to CCGs and that the main impact will be to senior management arrangements and organisation shape rather than to the roles that are available to NHS staff.”

The remaining 14 have all been found to have made good progress over all three criteria:

South Yorkshire
Staffordshire
North West London
Central and East London
Arden
North Yorkshire and Humber
Kent and Medway
Merseyside
Cheshire, Warrington and Wirral
Norfolk and Waveney
North East
West Yorkshire
Best West
CSS South

Queen announces draft Care and Support Bill in speech

11/05/2012 09:48:55

11/05/12

This year’s Queen’s speech has announced the government’s plan to publish a new plan, a draft bill to modernise adult care and support in England. This follows last year’s Caring for our future engagement, which was co-led by the Government and the care and support sector to understand people’s concerns and priorities for reform of the system.

The bill will set out what kind of support people could expect from the government, and actions the government would take to help people to plan and make informed decisions about their care.

The main points of Bill are:

Modernising the legal framework for care and support, to support the vision of the forthcoming White Paper on care and support
Responding to the recommendations of the Law Commission, which conducted a three-year review into social care law
Establishing Health Education England as a non-departmental public body
Establishing the Health Research Authority as a non-departmental public body
Creating a London Health Improvement Board
Carrying out engagement and pre-legislative scrutiny on the draft Bill, as many in the social care sector have called for, to enable government to listen to people with experience and expertise, to make the most of this unique opportunity to reform the law

The benefits would include:

Modernising care and support law to ensure local authorities fit their service around the needs, outcomes and experience of people, rather than expecting them to adapt to what is available locally
Putting people in control of their care and giving them greater choice, building on progress with personal budgets
Consolidating the existing law by replacing provisions in at least a dozen Acts with a single statute, supported by new regulations and statutory guidance
Simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people
Giving people a better understanding of what is on offer, to help them plan for the future and ensure they know where to go for help when they need it

For more information about the Queen’s speech, click here.

Regional directors announced by the Commissioning Board

11/05/2012 01:59:36

11/05/12

The NHS Commissioning Board has named the four people who have been appointed as the four regional directors.

All four were previously SHA or PCT bosses.

Richard Barker has been appointed for the North of England – he was previously the chief operating officer for the North of England SHA cluster.

Paul Watson has been appointed for the Midlands and East – he was previously the chief executive of the Suffolk PCT cluster.

Anne Rainsberry has been appointed for London – she was previously the chief executive of the North West London PCT cluster and deputy chief executive of NHS London.

Andrea Young has been appointed for the South of England – she was previously the chief operating officer and deputy chief executive of the South of England SHA cluster.

NHS Commissioning Board chief operating officer Ian Dalton said:

“I was looking for people who had the confidence to work in a more devolved system but also the leadership capacity to help the NHS in their areas deal with the very significant issues it will have to deal with over the next few years.”

Controversy over NHS Wales’ finances

08/05/2012 01:05:15

08/05/12

The Welsh government has announced that all NHS organisations in Wales have met their financial targets for 2011/12 – the provisional figures even show that there is a small surplus of £0.5 million.

Health Minister Lesley Griffiths said:

"I am pleased to announce all NHS organisations in Wales have met their statutory financial targets for 2011-12.

"This is a remarkable achievement given the financial pressures facing NHS Wales.

"Last October, I said NHS managers will be held to account for the financial management of their organisations, with strong action taken if financial targets were not achieved.

"To end the dependency on year-end financial support, the Welsh Government provided the NHS with an additional £145 million in October; with a warning there would be no further support during the financial year.

"In addition to coming in on budget, NHS organisations have also delivered £290 million financial savings in-year. This has been delivered whilst maintaining delivery against clinical performance, such as faster stroke treatment and a reduction in emergency re-admissions to hospital."

However, it has also been revealed that three health boards in Wales have had to have a £12.4 million loan from the government in order to break even – but Ms Griffiths insists there have been no bail-outs.

Opposition leaders have accused the health minister of making misleading claims that the performance by the Welsh health service has been a “remarkable achievement” and represent an “excellent result”.

This happened because Aneurin Bevan, Cwm Taf and Powys Teaching local health boards each needed approximately £4 million to reach the end of the financial year, and this money must be paid back from the budget allocations for 2012/13.

Tory opposition leader Andrew RT Davies said:

“At best the Welsh Labour government’s claims of a ‘remarkable achievement’ are misleading. At worst they are completely false”.

Welsh Liberal Democrat leader Kirsty Williams added:

“I am absolutely flabbergasted that the health minister can call this a ‘remarkable achievement’. What’s remarkable is that the health minister thinks that this is an achievement.”

The Welsh government stands by their agreement that Aneurin Bevan, Cwm Taf and Powys health boards could bring forward a portion of the 2012/13 budget.

First 35 CCGs seeking authorisation named

03/05/2012 10:40:24

03/05/12

The NHS Commissioning Board has revealed the names of the first group of CCGs who have chosen to stay ahead of the game and be assessed in the first wave of authorisation applications.

The CCGs, from all corners of England will be become the first GP-led statutory bodies from next April – if successful.

The first wave of authorisation applications will take place in July, with the final and forth wave in January 2013.

National director of commissioning development at the NHS Commissioning Board Dame Barbara Hakin said:

“All the emerging clinical commissioning groups have made fantastic progress to prepare themselves for authorisation. Today we are confirming those who have chosen to be assessed in wave one. We expect confirmation of which CCGs will be assessed in waves two, three and four shortly.”

First-Wave authorisation CCGs:

East Midlands

East Leicestershire and Rutland

Leicester City

West Leicestershire

East of England

Bedfordshire

East and North Herts

Great Yarmouth and Waveney

London

Islington

Kingston

Wandsworth

North West

Blackpool

Cumbria

Liverpool

Oldham

Warrington

West Cheshire

South Central

Newbury and District

North and West Reading

Oxfordshire

Portsmouth

South Reading

Wokingham

South West

Gloucestershire

Kernow

Somerset

West Midlands

Dudley

North Staffordshire

Sandwell and West Birmingham

Shropshire

Stoke on Trent

Yorkshire and the Humber

Bassetlaw

Calderdale

East Riding

North East Lincolnshire

Rotherham

Wakefield

Dr Gina Palumbo, East Riding of Yorkshire CCG chair said:

"Before the introduction of the Government's Health and Social Care Bill, GPs and other clinicians in the East Riding had already become more closely involved in the commissioning of local health care through five locality commissioning groups in Haltemprice, Holderness, Goole Howden & West Wolds, Beverley & Driffield and Bridlington. We also have good existing and integrated services with East Riding of Yorkshire Council who have also supported our application. This has meant that the development of the CCG has been more of a natural ‘organic' process, which has flourished with the continued support of the East Riding of Yorkshire PCT and the Humber Cluster Joint Board."

Dr Caron Morton, Designate Accountable Officer for Shropshire County CCG added:

“We are pleased to be in a position to be able to take this next step towards authorisation. Over the past twelve months we have worked closely with patients, our GP members, the local authority and all stakeholders. Together with our managerial colleagues, we have embarked on a programme of strategic transformational change across the local health economy to support the delivery of high quality sustainable healthcare locally. We look forward to progressing these areas of work and realising the improvements for our patients.”

Local suppliers to support CCG data services

02/05/2012 10:25:41

02/05/12

Most data intelligence services supplied to CCGs will be provided by local commissioning support units, and not done on a national scale.

This comes from a leaked NHS Commissioning board document that says that a standalone commissioning support service is being set up for communications and a “free market” approach will be taken to back-office functions.

It has also been reported that high-level business intelligence services will not be more than 4% of the total CCG running costs.

Published in April, the document says the business intelligence services should be priced at between 50p and £1 per head of population, compared with the £25 allowance per head for CCG running costs.

Business intelligence providers are classed as “data management and integration centres that provide data validation, integration and storage” and work to “cleanse, validate and link national and local data sets.”

The communication service is currently being led by Stephanie Hood, who used to be the director at South East Coast communications, and is now undergoing the same authorisation process at the 25 commissioning support units that have been set up by PCT clusters.

As with the other commissioning support services, the communications service will be hosted by the NHS Commissioning Board from the changeover date of April 2013 and by 2016 it will become a standalone private or voluntary sector organisation. They will also be able to inter into a partnership/joint venture with a non-NHS body.

This means that the NHS commissioning support service will have no choice but to use the national service if they want to supply communications services to their CCGs.

Emphasis is put on the commissioning support services having to meet “private industry standards” if they want to provide such services to CCGs.

CCG funding should take into account population age, not poverty

02/05/2012 09:58:59

02/05/12

Health secretary Andrew Lansley has put forward the idea that funding for clinical commissioning groups should be based on the ages of the population, rather than the indices of deprivation.

From 1 April 2012 the CCG budgets will be decided by the NHS Commissioning Board, with guidance from the Advisory Committee on Resource Allocation.

Mr Lansley said:

“Age is the principal determinant of health need.

“What should happen – the advisory committee will do this, I won’t – the number crunching should get progressively to a greater focus on what are the actual determinants of health need.”

Mr Lansley said that by making funding directly related to deprivation it gives expectations that the money should be spent entirely on poverty-related health needs.

“Wherever you are in the country you should broadly have resources equivalent with access to NHS services.

“They should be looking at what it is in your population data that is likely to give rise to a demand for NHS services - the respective burden of disease.

“What is likely to make the biggest difference, therefore? Actually it’s elderly populations who were not in substantial deprivation.”

He used the examples of Eastbourne and Fylde where there is a high elderly population but some of the lowest spending on strokes and cancer services in the country.

The health secretary sympathised with GP Commissioners, saying that the next six months would be more difficult than at any other time, while to get the new NHS structure set up successfully.

“A lot of people will be trying to live in two worlds at the same moment, try to do the day job while they’re trying to do the shaping of the future.”

Changes to the NHS “won’t happen overnight” according to the commissioning board chair

02/05/2012 09:52:37

02/05/12

The chair of the NHS Commissioning Board, Professor Malcolm Grant has told the Health Service Journal that people should not expect a “sudden overnight change on 1 April next year”.

He said that the challenge has been effectively running two services parallel to each other – one a transformed NHS, with GPs leading commissioning, and the other trying to make savings of £20bn whilst maintaining standards and performance.

“Running two systems in parallel is very risky. We don’t want to lose any momentum on QIPP or any of the achievements of the present system while we bring in the new. [The change] will not be overnight, it is not that suddenly the lights are going to go off on 1 April and a whole new sunlight will be turned on. It’s going to be a long process of really hard work.”

Professor Grant agrees with the system that the board’s chief executive Sir David Nicholson has put in place, a strictly controlled top-down approach to management of the service during the transition.

There have already been struggles getting the regional bodies of the commissioning board up and running, as three regional chiefs have decided against joining. All directors for the four regional sectors should be appointed by the end of May and it was expected that the current SHA cluster chief executives would be offered the jobs.

However, Dame Ruth Carnall from NHS London, Sir Ian Carruthers from NHS South of England and Sir Neil McKay from NHS Midlands and the East has confirmed that they aren’t planning to apply for the jobs.

The commissioning board has said that the “potential loss of senior leaders” is one of the main risks to the success of the NHS.

Dame Ruth Carnall has said that "there is plenty of talent in the system to come forward.”

There have been calls for the board to allow more local flexibility to make the roles more appealing, as at the moment it is looking like they won’t actually have much of a role in leading the service changes.

Northern Ireland’s waiting times increase at A&E

30/04/2012 12:56:10

30/04/12

There has been an increase in patients having to wait over four hours for emergency care in accident and emergency departments in Northern Ireland.

The latest figures from March show that 71% of patients were dealt with in the four-hour window – below the national target of 95%. This is an improvement on February’s figures, with only 69% meeting targets.

These statistics are released by the department quarterly and record the time it takes for a patient to either be treated and discharged or admitted following arrival at one of Northern Ireland’s 10 emergency departments.

The worst offender is Antrim Area Hospital, with only 63% being treated and discharged or admitted within the four hour limit.

Another of Health Minister Edwin Poots’ aims is that no patients should have to wait more than 12 hour to be seen, and the majority of A&E departments are on their way to meeting this target, as the number who had to wait over 12 hours has decreased by 34%.

Antrim Area Hospital is still falling behind, as 109 patients did have a massive wait, with a total of 960 patients waiting over 12 hours throughout Northern Ireland.

Despite this, the March figures are an improvement on February – especially as the number of patients at Antrim’s A&E has risen by almost 500 in a month.

The statistics from February 2012 were the poorest in over a year.

£70,000 fine for Aneurin Bevan Health Board after data breach

30/04/2012 03:18:55

30/04/12

Aneurin Bevan Health Board in Wales has become the first ever NHS body to be fined for breaching the Data Protection Act.

The health board has been ordered to pay a £70,000 penalty after it released sensitive data about a patient to the wrong person. It happened when a doctor mis-spelt a name and did not give enough detail about a patient to his secretary, meaning the report was sent to someone with a similar name.

Since the incident, Aneurin Bevan Health Board has introduced new precautions to ensure a breach like that doesn’t happen again.

The Information Commissioner’s Office (ICO) said the report contained explicit details relating to the health of the patient, and represented a serious breach of the Data Protection Act.

Further investigations by the ICO shows that neither the doctor nor the secretary involved had received any data protection training and the checks in place in the health board to ensure personal information was only sent to the relevant person were inadequate.

ICO’s head of enforcement, Stephen Eckersley said:

"The health service holds some of the most sensitive information available.

"The damage and distress caused by the loss of a patient's medical record is obvious, therefore it is vital that organisations across this sector make sure their data protection practices are adequate.

"Aneurin Bevan Health Board failed to have suitable checks in place to keep the sensitive information they handled secure. This case could have been extremely distressing to the individual and their family and may have been prevented if the information had been checked prior to it being sent."

The new measures introduced at Aneurin Bevan Health Board include training all staff on the storage and use of data policies, regular monitoring of compliance with data protection and IT policies and new processes to confirm a patient’s identity before any personal information is sent out.

A spokesperson for the Aneurin Bevan Health Board said:

"We accept the decision by the Information Commissioner's Office and have acted promptly on the points raised in their report.

"We have also apologised to both parties involved in this breach of confidentiality and are working directly with the patients affected. We wish to reassure all patients that we are committed to the protection of all clinical information."

£226.7m worth of planned cuts in Scotland

27/04/2012 12:15:25

27/04/12

Scottish Labour has said that a report from an independent health economist shows that NHS boards plan to make £226.7m savings next year.

The paper was prepared by Dr Andrew Walker, of the University of Glasgow, and examines the levels of savings the health boards plan to make in 2012/13. The official target is £3% of efficiency savings.

The report shows the health boards have planned to make the following savings:

NHS Ayrshire and Arran: £14m
NHS Borders: £5.9m
NHS Dumfries and Galloway: £7.5m
NHS Fife: £17.5m
NHS Forth Valley: £11.2m
NHS Grampian: £12m
NHS Greater Glasgow and Clyde: £58m
NHS Highland: £23.8m
NHS Lanarkshire: £19.2m
NHS Lothian: £27m
NHS Orkney: £1.4m
NHS Shetland: £2.5n
NHS Tayside: £24.5m
NHS Western Isles: £2.2m

However, the Scottish government have criticised Labour, saying that they are committed to protecting health spending and they are wrong to suggest that the budget is being cut.

Labour retaliated by saying that it is the frontline staff that have borne the brunt of the spending cuts, with over 4,500 NHS workers losing their jobs since 2009 – including over 2,000 nurses.

Scottish Labour health spokesperson Jackie Baillie said:

“The cold, hard reality is that across Scotland health boards are being forced to make multi-million pound cuts because of SNP budget decisions.

"The SNP government at Holyrood appear increasingly out of touch with the pain they are inflicting on our health services locally.

"It is grossly unfair that it is hardworking front line NHS staff that are being forced to bear the brunt of the SNP's cuts."

SNP MSP Jim Eadie said that completely disagreed, saying that Scotland’s NHS is in “very safe hands.”

A spokesperson for the SNP also added that the government is also investing funding in other health initiatives and projects, like the New South Glasgow Hospitals:

"These figures are absolutely not cuts to the health budget - boards are looking to make some services more efficient and any savings will be reinvested in local front line care.

"It is right that boards make sure the taxpayer gets the best possible value for money.

"It is also important to point out that the Budget Report by the parliament's health committee published earlier this year and agreed unanimously by all members concluded that the health settlement was generous."

NHiS’ interactive NHS map

25/04/2012 01:06:50

17/04/12

As you will be aware, the NHS in England is going through major changes. Any effective account plan must be based on a full and accurate understanding of the structure, working and direction of the NHS reform.

The NHS in England has been going through several well-documented major changes. Any effective account plan must be based on a full and accurate understanding of the structure of the NHS, along with the working and direction of the reforms.

To help with this challenging task, NHiS have developed an interactive schematic NHS structural map; outlining who does what, who works together and exactly how the NHS will look a year from now. Included within the map are hyperlinks to various briefing documents, which outline exactly what that organisation does, and how it fits into the wider NHS picture.

To view the interactive map and briefing documents, click here.

Doctors offered incentives to train in Wales

24/04/2012 11:56:07

24/04/12

New doctors will be offered various incentives to train in Wales, in a new measure to tackle decreasing numbers of medical professionals.

The campaign, called Work for Wales, is being led by First Minister Carwyn Jones and Health Minister Lesley Griffiths. The government is hoping to persuade medics of the benefits of living and working in wales – and offering cash awards to encourage doctors to develop their own inventions.

Work for Wales continues to see first-year medics receiving free accommodations, and will also create a network of clinical ambassadors for Wales.

It is believed that there are between 50-200 medical vacancies in Wales at the moment, but NHS statistics show there has been a 2.8% increase in the number of medical and dental staff employed between 2010 and 2011.

The second phase of the campaign included the Invent scheme, whereby the government rewards clinicians in Wales to allow them to develop their own inventions.

In the first round of Invent, there were two awards made – one to Jon Featherstone, whose invention relates to a surgical device, and Dr Jane Harrison, an ear not and throat specialist registrar.

Speaking during a visit to Morriston Hospital in Swansea, First Minister Mr Jones said:

“The Work for Wales campaign will promote the unique prospects Wales can offer doctors at all levels, from free accommodation for those just starting out in their career and schemes that reward staff for developing ideas that benefit patient care, to the unique opportunities at senior consultant level in terms of leading innovations in care.”

“There are certain medical specialties, and certain parts of Wales, where there have been on-going difficulties filling vacant posts.

“This is not solely a Welsh problem, as there is a UK-wide shortage of doctors in specialties such as emergency medicine, psychiatry and paediatrics. The campaign will sell Wales as a great place to live and work.”

Ms Griffiths added:

“We have to ensure the great work going on in Wales is highlighted and promoted outside Wales. I firmly believe we have been too reticent to shout about our successes in the past.

“This is something we have to change, and Work for Wales will give doctors from outside Wales who are considering re-locating a chance to discuss what opportunities exist and what working and living in Wales offers.”

There is a danger that CCGs could transform into “the worst of PCTs”, GP leaders have warned

24/04/2012 11:55:30

24/04/12

Clinical commissioning groups are excluding LMCs from their development, leading to fears that they could adopt all of the bad PCT habits.

GPC members have backed a motion calling for CCGs to sign up to seven key principles in a ‘fair commissioning charter’. Chairman Dr Laurence Buckman believes this will empower GPs and allow practices to say “no” to constitutions that impose unnecessary conditions. He said:

“We are encouraged to hear examples of GPs feeling empowered to say 'no' when PCTs are thrown into rapid clustering against their will and are making decisions to do with commissioning support with 48 hours' notice saying "you have to decide this or else". Because of our guidance some practices and GPs are saying "we’ll have a think about this" and this document is part of that empowering process.”

The seven principles are:

Work to improve the quality of and access to local health services and reduce health inequalities

Develop a culture of genuinely clinician-led commissioning, taking decisions in the best interests of the local population

Engage with patients and the public with respect to decisions taken about their health services

Operate in a transparent and open manner, and in the interests of transparency, not engage in any contracts or negotiations which impost conditions of commercial confidentiality; in the further interests of transparency will take decisions in public unless to hold them in private for legal reasons

Resist any qualified provider being imposed from sources outwith the CCG

Always take decisions in the light of the likely effect on the important relationship between individual GPs and their patients

Establish and strengthen working relationships with LMCs, further enabling successful outcomes in commissioning

However, the GPC said that the principles were not meant to be prescriptive and could change following feedback from CCGs and LMCs.

“We have had reports about unhelpful constitutions being proposed, that would if a practice signs up to them put them under significant burden and expectations that would take them beyond the relationship they have with their PCT. Clearly we want practices and GPs to be fully engaged with their CCG.

“What we don’t want is some CCGs to emulate the worst of some PCTs, where decisions were made remotely without any involvement of clinicians and then imposed top-down onto practices and clinicians in a draconian way preventing them from prescribing in a particular way, preventing them from referring in a particular way.”

GPC Negotiator Dr Chaand Nagpaul added:

“We believe that LMCs should be central to enabling fair constitutions that allow two-way accountability. The constitution is not something to be presented to practices as a fait accompli.”

NHS Commissioning Board to devolve power to CCGs?

24/04/2012 10:44:45

24/04/12

Andrew Lansley has written a letter to the NHS Commissioning Board (NCB) containing its “strategic priorities”, apparently aiming to devolve power to clinical commissioning groups.

The strategic objective, set out until April 2013 are:

Transferring power to local organisations

Establishing the commissioning landscape

Developing specific commissioning and financial capabilities

Developing excellent relationships

The letter, written to the NCB chair Professor Malcolm Grant, also mentions plans to publish minutes of future accountability meetings with the chair.

This follows concerns that the NCB may attempt to retain more control over the CCGs that originally intended. It says:

"At the heard of our shared agenda for the NHS is a commitment to achieving a fundamental shift of power from national and regional organisations to CCGs, Health and Wellbeing Boards, local providers and patients.

“The challenge for the authority is to ensure that preparations for the board make a reality of this commitment. The process of decentralisation of decision-making and promoting the autonomy of CCGs must be embedded within the culture of the board.

“The first - and overarching - objective is to design the board so that it transfers power to local organisations.”

The letter has been welcomed by the National Association of Primary Care and the NHS Alliance, who are currently working together under the NHS Clinical Commissioners to represent CCGs.

Alliance chair Michael Dixon said:

“The letter puts down a number of critical markers for which the NHS CC coalition has been actively lobbying.” He said the aims in the letter were “fundamental to the transformation that is to take place over the coming months and years."

Independent prescribers across the UK can now prescribe controlled drugs

24/04/2012 10:37:14

24/04/12

Drug legislation has now changed in the UK to allow up to 20,000 nurses and midwives, and 1,500 pharmacists are now able to prescribe controlled drugs, including morphine and co-codamol.

Independent prescribers can also supply or administer morphine or diamorphine under patient group directions, for urgent treatment of sick or critically injured patients.

They will also now have the power to mix a controlled drug with other medicines for patients are need drugs intravenously.

Professor Dame Chris Beasley, chief nursing officer for England, said that the changes will “help deliver faster and more effective care, making it easier to patients to get the medicines they need, without compromising safety.”

“Enabling appropriately qualified nurses and pharmacists to prescribe and mix those controlled drugs they are competent to use, for example in palliative care, completes the changes made over recent years to ensure we make the best use of these highly trained professionals’ skills, for the benefit of patients.”

Professor Matt Griffiths, former Royal College of Nursing prescribing advisor, said that he believed that the changes represented a “historic” change for nursing:

“Nurses have been safely prescribing these medicines for a number of years, in fact before we reached the public consultation more than 1 million controlled drug prescriptions had been prescribed by nurse prescribers...It’s the legal mechanism that has been frustrating here for both nurses and their patients.

“The formal process of supplementary prescribing many of these medicines to date has meant delays to patients receiving the medicines and therefore in some cases extended periods or pain.

"This legislation will support us in ensuring our patients receive the best care.”

Vast majority of GPs convinced financial strain will increase in next five years

19/04/2012 09:31:43

19/04/12

A survey has revealed that over 90% over GPs believe that financial pressures will increase in the next five years.

BDRC consultants conducted a survey of 167 GPs on behalf of Lloyds TSB Commercial between October 2011 and January 2012, which showed that 91% of GPs expected the financial pressures to increase, and 73% said that they believed practices profits would also decrease.

Only 37% of GPs questioned said they believed that the move to clinical commissioning groups is a positive step forward. 51% disagree, whilst 12% are still unsure.

However, 52% of GPs are confident in the future of healthcare provision to patients in the UK, but 60% expect NHS services to reduce by some degree over the next five years.

73% of GPs asked said that they expect ‘single handed’ GP practices to decline by 2017, with 89% also saying they expect more practices to merge.

Head of healthcare banking services for Lloyds TSB Commercial, Ian Crompton said:

“Partners in every size of practice have financial decisions to take and the Healthcare Confidence Index suggests that many are waiting for a clearer picture of a revamped NHS before they make them.

“GPs who are taking decisions now and preparing for reforms with mergers, new premises and investment, may well be the ones who do feel most confident about change and are best placed to deliver when it arrives.”

Northern Ireland launches social work strategy

17/04/2012 03:57:48

17/04/12

Health Minister Edwin Poots has launched Northern Ireland’s first ever strategy for social work.

The strategy sets out various plans to strengthen the support for social workers and improve other social work services.

The strategy focuses on early intervention and family support. It also confirms the role of social work in protecting children and vulnerable adults.

The recommendations include:

Development of a regional social work out-of-hours service

Introduction of extended/flexible hours

Strengthening integrated and partnership approaches in practice

Improving employer supports for frontline staff

Edwin Poots said, as the strategy was launched at Belfast’s Queen’s University:

"Social workers help many vulnerable people in our society to live safer lives.

"They need our support and they deserve our appreciation.

"I am delighted to launch this strategy which sets out the direction for social work services for the future in Northern Ireland.

"It will help improve outcomes for service users, strengthen supports for frontline workers and improve the quality of social work services."

GPs to argue that they should have the power to sack underperforming CCG boards

17/04/2012 01:13:00

17/04/12

GP leaders are to put forward their argument to allow them to dismiss CCG boards if they do not perform well at this year’s UK LMC conference.

The motions submitted demand a financial mechanism to fund work transferred to primary care – along with a new definition of core GP services. This is to stop any unfunded work being handed to the GPs.

Other things expected to be brought up at the conference include the rollout of revalidation, cuts to pensions, implications of the Health Act reforms and a GP recruitment crisis.

Essex LMC chief executive Dr Brian Balmer said that if the majority of CCG members thought the group was making poor decisions, they should have the ability to hold an emergency general meeting and a vote of no confidence in the CCG board.

A North East Essex LMC motion called for practices to be able to “recall the CCG governing body should a majority of practices support such action.”

Somerset LMC has also submitted a motion which calls for CCGs to become more accountable to local GP commissioners. Chairman Dr Barry Moyse said that he believed the motion urged CCGs to explain the rationale behind their commissioning decisions and it also allows the practice to make suggestions.

Even though there is plenty of strong opposition to the Health Act, the LMCs said that motions which urged GPs to boycott commissioning were unlikely.

Dr John Canning, Cleveland LMC secretary said “No one would want to disengage entirely. We need to make this work.”

Dr Balmer added “The LMCs are going to have to deal with this day-to-day. I’m not surprised that there are not a lot of ‘take to the streets’ motions against commissioning.”

Inequalities will widen thanks to Health Bill

12/04/2012 04:15:33

19/03/12

The Faculty of Public Health have put together an alternative “risk register” which outlines how they believe Health Bill will widen health inequalities, reduce the quality of care and increase costs.

The faculty published their version of the risk register as a response to the government’s refusal to publish the official document. The government’s risk register also sets out the potential impact of the Health Bill.

The Faculty of Public Health said it had “undertaken to document what it believes are significant risks associated with the NHS structures, the new health system and environment that the bill will enact”.

Many organisations have argued that the official risk register should be published and last week the Department of Health lost a High Court appeal against a previous ruling that it should publish the register. It is not yet known when the document will finally be published.

The register published by the faculty highlights causes that revoke Andrew Lansley’s duty to provide and secure the provision of a comprehensive health service – including CCGs and their power to determine what care is necessary for their populations.

The faculty argue that this has the possibility to create a postcode lottery with CCGs as it allows commissioners to obtain services which are offered by private providers and stop commissioning services currently available through the NHS.

They also argue that costs will be increase through the need for greater regulation, transaction costs and commissioning support despite the government’s view that increased competition will reduce the cost of services.

It is also claimed in the faculty’s register that a competitive market will provide “no incentive for providers to collaborate to provide integrated pathways of care” – and therefore negatively affect quality.

They also believe that the “most vulnerable” will be the most disadvantaged as a result of the reforms, with the gap widening health inequalities.

“Operation of choice in an environment of multiple providers will disadvantage those who are less educated, have reduced access to resources such as the internet, or for other reasons are less able to navigate the healthcare market.”

GP commissioners are losing faith in the NHS reforms

10/04/2012 10:39:23

10/04/12

A poll, carried out by the BBC has shown that the number of GPs who believe in the government's changes to the NHS is falling.

It was found that only 12% of GPs agreed that putting CCGs in charge of the budget would mean that patients would see a “noticeable” improvement in their healthcare services.

That figure has dropped from 23% when a similar survey was carried out in September 2010.

Also, a massive 83% said they believed there would be increased rationing in their area because of financial pressures. However ministers believe that the changes in the NHS will actually help financial strain and this is one of the reasons they have pushed ahead with the reforms.

While 12% of GPs think that CCGs will improve care, 55% disagree and 33% said they didn’t know.

The role of the private sector was also mentioned in the poll, which found that 87% of those asked believed that the private sector will play a bigger role in healthcare thanks to the Health Act.

Health think tank, the King’s Fund said that poll highlighted the challenge the government faces to implement the health reforms. Chief executive Chris Ham said:

"GPs will be in the vanguard of this - their commitment is essential for implementing clinical commissioning, the government's big idea for ensuring that care meets the needs of patients.

"The public will judge the government's stewardship of the NHS on the basis of whether patient care improves, so ministers should be concerned that many GPs fear that care will get worse rather than better in the years ahead."

Chairman of the BMA’s GPs committee, Dr Laurence Buckman said he wasn’t surprised at the findings, as this is what doctors had been telling them directly:

"Increasingly, GPs are worrying that they will be blamed for making the hard decisions that may need to be made in order to meet the £20bn savings target set by the government. The government needs to be much more upfront with the public about the scale of savings that need to be made and why.

"If those who will have to deliver the latest health reforms are unconvinced and reluctant, the government should take notice of what they say."

Despite the latest government figures showing that all NHS waiting targets are being met and that they have found the savings needed in the last financial year, the BBC poll shows that there is still a considerable amount of anxiety.

49% of those questioned thought that the NHS would not be able to continue to meet the 18-week target for routine treatments, with only 22% thinking that it would still be possible. The same was found for A&E departments, with 42% believing that the NHS would need to close or downgrade some in the next 5 years.

However, health secretary Andrew Lansley disagrees:

"Of course, every important reform to the NHS, under whatever government, has had its critics from within the system. But putting GPs in leadership positions in the NHS will mean they can improve services for their entire local population. Patients want doctors to make decisions about their care, not managers, and that is what our reforms will deliver."

NHS Commissioning Board to have the power to stipulate CCG staff

05/04/2012 01:14:39

05/04/12

Draft authorisation to be discussed this month has alleged that the NHS Commissioning Board could decide the types of staff CCGs should employ.

In the document, it details the four application waves the CCGs can take part in before becoming fully authorised, also with the six criteria all bodies are expected to fulfil before being handed over control from the PCTs.

The authorisation criteria are:

A strong clinical and multi-professional focus which brings real added value.
Meaningful engagement with patients, carers and their communities.
Clear and credible plans, which continue to deliver the Quality, Innovation, Productivity and Prevention (QIPP) challenge within financial resources, in line with national requirements (including excellent outcomes) and local joint health and wellbeing strategies.
Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commissioning all the services for which they are responsible.
Collaborative arrangements for commissioning with other CCGs, local authorities and the NCB as well as the appropriate commissioning support.
Great leaders who individually and collectively can make a real difference.

CCGs have a year to complete the process, as they are expected to complete authorisation by April 2013. There may be cases were CCGs are authorised with various conditions, as the guidance says:

“If a CCG has some significant areas where it does not meet the criteria the NCB may assess the CCG needs temporary additional support to develop and deliver. The NCB sector will determine the most effective source of support which might include putting specific management support in the CCG, the option of placing a representative on the CCG governing body for oversight, and assurance or temporarily ‘junior partner’ status in collaborative commissioning arrangements may be agreed where necessary. The NCB could make full alternative arrangements for the commissioning of some services”

National director of commissioning developed at the NHS Commissioning Board, Dame Barbara Hakin spoke to GP and said that when CCGs do become fully authorised, they would enjoy various freedom, and any conditions would most likely have a time limit imposed. This could mean that neighbouring CCGs could initially commission services if that CCG had restrictions.

“CCGs are brand new organisations. We can’t be in a position where we expect them to be brilliant from day one, although they are on the right track to become really good.

“I firmly believe that you can’t run organisations from outside. If you have three CCGs in a city and have a couple of main providers, quite often this might already have begun.

“If you have a really advanced CCG and one much less able, you might see for the moment that the more mature one leads with that provider.”

She also said that it would only be in exceptional circumstances that the NCB would tell a CCG who to employ, for example, if a group of commissioners were in financial trouble.

Tasks which the CCG could undertake to help them with the authorisation process have been drawn up, including 12 examples where its intervention has improved patient services.

The draft guidance is set to be discussed at a meeting of the NCB in Leeds on 13 April 2012.

England prescription charge increased to £7.65

04/04/2012 08:54:33

04/04/12

The 25p increase to prescription charges in England, a rise of 3.4%, is the largest in the last decade.

All other devolved nations have free of charge NHS prescriptions, with Wales abolishing their charges in 2007, Northern Ireland in 2010 and Scotland last year.

Currently, all three are contemplating reinstating some form of prescription charges again. GPs in Scotland have warned of a rising workload, and Northern Ireland’s Department of Health, Social Services and Public Safety believes that the move could raise revenue and maintain services.

The BMA believe that prescription charges in England should follow suit, chair Dr Hamish Meldrum says:

“Patients with disabling long-term conditions still have to pay them despite a recent report recommending they be phased out. Most importantly, the principle of charging for prescriptions runs counter to the founding principle of an NHS that is free at the point of use.

“The BMA understands that we live in financially difficult times, but this is a tax on the sick that contributes only a modest amount to the NHS is budget and does not offset the unfair disadvantage of asking the ill to pay for their medicine.”

Free prescriptions under fire in Wales

04/04/2012 08:45:12

04/04/12

Questions have been raised about the number of free prescriptions which have been dispensed in Wales since the legislation for free medicines began in April 2007.

People in Wales now receive an average of 24 prescription items each year – and this has risen by a fifth since all charges were dropped. The overall cost of prescription medicines has risen by almost £14m since 2006.

This has led to major concerns about wasted medicines which patients no longer want or need – and these costs Wales an estimated £50m each year.

Health Minister Lesley Griffiths said:

“When we introduced free prescriptions, critics called it a gimmick.

“However, not only is the policy keeping more people healthy and out of hospital, it has had a significant effect on those whose incomes were just above the benefit level, for whom the full cost of prescriptions otherwise would have an immediate and detrimental impact on the difference between income in work and on benefits.

“By making prescription medicines available to all, we have removed this barrier to work, allowing people to manage their conditions and reducing the number of people admitted to hospital, and therefore lessening the burden on the NHS.”

However, overall in Wales the costs for prescriptions have been kept down as they have pioneered the use of generic, lower priced medicines. The Welsh government spends less on medicines than with Scottish or England governments. The average cost per item has fallen to a record low of £8.14 for Wales in 2011, compared with Westminster who spend £9.27, Scotland £10.33 and Northern Ireland £12.23.

NHS Wales 2012/13 financial challenge – even with £300m savings last year

04/04/2012 08:41:14

04/04/12

Director of the Welsh NHS Confederation, Helen Birtwhistle explains why NHS Wales has a tough year ahead when it comes to savings, despite a massive amount being saved last year.

The 2011/12 financial year was a difficult one for the NHS in Wales, with preliminary figures showing that the health boards have made savings of £300m, a big achievement for NHS staff.

The amount for the 2012/13 budget for healthcare is £6.2bn, broken down to £2,000 per head of population – the equivalent costs of one non-emergency caesarean section.

For the next three years, NHS Wales needs to make 5% savings every year. To put this into perspective, operations such as fitting a pacemaker can cost up to £10,000 – which makes maintaining strict savings very challenging.

The savings that have already been made were achieved through a range of initiatives designed to improve efficiency without compromising patient services. The health boards saved £49m by finding better ways of buying prescription medicines and £66m by joining up how stocks and equipment are ordered across different departments and organisations.

The only issue with this is that they’re one-off savings. Once the problem has been solved however, there is no more opportunity to make that saving again.

To combat this, the NHS is looking to make more fundamental changes to the way services are delivered. This means supporting patients earlier in their care pathway, preventing them from needing hospital care. At the moment, 60% of hospital bed days are taken up by patients with chronic conditions when evidence has shown many of these people could be treated closer to home.

This should increase savings as running a hospital ward in an acute hospital costs up to £1m a year – so the less people going to hospital the more savings can be made by NHS Wales.

Patients can also rest assured that everything is done with them in mind and to improve patient care - it has also been proven the patients prefer to be treated closer to home.

The advice and expertise of clinicians will be central to how Wales manages with the savings over the next 12 months, and work is continuing to gather views on how the best care can be delivered within the resources available.

Tough battle ahead for CCGs when it comes to savings

30/03/2012 01:52:33

30/03/12

It is looking increasingly likely that CCGs will be inheriting the unpleasant financial legacy from their PCT.

This comes despite a report showing that they are on track for efficiency savings worth £5.8bn in 2011/12.

A Department of Health financial report showed £3.9bn worth of savings from the QIPP scheme were reported from PCTs by the third quarter of 2011/12.

David Florey, deputy NHS chief executive said:

“The NHS has proven that it can work hard to provide the best care for patients whilst maintaining or improving quality. The results from the third quarter of 2011/12 are encouraging, and show the NHS continues to deliver the best care for patients while maintaining a healthy financial position.

“The NHS is on track to deliver its estimated efficiency savings for this financial year.”

The report showed that waiting times and patient satisfaction performance had been maintained and that “examples where transformational programmes have begun implementation with positive progress, both in terms of improved quality to the patient and provision of care at a lower cost”.

However, Dr Chaand Nagpaul, GPC negotiator has warned that the financial data should be treated with extreme caution, as no one is quite sure how QIPP had affected patient care at the moment. He believes that there should be greater efforts must be made to measure exactly how well the ‘quality’ element of the QIPP programme had been delivered.

“We are concerned CCGs should not inherit concealed expenditure. Short-term reductions in costs can be counter productive and result in increased costs in the future – it can be a false economy to make drastic cuts.”