| Medical
directors' bulletin
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
Problems accessing information
CONTENTS
Take action
1. Choice consultation
2. International consultant recruitment
3. Clinical excellence awards
4. General hospital care for older people
5. Genito-urinary medicine (GUM) development pilots
6. Women's mental health strategy
7. Repeat dispensing pathfinder sites
8. Generic medicine consultation
9. Pharmaceutical price regulation - consultation
10. Every Child Matters - consultation
11. Safety prioritisation - consultation
Recent news
12. Consultant contract - revised timetable agreed
13. New GMS contract - update
14. Violence against NHS staff
15. Calling time… Working Time Directive bulletin
16. GP recruitment
17. Communication skills
18. Beyond first registration
19. Independent treatment centres
20. Genetics training centre
21. Get the right treatment campaign 2003-2004
22. Flu immunisation campaign
23. Sexual health
24. Modernising the fabric of the NHS
25. NHS foundation trust information booklets
26. Investment in dentistry
27. Vision on
28. Neonatal intensive care
29. Management of latex allergy
30. Police protection powers
31. INVOLVE
32. New appointment
National standards and guidance
33. Judgement on R (Munjaz) v Mersey Care NHS Trust
34. Mental Health Policy Information Guide
35. National occupational standards in mental health
36. Heart failure management
37. Photodynamic therapy
38. Medicines management
Safety notices
39. Medical device alerts
40. NHS Estate notices
Diary
41. Practitioners with a Special Interest
42. System reform, choice, payment by results, NHS foundation
trusts
43. Transformation, motivation and culture change
44. Chronic disease management - applying US models
TAKE ACTION
Choice consultation
The consultation on choice, responsiveness and equity was launched
on 1 August. The consultation is supported by a resource pack.
Strategic health authorities are asked to co-ordinate the views of local
communities, including frontline staff, and provide feedback. Eight national
task groups will report by mid-November and other stakeholders are being
invited to facilitate debate amongst their members and contribute ideas.
Further information and the resource pack are at www.doh.gov.uk/choiceconsultation/
Top
International consultant recruitment
Interviews for international consultants must be held by end November
to allow them be in post by end March 2004. The deadline for registering
vacancies for NHS International Fellowship joint trust interviews in November
was 29 September. But it is still possible to arrange single trust fellowship
interviews. Further joint interviews will be held in March 2004 to fill
posts from September 2004: for these interviews, please register an interest
by 30 October.
Contact Susan.A.Smith@tmp.com
on 020 7406 5241. Vacancies can also be filled through the global or managed
placement scheme. See www.doh.gov.uk/international-recruitment
for further details.
Top
Clinical excellence awards
These sub-committees require a greater input from employers (up to
four on each sub-committee).
Employer representatives can be trust or SHA chief executives, medical
directors or HR directors. SHA chief executives have been asked to put
forward people who can subsequently be invited to sit on the new sub-committees.
For more information contact Siobhan Guascone on 020 7972 5035 or e-mail
siobhan.guascone@doh.gsi.gov.uk
Nominations should be sent by 17 October.
Top
General hospital care for older people
PCTs, working with acute trusts, are invited to bid for funding to
run projects to help implementation of the National Service Framework
for Older People's general hospital care standard. A sum of £2.8
million is available in 2004-2005 and 2005-2006 to support initiatives.
The letter, proforma and contacts are at www.doh.gov.uk/nsf/olderpeople/genhospcarestandard.htm
Further information at www.doh.gov.uk/nsf/olderpeople/news.htm
Top
Genito-urinary medicine (GUM) development pilots
Funding is available for 10 pilots to develop GUM services in areas
where there is currently limited or no provision. £1.8 million is
available from the sexual health and HIV strategy budget in this and each
of the next two financial years to fund these pilots. Strategic health
authorities are being asked to help identify those areas in the country
with the greatest need.
More at www.doh.gov.uk/sexualhealthandhiv/sexuallytransmittedinfections.htm
Top
Women's mental health strategy
The Government's campaign to remove inequalities in mental health
services now includes a strategy for women.
The new guidance recommends that primary care and mental health trusts
should appoint a senior person responsible for women's mental health who
will ensure more co-ordinated working between all services.
The statutory and voluntary sectors should also work together to ensure
there are no gaps in services for women with mental health problems.
The guidance is available at www.doh.gov.uk/mentalhealth/women.htm
Top
Repeat dispensing pathfinder sites
Regulations for the first wave of 30 pathfinder repeat dispensing
sites came into force in May. The sites have since begun to implement
these arrangements. PCTs are invited to apply to be part of the second
wave of 40 pathfinder sites. This will increase the scope of the arrangements
to include nurse and pharmacist prescribers as well as GPs.
Further details and application forms are at www.doh.gov.uk/nhsrepeatdispensing
Applications must be received by 12 November.
Top
Generic medicine consultation
The Department of Health is seeking comments on the proposed arrangements
for the long-term supply and reimbursement of generic medicines to the
NHS in primary care in England. These proposals have been widely discussed
with representatives of the manufacturers of generic medicines, wholesalers
and pharmacists. If accepted, they could replace the current maximum price
scheme which controls the prices of a range of specified generic medicines.
The discussion paper is at www.doh.gov.uk/generics/genericmedicinesconsultation2003.htm
Top
Pharmaceutical price regulation - consultation
Stakeholders are invited to comment on the future of the Pharmaceutical
Price Regulation Scheme (PPRS).
The consultation invites stakeholders to comment on rolling forward the
1999 PPRS agreement without change, potential deregulation and other suggested
alternatives.
The PPRS scheme limits the prices of branded prescription medicines to
the NHS and the existing agreement ends in September 2004.
The consultation will also consider the need to ensure patients get a
reliable supply of branded medicines to the NHS at reasonable prices and
the importance of a competitive and successful pharmaceutical industry
to the UK economy.
Consultation will run until 31 October.
The consultation is at www.doh.gov.uk/pprs/
Top
Every Child Matters - consultation
This Green Paper has been published together with a suite of documents.
These include Keeping Children Safe - the Government's Response to the
Victoria Climbié Inquiry Report and the joint chief inspectors'
report Safeguarding Children, as well as the Social Exclusion Unit's report
on the education of looked after children.
Any comments on the Green Paper should be e-mailed before 1 December to
consultation1.childrensgp@dfes.gsi.gov.uk
The documents are at www.dfes.gov.uk/everychildmatters/
Hard copies from book.orders@tso.co.uk
or by calling 0870 600 5522
Top
Safety prioritisation - consultation
The National Patient Safety Agency is consulting its stakeholders
on the process it should follow when prioritising areas of NHS care to
develop safety solutions.
The NPSA will be seeking guidance from those with an interest in patient
safety including patients, carers, voluntary organizations, health care
professionals, professional bodies, policy makers, trust boards, strategic
health authorities, local government health scrutiny committees and social
care providers.
The consultation is at www.npsa.nhs.uk/admin/publications/docs/prioritisation_consultation.pdf
More at www.npsa.nhs.uk or e-mail consultation@npsa.nhs.uk
Top
RECENT NEWS
Consultant contract - revised timetable agreed
The BMA and the Department of Health have agreed to allow a short
extension to the timetable for the consultation and BMA ballot. The date
by which consultants shall be asked whether they wish to give a commitment
to the new contract is 31 October. This change has now been reflected
in a letter from the Department of Health's director of human resources
to NHS chief executives, HR directors and medical directors which can
be found at www.doh.gov.uk/consultantframework
Top
New GMS contract - update
A package of measures, including a backdated pay deal for 2003-04,
has been agreed between the Department of Health, the NHS Confederation
and the BMA.
This represents the first wave of investment under the new GMS contract.
The Doctors and Dentists Remuneration Review Body has endorsed the new
contract agreement, including the 2003-2004 pay deal. The pay deal includes
an increase in the fee scale of 2.85 per cent which taken together with
the seniority improvements gives an overall rise of 3.225 per cent. The
increase will be available to PCTs from 27 October and will be backdated
to April.
A new UK-wide quality preparation payment will be available as a lump
sum from 20 October. This will amount to about £9,000 per average
practice based on its patient list size.
New measures to help GPs move from old buildings into modern premises
are also part of the package. GPs will be able to receive assistance to
enhance their premises including grants to meet legal and other professional
fees, revised cost rent and notional rent arrangements and grants to move
from old owner-occupied buildings. A comparable increase will be available
to PMS GPs and the money will be allocated separately to PCTs. This will
aid delivery of the Government commitment to unlock investment worth £1
billion to refurbish 3,000 GP premises and establish 500 one-stop primary
care centres by December 2004.
The announcement forms part of the unprecedented investment in primary
care of 33 per cent from £6.1 billion in 2002-2003 to £8 billion
by 2005-2006. The successful implementation of the GMS contract will enable
the profession to benefit from new flexibilities and extra investments
and patients will benefit from a wider range of high quality services.
New payments for GPs to give flu vaccinations to patients under the age
of 65, who are at risk, have also been agreed.
More at www.doh.gov.uk/gmscontract
Top
Violence against NHS staff
Greater awareness of national 'zero tolerance' policies on violence
against NHS staff is believed to have contributed to a rise in reported
cases.
Although reported levels of violence, accidents and harassment have increased
over the last year, much of this is due to improved reporting.
The 2002-2003 Survey of violence, accidents and harassment in the NHS
showed 116,000 incidents of violence in the NHS.
This was an increase of three per cent over the previous year, although
this increase was lower than the previous year's rise of 11 per cent.
The highest levels of violence per employee (34 per 1000 per month) were
recorded in mental health and community trusts, while acute trusts figures
were only six per 1000 staff per month.
More on the Government's zero tolerance scheme at www.nhs.uk/zerotolerance/intro.htm
Top
Calling time… Working Time Directive bulletin
This newsletter shares news, knowledge, findings and resources aimed at
meeting the challenges of implementing the working time directive for
junior doctors.
It is at www.modern.nhs.uk/workingtime/bulletin
Top
GP recruitment
The latest workforce census figures have revealed that NHS Plan GP numbers
rose by 293 for the period 1 April to 30 June this year. That follows
an increase of 507 between September 2002 and March 2003.
There has been a total increase of 1,535 NHS Plan GPs since 1999 against
The NHS Plan's target of having 2,000 more in post by March 2004.
At the current rate of increase that target is expected to be met by the
Department of Health.
The June census also shows The NHS Plan target for increasing the number
of GP registrars) by 550 has been achieved nine months early. The increase
is 637 since 1999.
More at www.doh.gov.uk/public/nhscensus2003.xls
Top
Communication skills
The NHS Plan stated that it will be a pre-condition of qualification
to deliver patient care in the NHS that an individual has demonstrated
competence in communication with patients.
The Kennedy report, the NHS Cancer Plan and the Health Ombudsman reinforce
the need for improved communication skills for all health and social care
staff.
A joint statement has been prepared following discussions between the
Department of Health, Universities UK, the Health Professions Council,
the General Medical Council and the Nursing and Midwifery Council. It
sets out guiding principles relating to communication skills for the commissioning
and provision of education, and the support for healthcare students at
pre-registration and undergraduate level.
The full guidance is at www.doh.gov.uk/hrinthenhs/learning/section1b/communicationskills.htm
Top
Beyond first registration
The Department of Health is to develop a shared framework to support the
learning and development of healthcare staff, following their first registration.
The contract for the work, which will take a year to complete, has now
been awarded to a partnership brought together by the University of Salford.
The partnership includes two PCTs, an acute trust, two workforce development
confederations and a postgraduate medical deanery. This work will be taken
forward in full collaboration with stakeholders. A small steering group
has been established and a much broader reference group, whose aim is
to ensure that all key interests have a direct role in shaping the framework,
is being set up.
More at www.doh.gov.uk/hrinthenhs/learning/section2a/policyareas.htm
A detailed two-way communication plan is being prepared, the central feature
of which will be a dedicated, interactive website.
Further information about communication arrangements will follow shortly.
Top
Independent treatment centres
A series of new treatment centres, separating elective from emergency
care, are to be run by the independent sector, benefiting 250,000 patients
a year.
These will all provide treatment for NHS patients, such as orthopaedic
and ophthalmology surgery - and are expected to cut waiting times dramatically.
A total of 34 new treatment centres (previously known as diagnosis and
treatment centres) will be run by the independent sector.
These will be part of a national programme, which includes 46 NHS-run
treatment centres, all of which will open by 2005. These will deliver
150,000 extra procedures a year.
The independent sector centres will handle 250,000 procedures per year
from 2005 - 135,000 will be new and 115,000 will be transferred from those
already planned by the NHS.
A shortlist of preferred companies to run the centres has been announced.
Final contract negotiations will now take place.
More at www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0337?OpenDocument
Top
Genetics training centre
Bids from universities and other organisations with a track record in
education and training are being invited to set up the new NHS Genetics
Education and Development Centre.
The centre will help train and educate staff in the latest genetic developments
to help them deliver better services to patients.
The White Paper Our inheritance, our future - realising the potential
of genetics in the NHS set out the Government's commitment to create the
centre.
The centre will act as a focus for leading edge practitioners in genetics,
stimulate good practice and help raise the profile of genetics.
The contract notice is at www.doh.gov.uk/purchasing/tenders.htm
The White Paper is at www.doh.gov.uk/genetics/whitepaper.htm
Top
Get the right treatment campaign 2003-2004
The Department of Health is again running its annual Get the Right
Treatment campaign. The aim of the campaign is to promote awareness of
the health care options available to patients. This year there will be
a focus on newer services, including NHS walk-in centres, as an alternative
to visiting GPs, A&E departments or dialling 999.
The campaign begins this month. A poster and credit card-sized concertina
leaflet, containing the campaign messages, will be distributed to staff
to help signpost people to the options available. It is hoped that staff
will support the campaign by continuing to offer guidance to the public
on the healthcare options available.
Top
Flu immunisation campaign
The campaign launches on 1 October with TV and press advertising featuring
Henry Cooper and advertising on other media such as buses, pharmacy bags
and online. New support materials and downloadable artwork are at www.doh.gov.uk/fluimmunisationcampaign2003-2004/
Top
Sexual health
The Government's response to the Health Select Committee report on sexual
health issues was published on 10 September. It announced additional investment
of £5 million in genito-urinary medicine services, £1m in
contraceptive services and £5m (in addition to the £3m previously
announced) to help NHS laboratories use more efficient methods of chlamydia
testing. The Department of Health will be seeking bids from PCT directors
of public health for the chlamydia funding. Strategic health authorities
will be given a co-ordinating role. The response is at www.doh.gov.uk/sexualhealthandhiv
Top
Modernising the fabric of the NHS
This report about investment in NHS buildings and equipment cites many
examples of how capital investment is improving the patient experience.
It is at www.nhsestates.gov.uk/news_update/index.asp
and is available on request from Danielle Holme at NHS Estates on
0113 254 7022.
Top
NHS foundation trust information booklets
A series of information booklets covering key aspects of NHS foundation
trust policy and related areas have been published. Details at www.doh.gov.uk/nhsfoundationtrusts/index.htm
where hard copies can be ordered.
Top
Investment in dentistry
NHS dentistry services are being given more than £65 million to
help update IT equipment and improve access to services.
The plan is to allocate an extra £35m to PCTs for them to improve
access, choice and quality, in areas that have problems. A further £30m
will be spent updating IT so that dentistry is fully integrated into the
national IT programme and an extra £200,000 will develop dental
leadership skills within PCTs.
Under the Health and Social Care (community health and standards) Bill,
PCTs will take over the funding and commissioning of local NHS dental
services.
The NHS Modernisation Agency is also working with 48 teams across England
to test new ways of working outlined in the bill.
Details at www.modern.nhs.uk/dentistry
Top
Vision on
People with sight problems will have faster access to services following
changes to the registration system.
New procedures will come into force from November to speed up the process
by which people who are blind or partially sighted are registered with
social services.
New methods are also being introduced to refer people who could benefit
from social services help.
The changes include a more user-friendly forms and referral letters.
More at www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0341?OpenDocument
Top
Neonatal intensive care
Additional recurrent funding (£12million this year increasing
to £20m thereafter) is being provided to PCTs to improve neonatal
care services. PCTs need to work closely with specialised commissioning
groups to take forward plans, which include increasing provision nationally
and the establishment of managed clinical networks for neonatal care.
Further good practice is at www.doh.gov.uk/nsf/neonatal.htm
A software capacity planning tool will also be available from specialised
commissioning groups.
Top
Management of latex allergy
Chief executives are being asked to ensure that their trust completes
a questionnaire on NHS services for patients and staff allergic to latex
in health care products. Latex allergy has been raised by patients as
a serious safety issue and is increasing significantly among staff.
The survey, which has been developed in consultation with the Department
of Health, comes from the National Patient Safety Agency, working in conjunction
with the Latex Allergy Support Group and the National Association of Theatre
Nurses. The questionnaire and an explanatory letter are at www.npsa.nhs.uk/latex/
Top
Police protection powers
The Home Office has revised a police circular on the use of police
protection powers. It gives more precise guidance on the Children Act
1989. For example, keeping a child in hospital if there is evidence that
he or she is at risk. The circular addresses concerns raised in the Victoria
Climbié Inquiry Report.
The circular is at www.doh.gov.uk/cebulletin/policecircular.htm
Top
INVOLVE
INVOLVE (formerly Consumers in NHS Research) promotes and supports
public involvement in NHS, public health and social care research. This
name change reflects the wider remit the Department of Health has asked
the group to cover. More at www.invo.org.uk
Top
New appointment
Professor Peter Hutton has been appointed to chair the National Clinical
Advisory Board of the National Programme for IT. He will spend two days
per week in the role which will serve to increase the involvement of clinicians
in implementing a substantial new investment in IT.
Top
NATIONAL STANDARDS AND GUIDANCE
Judgement on R (Munjaz) v Mersey Care NHS Trust
The Court of Appeal has confirmed that the Mental Health Act 1983
Code of Practice should be observed by all to whom it is addressed unless
they have good reason for departing from it in relation to an individual
patient. The Court has also made clear that good reasons for particular
departures may be identified in relation to an individual or to groups
of patients who share particular well-defined characteristics, so that
if a patient falls within that category there will be good reason for
departing from the code in his or her case. The department considers it
best practice for the reasons for any departure from the code to be
recorded. Further, it should be noted that the Mental Health Act Commission's
policy is to treat unsubstantiated departures from the code to be prima
facie evidence of poor practice.
Top
Mental Health Policy Information Guide (MHPIG)
A fidelity and flexibility paper has been developed on the MHPIG. This
is as a result of questions being raised on whether it is mandatory to
conform to the MHPIG in every detail and what scope there is for flexibility
given that the MHPIG talks about tailoring services to local needs. The
paper outlines the agreed criteria on these issues following consultation
with strategic health authority mental health leads and CHI.
More at www.nimhe.org.uk/networks/shamh.asp
Top
National occupational standards in mental health
These standards are now available at www.nimhe.org.uk/priorities/workforce.asp
Top
Heart failure management
NICE has issued a guideline on the management of chronic heart failure
in adults in primary and secondary care at www.nice.org.uk
The Department of Health has published a toolkit to help the NHS implement
the heart failure standards in the National Service Framework for Coronary
Heart Disease as well as the Planning and Priorities Framework heart failure
target and the NICE heart failure guideline.
More at www.doh.gov.uk/heart/heartfailure
Top
Photodynamic therapy
NICE has issued guidance on photodynamic therapy for age-related macular
degeneration. The guidance is at www.nice.org.uk/cat.asp?c=86772
and the management guidance on the implementation process is at
www.doh.gov.uk/ophthalmicservices/photodynamictherapy.htm
Top
Medicines management
The Medicines Management Framework was launched on 17 September. Trust
chief executives are responsible for the systems for management of medicines
within their organisations and related health economy.
Medicines expenditure in England has risen to over £8 billion with
just over £1.7 billion spent on medicines in hospital in 2001-2002.
Strategic health authorities will be establishing review groups, led by
directors of performance management, to analyse trust returns and ensure
remedial local arrangements are in place ahead of value for money audits
which are expected to be undertaken by the Commission for Healthcare Audit
and Inspection in 2005.
The framework is at www.doh.gov.uk/hospitalmedsmanframework
Top
SAFETY NOTICES
Medical device alerts
MDA/2003/027 - Marshall Products Ltd, Laryngeal Airway Device (LAD)
MDA/2003/028 - CYPHERTM Sirolimus-eluting Coronary Stent.
MDA/2003/029 - bath and shower seating equipment.
MDA/2003/030 - Roche Diagnostics Ltd, CoaguChek PT test strips (12strip
pack), Catalogue number: 1937634-190, lot number: 583
MDA/2003/031 - Ulti-Mate and essential wheelchair seat cushions manufactured
by Invacare
More at www.mhra.gov.uk
NHS Estates notices
The following hazard notice has been issued by NHS Estates:
High voltage 11kV switch (Long and Crawford Type J3 and J4). Risk - unable
to switch "OFF". Hazard Notice - NHSE HN (2003) 05. Issued 10
September 2003
High voltage 11kV switch type (Rayrolle OKSS, ROKSS and ROSS RMU). Risk
- failure of 11kV supply. Hazard Notice - NHSE HN (2003) 06. This notice
was issued on 15 September.
Further information at nhsestates@doh.gsi.gov.uk
Top
DIARY
Practitioners with a Special Interest
The Practitioners with a Special Interest event is sponsored by the
National Primary and Care Trust Development Programme (NatPaCT).
It is also endorsed by the Royal College of General Practitioners, the
Royal College of Nursing and the Allied Health Professionals Forum.
The aim of the conference is to:
- equip managers and practitioners to put policy into practice.
- challenge and inspire practitioners to improve the patient experience,
and to provide better services
- offer practical advice on how redesigned services can be set up
- help achieve targets.
The event to be held on 6 November in London is open to doctors, nurses,
allied health professionals, chief executives, directors and managers
in finance, commissioning, modernisation, service development within strategic
health authorities, primary and secondary care trusts.
For further details on this event and to book a place go to www.natpact.nhs.uk/events
Top
System reform, choice, payment by results, NHS foundation
trusts
Events in these four areas are being held for all PCTs and strategic
health authority colleagues.
They will be held on: 20 October - London; 21 October - Bristol; 23 October
- Leeds; 28 October - Birmingham. Further information at www.doh.gov.uk/cebulletin/systemreformevents.htm
Top
Transformation, motivation and culture change
Places are still available for the 4th Chief Executives Leadership
Lesson on 4 November in London. E-mail Kate Oldershaw on ko@wig.co.uk
or call 020 7222 1166.
Top
Chronic disease management - applying US models
Learning from Kaiser -- first chance to hear nine PCTs' experience of
applying US models to chronic disease management, with impacts on acute
and social care, 4 November, London. More details and online booking at
www.natpact.nhs.uk/events/d_view.php
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