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Medical directors' bulletin: July 2002, Issue 13 Welcome to the latest e-bulletin for medical directors. It aims to provide a practical summary of NHS developments, with access points for further information. Please tell us of any improvements you'd like to see. Please send feedback to jeffrey.graham@doh.gsi.gov.uk Contents N.B. Items marked * have not previously appeared in other Department of Health bulletins. Guest editorial by national director for mental health, Louis Appleby* Staff issues:
Consultative documents:
For information:
Progress in mental health modernisationGuest editorial by national director for mental health, Louis Appleby It is now two years since I took up post. We still have a long way to go to modernise our mental health services, but a great deal has been achieved. We have in place:
We have reached some major milestones:
A great deal of work is under way to secure the properly trained mental health workforce we need. A specially established group has been instrumental in the following work in progress:
Work is under way to recruit through the global recruitment campaign and the International Fellowship Scheme. www.doh.gov.uk/international-recruitment From 2003, we aim to introduce outcome measures. We will be measuring the impact of our services for patients in four key areas: mortality, morbidity, quality of life, and user and carer satisfaction with services. Pilot projects are being set up. When the scheme is implemented nationally, the information collected will provide valuable feedback and learning at both national and local levels. The scheme is revolutionary in that it will involve a measure of the patient's judgment of the benefit of services received. I am aware that some professionals will have concerns about this, but when viewed positively, it can be supportive to patients and professionals alike: allowing patients the benefits of greater involvement in their own treatment and bringing greater job satisfaction to the professional. Finally, I appreciate that those in the field are working in very difficult and challenging times. I very much value your support. I aim to visit some of the new mental health services over the coming year. I would welcome the opportunity to meet you then and to discuss any concerns with you and your colleagues. Implementation of a new consultant contract will start from April 2003. This follows last month's announcement by the UK health departments, the NHS Confederation and the British Medical Association of an agreed framework for the contract. The new framework is designed to provide a more effective system of planning and timetabling consultants' duties and activities within the NHS. It achieves the NHS Plan objective to secure a higher quantity of direct clinical care from newly-qualified consultants, and commitment of their maximum allowable working time to the NHS during their first seven years. Key elements of the new contract are:
To promote stability in the transitional period, the new contract will be accompanied by a pay deal of 10 per cent over the three years from April 2003. The full text of the framework is at www.doh.gov.uk/consultantscontract. Enquiries may be directed to the Department of Health's NHS pay unit by e-mail to enquiry-box@doh.gsi.gov.uk or tel (0113) 254 5710. Excessive hours worked by junior doctors has been a cause for concern for some years. Aware of concern in the NHS about how to design services and posts for compliance with the working time directive, the Department of Health is talking to the NHS about how to help trusts achieve solutions that enhance rather than diminish services. Further information on the working time directive, as well as a table with key dates, are available at www.doh.gov.uk/workingtime. Further information from Shain Clarke, e-mail Shain.Clarke@doh.gsi.gov.uk. Specialist registrar increases: new flexibilities New flexibilities have been agreed which allow NHS trusts to recruit additional specialist registrars and to increase the pace of specialist registrar expansion. Central funding is being distributed to support this. For each specialty, a 'floor' and a 'ceiling' have been set. The 'floor' is the minimum number of specialist registrars to be implemented by deans and workforce development confederations. The 'ceiling' is the maximum number of specialist registrars that can be appointed, if additional funding can be identified. Trusts are now allowed to fund additional specialist registrars up to the ceiling in each specialty, by remapping funding for the post into the central multi-professional education and training levy. This will be led locally by postgraduate deans.
This is a new flexibility which provides significantly more freedom for trusts to recruit the specialist registrar workforce they need. The first round of bids for additional posts should reach lead deans by 15 September 2002. Decisions on which bids will be supported will be made by 1 November. Further information from Anna Robinson, tel 0113 254 5783, or Liz Scott, tel 0113 254 5867. Pre and post appointment checks for all NHS staff Recent cases have highlighted the need to strengthen recruitment and retention procedures in the NHS. A new circular on this subject is intended to supplement the checks and enquiries that NHS bodies are required to carry out by law, both before and after appointment. Reform of the General Medical Council Regular revalidation for all practising doctors in the UK is one of the proposed changes in a consultation document published by the government on reform of the General Medical Council (GMC). Every five years, each practising doctor will have to submit evidence to the GMC that their practice is up to date and in line with GMC standards. Also proposed are changes to fitness to practise procedures to help speed up and simplify the process, and changes to GMC governance arrangements relating to the size, structure and composition of the council. The Government's commitment to reform the GMC was included in the NHS Plan. The aim of reform for all the regulatory bodies is that they should be faster, streamlined and more transparent with much greater public and patient involvement. The consultation document is at www.doh.uk/gmcreform.htm. Modernising pathology services The Department of Health published draft guidance for the NHS on modernising pathology services on 20 June. The consultation runs till 30 September. The key change proposed is that NHS pathology services should be delivered through larger networks, managed by a lead trust on behalf of all the trusts involved. The draft also covers good practice guidance on issues such as standardisation, the pathology workforce and technology. The draft guidance is at www.doh.gov.uk/pathologymodernisation/essentserv.htm. For further information, contact Deirdre Feehan on 020 7972 4789 or Paul Clegg on 020 7972 4302, or write to the Pathology Modernisation Team, Department of Health, 423 Wellington House, 133-155 Waterloo Road, London SE1 8UG. HIV-infected healthcare workers Revised guidance has been issued for consultation on the management of HIV-infected healthcare workers and patient notification. Under the guidance, it will no longer be necessary to notify every patient who has undergone an exposure-prone procedure by an infected health care worker, because of the low risk of transmission and the anxiety caused to patients and the wider public. The decision on whether to carry out a patient notification exercise will be assessed on a case-by-case basis using a criteria-based risk assessment framework. The closing date for comments is 18 October. The consultation letter and guidance are at www.doh.gov.uk/aids.htm. Hard copies may be requested from the NHS Responseline on 08701 555455. Further information from Ruth Hickson, tel 020 7972 6506, e-mail ruth.hickson@doh.gsi.gov.uk. Commissioning arrangements for specialised services Earlier this year health minister John Hutton announced a review into commissioning arrangements for specialised services. The review will recommend a framework to ensure effective commissioning and provision of specialised services in line with the principles of Shifting the Balance of Power. In particular, the review is canvassing views on how to integrate the current eight regional specialised commissioning group (RSCG) arrangements with the four health and social care regional boundaries, to ensure that highly specialised services covering large geographical areas are properly planned, funded and monitored. RSCGs are being asked to seek the views of their local providers, commissioners and patients' and carers' representatives on the review questions, and submit their overall response to the Department of Health by 30 September. Further details are at www.doh.gov.uk/commissioning/reviewintocommarr.htm. Further information from Julia Stallibrass, e-mail julia.stallibrass@doh.gsi.gov.uk. Guidance on working with young disabled children A new consultation document offers guidance for professionals working with disabled children aged up to two and their families. Together from the start was developed by a multi-agency working party, and jointly issued by the Department for Health and the Department for Education and Skills. The central themes are:
The consultation runs to 23 September and responses can be made online. See www.dfes.gov.uk/consultations/active/index.cfm?CONID=177 or obtain a copy from DFES Publications, PO Box 5050, Sherwood Park, Annesley, Nottingham NG15 ODJ (ref DFES 0184/2002). Patient and public involvement The new national Commission for Patient and Public Involvement in Health (CPPIH) will be established in January next year. Its role will be:
Forums in every NHS trust and PCT will monitor and review local health services and make reports and recommendations to local trusts. They will be able to inspect all health services - whether provided within NHS facilities or through contracts with the private sector. A member of each forum will have a place on trust boards. The timetable for implementation is currently being finalised. Further details will be available shortly. Extending choice for heart surgery patients National director for heart disease Dr Roger Boyle has written to the directors of health and social care to update them on various aspects of the scheme to extend choice for heart surgery patients, which began on 1 July. The letter includes information on:
The letter is at www.doh.gov.uk/extendingchoice New guidance has been issued on better blood transfusion and the appropriate use of blood. The aim is to make blood transfusion safer, avoid unnecessary use of blood, and provide better information to patients and the public about transfusion. The guidance is in circular HSC 2002/009. A toolkit is being developed to help trusts implement the guidance. Further information from Amal Rushdy, tel 020 7972 5376 or e-mail Amal.Rushdy@doh.gsi.gov.uk. Delivering the NHS Plan with IT The government's national programme for information technology in the health service will significantly affect how the NHS implements IT and at what pace. Key elements of the programme are:
The strategy is at www.doh.gov.uk/ipu/whatnew/deliveringit. Further information from Stan Lajca at stan.lajca@doh.gsi.gov.uk. Local action is needed if intermediate care is to realise its potential to transform service delivery and the experiences of service users. That is one of the conclusions of a recently-published review of progress in intermediate care. The review concludes that intermediate care is central to the modernisation agenda and has made significant progress, but must develop further. The review and an executive summary can be seen at www.doh.gov.uk/intermediatecare/icmovingforward.htm. For further information contact Gareth Jones, e-mail Gareth.H.Jones@doh.gsi.gov.uk. Tackling violence against NHS staff Updated guidance will be issued to NHS managers this month, introducing a greater emphasis on liaising with the police to tackle violence against staff. It will also ask trusts to consider with their lawyers the need, where appropriate, to support a prosecution against an individual in cases where the Crown Prosecution Service decides not do so. Director of human resources at the Department of Health, Andrew Foster, has asked all trusts to:
Copy of the letter from Andrew Foster For further information contact Meena Paterson, tel 0113 254 5758 or e-mail meena.paterson@doh.gsi.gov.uk. The Department of Health has published the implementation action plan for the national sexual health and HIV strategy. This follows the consultation exercise undertaken on the strategy last year. See www.doh.gov.uk/sexualhealthandhiv. Hepatitis B vaccine is being made available to genito-urinary medicine clinics in 2002/2003 to 2004/2005, as part of implementation of the sexual health and HIV strategy. The strategy proposes improving the uptake of hepatitis B immunisation by homosexual and bisexual men, who are at increased risk of infection. Vaccine distribution details are at www.doh.gov.uk/hepatitisb/extravaccine.htm. Further information from Helen Christmas, tel 020 7972 6061 or e-mail Helen.Christmas@doh.gsi.gov.uk. Thirty pathfinder sites for repeat dispensing schemes will be in place this autumn. The NHS Plan announced the development of a repeat dispensing scheme nationwide by 2004. The scheme will make it easier for patients with chronic conditions to get repeat prescriptions, speeding up services and relieving pressure on GP surgeries. Details of the scheme are at www.doh.gov.uk/nhsrepeatdispensing. Further information from the Department of Health's principal pharmaceutical officer, Susan Grieve, at susan.grieve@doh.gsi.gov.uk. Audit Commission data quality reviews Data quality reviews are currently being carried out by the Audit Commission. A letter explaining the powers of the auditors appointed under the Audit Commission Act 1998 regarding access to patient information is available at www.doh.gov.uk/ipu/confiden/audit/auditcom.pdf. Further information from Raj Kaur, e-mail rajbant.kaur@doh.gsi.gov.uk. National Service Frameworks and the pharmaceutical industry A note setting out how the pharmaceutical industry can be involved in the development and implementation of National Service Frameworks is at www.doh.gov.uk/nsf/pharmaceutical.htm. Further information from Liz Baldock, e-mail liz.baldock@doh.gsi.gov.uk. Appropriate use of ambulance services Guidance has been produced for ambulance trusts to follow in collaboration with local partners to handle hoax 999 calls, inappropriate calls and calls from frequent callers and locations. See www.doh.gov.uk/ambulanceservice. Mental health advocacy services Mental health service users who are subject to compulsory powers will have access to independent specialist advocacy services, under the draft Mental Health Bill published last month. Independent Specialist Advocacy in England and Wales: Recommendations for Good Practice recommends clear boundaries for these advocacy services. It also recommends a code of practice and the establishment of core standards. The report is at www.doh.gov.uk/mentalhealth/advocacy. Mental health second opinion procedure The Mental Health Act Commission has issued guidance on new legal duties of responsible medical officers in relation to second opinions under the Mental Health Act 1983. The duties relate to offering patients access to information provided by second opinion appointed doctors (SOADs). The Commission has also issued guidance to SOADs. Both documents are at http://www.mhac.trent.nhs.uk/publications.htm. Further details from Mat Kinton at kintonm@mhac.trent.nhs.uk. The NHS Modernisation Agency has launched new guidance to help trusts reduce cancelled operations and achieve their waiting and booking targets. The step guide to improving operating theatre performance includes four diagnostic toolkits that can be used to identify and analyse areas for improvement. A copy is being sent to all NHS trusts. The guide is also available at www.modern.nhs.uk/theatreprogramme. The Department of Health has reminded all primary care trusts about the local options available for the supply of gluten-free foods. This follows the Cabinet Office report, Making a difference: reducing GP paperwork, which recommended that GPs should no longer have to issue repeat prescriptions for gluten-free food. Health Service Ombudsman reports The Health Service Ombudsman has published his Annual Report for 2001/2002 and his latest report on completed investigations, covering the period December 2001 to March 2002. Both reports are available at www.ombudsman.org.uk. New arrangements between the EU and Switzerland A new healthcare agreement between the EU and Switzerland came into force on 1 June. The following people are now entitled to immediately necessary treatment on the NHS when visiting the UK if they fall ill or have an accident:
Similarly, visitors to Switzerland from the UK may now access reduced-cost immediately necessary treatment there (with a form E111) or be referred for specific treatment (with form E112). For further information, see www.doh.gov.uk/international/switzland.htm or email international@doh.gsi.gov.uk. Merger of Medicines Control Agency and Medical Devices Agency The Medicines Control Agency and the Medical Devices Agency are to become a single agency from 1 April 2003. The new body will remain an executive agency of the Department of Health, and will continue all the functions currently carried out by the two agencies. As plans proceed, there will be discussions with all stakeholders, including those in the NHS. The following safety and hazard notices and device alerts have recently been issued by the Medical Devices Agency:
Full details at www.medical-devices.gov.uk.
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