| Introduction
I have been
appointed editor of this monthly bulletin and one of my first
tasks is to welcome John Hutton to his new post as Minister of
State for Health. Mr Hutton has specific responsibility for primary
care and feels, as I do, that this bulletin should in future be
formatted differently and contain contributions from GPs and our
primary care colleagues involved in developing improvements in
care for our patients, include feedback from my meetings with
clinical colleagues on my travels, and continue to provide you
with information from the Department.
I am very
willing to visit, listen, discuss and, where requested, advise
on current "hot" issues with groups of GPs and your fellow workers.
I would like to cover key issues like access and managing demand
in this bulletin, along with other topics raised by yourselves.
I cannot personally reply to all comments but hope to respond
in future editions.
I am still
a GP in a busy practice and understand the need to meet patients'
expectations of us as described in the NHS Plan, but equally recognise
the enormous pressures on you and your colleagues.
I still love
being a GP and am extremely content that primary care continues
at the centre of the Government's plans for the NHS, and that
the practice is the key unit for the delivery of primary care.
The importance of general practice has been emphasised by Ministers;
legal powers have been passed by Parliament to ensure the primacy
of primary care and the devolution of decision making to PCTs
means that far greater control is in the hands of frontline primary
care professionals.
There is still
a lot to address, and one of the highlights of last month was
the meeting between the Department, various GP leaders and colleagues
from management and nursing to discuss the shape of a new GP contract.
Mr Hutton took the opportunity early in his new job to meet the
participants. We all know of your strong feelings on many issues,
so please use this bulletin and myself to continue dialogue.
Dr
David Colin-Thome
Clinical Director of Primary Care
Department of Health
 Top
Shifting
the Balance of Power in the NHS
The past few
months have seen some major developments in the NHS. At the heart
of these is the commitment to devolve power to frontline NHS staff.
Some of the key messages for Primary Care were strongly put in
Alan Milburn's speech last month to the British Association of
Medical Managers:
- GPs and
other staff are doing a good job under real pressure.
- The priority
has to be to increase the number of GPs as fast as possible
alongside expansion in nursing and other primary care professions
- It has
to be about getting extra investment directly to the frontline
in primary care both to improve services for patients and to
relieve pressures on staff.
- By 2004
PCTs will control 75% of NHS resources.
- By 2004
two-thirds of existing health authorities will have been abolished.
- The NHS
regional offices will also have been abolished to devolve power
to frontline NHS services.
- Within
the next two years cash will no longer be allocated for local
health services to health authorities. Instead it will be allocated
directly to local primary care trusts so that they can decide
how to commission services for the local communities they serve.
- A reformed
Department of Health will provide the resources, setting the
standards and holding the system to account.
- Every member
of NHS staff will have the opportunity to contribute to the
programme of NHS reform through local modernisation reviews
this summer, culminating in local three year action plans that
set out the changes and investment required to deliver the NHS
Plan.
Top
New
contract
Representatives
from key stakeholder groups including the GPC, the RCGP, the NAPC
and the NHS Alliance and Department officials recently took part
in a seminar to gather ideas about the new contract. The new minister,
John Hutton, re-emphasised the commitment made by his predecessor,
John Denham to make progress on this important work. He has invited
Dr. John Chisholm, Chairman of the GPC, to a meeting to discuss
issues of concern to GPs.
The atmosphere
of the day was both positive and constructive and the themes which
emerged will inform further discussions with the profession. Professor
Martin Roland, Director of the National Primary Care Research
and Development Centre, introduced the seminar with a thought-provoking
presentation about the past, present and most importantly the
future of the contract. After the day, he commented, "There is
a great deal of common ground between what the profession and
the Government are trying to achieve. I hope the obvious differences
won't obscure the fact that there is an awful lot in common".
Top
GP
workload survey
Increasing
workload has often been raised by GPs as a serious issue. To help
address workload issues, and to inform discussions around developing
a new GP contract, the Department of Health has formally suggested
carrying out a joint survey of GP workload. The survey would be
both quantitative and qualitative, taking account of complexity
as well as volume. Further details will be given in future editions.
Top
Fourth
wave of PMS pilots announced to begin in 2002
The fourth
wave of Personal Medical Services (PMS) contract pilots was formally
announced last month.
Health Minister
John Hutton said: "The 4th wave of PMS pilots will build on the
success of the first three waves and help make the transition
to PMS as straightforward as possible. At the same time we need
to ensure that existing pilots have effective ongoing support
and information so that they can continue to improve front line
primary care services. That is why we are appointing 20 new "PMS
facilitators" to give advice and support to PMS pilots, backed
up by a helpline and a website as part of a "PMS Development
Programme".
"By introducing
the Development Programme and the "facilitators", we want to make
it even easier for GPs to work under PMS. That will mean more
GPs and nurses working in deprived and under-doctored areas to
the benefit of the local population whose patients' needs are
often so much greater."
The PMS Development
Programme, announced in the last edition of the Bulletin, will
also:
- Provide
support and information for those wanting to apply to become
pilots
- Run PMS
seminars which have proved to be very helpful to regional PMS
teams
- Ensure
that there is consistent understanding of the key elements of
primary care funding at all levels
- Devolve
parts of the application process to health authorities from
regional NHS offices to speed up the process and focus further
on the local health agenda.
The White
Rose Surgery, South Elmsall in Wakefield is a PMS pilot that has
been operating since the second wave. The pilot has used the PMS
opportunity to widen the scope of primary care activity to include
services traditionally offered by secondary care, resulting in
a reduction in waiting times for ALL patients. The pilot is now
able to respond and target services more effectively to the needs
of the local population. There has also been a 50% reduction in
numbers attending local casualty units.
If you or
your practice is considering entering PMS, please inform your
health authority of your interest and the type of pilot you are
seeking to establish as soon as possible.
Further information
is available at www.doh.gov.uk/pricare.
Top
Health
and Social Care Act
The Health
and Social Care Act received Royal Assent on May 11 2001. Designed
to support the NHS Plan and the Government's response to the Royal
Commission on long-term care, the act is wide-ranging. Many of
its final provisions will have an impact on general practice.
These are:
- new powers
to establish NHS LIFT to improve primary care premises
- the introduction
of a new formula for allocating resources to ensure HAs have
the resources appropriate to primary care needs, including GP
numbers in their area.
- a new requirement
for HAs to register all GPs (including deputies, locums and
those performing PMS) in their area
- new powers
for HAs to refuse admission to a list, and to suspend or remove
dangerous, fraudulent or unsuitable doctors quickly based on
local knowledge
- a reconstituted
FHSAA as a fully independent appeal body, providing a right
of appeal for practitioners against HA decisions to remove or
exclude them from lists
- extension
of these new arrangements for doctors to all the other family
health service practitioners (pharmacists, dentists and opticians,
their deputies, locums and employees of corporate bodies) to
ensure the same standards are applied to all professional groups
- removal
of obstacles to the development of a new national contract for
GPs, based on quality of care rather than patient numbers
- a requirement
for all GP out of hours services to be accredited by Health
Authorities
Other aspects
of the Act relating to both the NHS and social care will also
be of interest to general practice. The NHS provisions include:
- the introduction
of Local Pharmaceutical Services (PMS type arrangements for
pharmaceutical services) to encourage innovative new ways of
contracting for pharmacy services and the provision of pharmaceutical
services by remote means
- enabling
the extension of prescribing rights to registered health professionals
beyond doctors and nurses, as recommended by the Review of Prescribing,
Supply and Administration of Medicines in March 1999
- enabling
PCTs and local authorities to apply jointly to become a Care
Trust, to facilitate closer integration between health and social
services, as well as allowing the Secretary of State to compel
local partners into joint working through the use of the 1999
Health Act flexibilities (pooled budgets, etc.)
- enabling
the payment of extra cash bonuses for the best performing NHS
organisations (part of the new Performance Fund arrangements)
- clarifying
the legal position with regard to flow of patient information
in prescribed circumstances to enable, for example, the continued
operation of services such as cancer registries, which rely
on patient identifiable information.
The new provisions
linked to social care include:
- the introduction
of free nursing care in every setting
- the ability
for English and Welsh local authorities to place people in residential
care in Scotland and Northern Ireland
- a new deferred
payments scheme so that contributions are not sought whilst
residents are in a residential care home, but are recovered
as a charge against their estate.
Some of the
initial proposals on public involvement in the NHS were lost as
agreement could not be secured in the House of Lords within the
time available. This included the move to replace community health
councils (CHCs) with patients' forums and patients' councils.
In another
move to empower patients, independent advocacy services will be
provided to help anyone with a complaint about the NHS which cannot
be dealt with locally. A new duty has also been placed on the
NHS to involve and consult the public when decisions are being
made about changes in the way services are provided.
A new Bill
was announced in the Queen's speech on 20 June, which will further
enhance devolution of power to frontline staff.
Copies of
the Health and Social Care Act are available from The Stationery
Office (0870 600 5522) or it can be downloaded from the HMSO
website.
Top
NHS
LIFT workshops
A series of
workshops on NHS LIFT (Local Improvement Finance Trust), the new
public-private partnership to improve primary care premises, will
take place in July. The venues are:
| Bristol |
Tuesday
July 10 |
| Leeds |
Tuesday
July 17 |
| London |
Tuesday
July 24 |
| Manchester |
Thursday
July 26 |
The all-day
workshops will cover the following topics:
- LIFT plc;
- Creating
a strategic service development plan;
- Learning
from the Newcastle and North Tyneside experience;
- Delivering
the NHS Plan's access targets;
- Stakeholder
involvement and decision-making;
- Submission
and approval process.
If you are
interested in attending, please contact Richard Tybinski for more
information and a booking form:
tel 01423 857209, email rtybinski@nhsestates.gov.uk
For more information
on NHS LIFT, see www.doh.gov.uk/pfi/nhslift.htm
Top
Cutting
bureaucracy in Primary Care
In "Making
a difference: Reducing GP paperwork", a number of bureaucratic
procedures were recommended for removal from normal GP workload.
In the medical
press, the spotlight has been on the removal of the requirement
to sign driving licence or passport applications but inroads have
been made into other bureaucratic procedures, with immediate effect.
For example,
where appropriate GPs may now delegate the task of checking screening
lists and immunisation returns. It is important, though, that
practices check screening lists carefully to filter out those
patients for whom an invitation to screening would be potentially
distressing (for example, a woman who has had a double mastectomy
or who has had her cervix removed).
Top
Amendment
to the Red Book
Amendment
23 to the Statement of Fees and Allowances (the Red Book) has
been made and is available on the NHS Responseline (08701 555
455). The website version will be available shortly on www.nhs.uk/redbook.
Practice managers
should make a bulk order for their practice from the NHS Responseline.
Top
Mental
health information strategy
The Department
of Health has issued a new strategy aimed at underpinning the
delivery of first-class mental health care through electronic
information.
By creating
systems that reach across organisational boundaries, the strategy
aims to surmount the current problems that arise in recording
and accessing information. Key goals include:
- Helping
service users to take an active role in their care
- Supporting
professionals with appropriate and constantly-available information
- Providing
an up-to-date evidence base, through the National Electronic
Library for Mental Health
- Providing
quality and management information that will enable professionals
to be involved in planning and monitoring services
Further information
and the full strategy document are available at www.doh.gov.uk/nhsexipu/strategy/nsf/2.htm
Top
Informed
Choice Project for PSA testing
A consultation
exercise is now underway to assess the usefulness of leaflets
on PSA testing for asymptomatic men. These materials have been
developed as part of the Informed Choice Programme announced last
September in the NHS Prostate Cancer Programme, and are available
on the National electronic Library for Health website. The address
is: www.nelh.nhs.uk/psatesting/.
They have
been developed in recognition of the fact that more men are becoming
aware of prostate cancer and are increasingly requesting PSA tests.
Evidence has
shown that if men who have no symptoms of prostatic disease are
given full information about the implications of the PSA test
they are less likely to want to go ahead with it. Any man over
50 approaching his GP requesting a PSA test should be offered
the leaflets. He can then use the information to decide on whether
to go ahead and have the PSA test, which the GP will be able to
offer.
GPs and patient
focus groups have been involved in developing the leaflets which
fully explain the details of the test, setting out its benefits
and drawbacks. The leaflets explain what happens if the PSA level
is high, what this might signify and the other tests that need
to be undertaken in order to confirm a prostate cancer diagnosis.
It also sets out the risks from these tests and any subsequent
treatment. Also included on the site will be educational material
for GPs and Frequently Asked Questions.
Over the next
six months GPs and the general public will be able to access these
leaflets. Feedback on their usefulness and the impact they have
on the general level of requests for PSA tests from men are particularly
welcomed. There will be a message box for comments from users
and any suggestions for improvements necessary for a final version
to be published next year.
Top
Help
for rural distress
RuralMinds,
an independent initiative of the mental health charity MIND, has
produced a factsheet for people feeling distressed as a result
of the foot-and-mouth disease outbreak.
The foot-and-mouth
"first aid kit" (a single A4-sized sheet) provides information
on emotional support and practical help available to members of
the public. A Welsh language version is available.
Copies may
be obtained free, in any quantity required, for GPs willing to
make them available to patients, from RuralMinds. Tel 024 7641
4366; fax 024 7641 4369; email ruralminds@ruralnet.org.uk
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