NAPC Bulletin 1 May 2012

Message From NAPC Chairman

‘Stay on target’, says Dr Charles Alessi, Chairman of NAPC.

‘We are at a stage in the reforms, where we need to keep our nerve and remain focused.  Transitions are not always the smoothest periods and it is likely we will encounter some obstqckesl and some unforeseen problems.

The environment we are in is changing fast.  The power and control, which was held by the clusters and the strategic health authorities is starting to fade and is being replaced by the new CCGs.  It may not feel like this everywhere throughout the country, but the tide is turning and turning fast.

The Mandate that is set to govern how the National Commissioning Board will conduct itself is to be consulted upon shortly.  We have been very active in lobbying to ensure that CCGs have the assumed autonomy they need and have been encouraged by the letter sent to the Chairman of the Board and by his comments at our conference last week.  We need to remain vigilant and ensure we maintain the direction of travel signalled, not reign back to the ways of old.

What is really important now is for us to connect with other practices within our CCG and ensure we build relationships and start to delineate how we will work together to deliver the best care we can afford within the budgets we have.  It is also important to start to move away from the polarised environment we have got used to with our colleagues in secondary care.  They also have a part to play in managing the care of our population and need to feel welcomed and relevant.  We must be very careful to ensure the new CCGs do not lose contact with their constituent practices and resist a culture of telling them what to do.  This recreation of past behaviours is something we all need to watch if we are going to be successful.  We are not going through all this change merely to recreate old behaviours.

What about our relationships with the outposts of the National Commissioning Board?  I would suggest that we will have a new relationship with them which will be more adult and also very different.  It is likely that there will be substantially fewer than fifty of these throughout England and thus the relationships are bound to be different and significantly different to what we have become used to.

We are also seeing some encouraging signs in the new Commissioning Support Organisations.  They are starting to understand that the customer is the CCG, not the cluster and also they are starting to offer a more bespoke service, which is sensitive to the needs of the CCG.

We are here to represent you and to champion your interests.  To do this, we need to know what is going well and also what is going wrong to enable us to make representations on your behalf.  Please keep in touch with us and call NAPC’s office on 020 7636 7228 or email either Maggie Marum at This e-mail address is being protected from spambots. You need JavaScript enabled to view it. or me directly at This e-mail address is being protected from spambots. You need JavaScript enabled to view it. .

There is a scene in the movie, Star Wars, where Luke Skywalker is attacking the Death Star.  He succeeds because he keeps on target despite all the noise and confusion surrounding him.  The CCGs must also remember what their function is and keep going in the right direction.  By working and learning together, we have a far greater chance of making this transition less difficult and more comfortable.

Strong Light May Reduce Damage Of Heart Attack

Heart attack patients are less likely to suffer permanent damage if they are exposed to daylight in hospital, research has suggested.

Researchers think that strong light could reduce the risk of permanent damage after a heart attack, or even prevent one, possibly due to the body’s circadian rhythm, which is linked to light.  The same proteins that regulate the body clock are found in the heart and a team at the University of Colorado found that one of these proteins, called Period 2, played a vital role in fending off damage.

NHSE Seeks Change To Pay Rise Rules

NHS Employers has launched another bid to reduce the impact of incremental pay rises awarded under Agenda for Change, it has been reported.

Details of the changes employers may want to make to the Agenda for Change pay framework were given by Unison’s head of health, Christina McAnea at the union’s health conference in Brighton.

According to Ms McAnea, under the draft plans, a ceiling would be put in place beyond which incremental pay rises would always be discretionary, based on performance.  Automatic incremental pay rises would be abolished completely for Band 5 nurses in their two years after qualifying.  Meanwhile, employers want to see an end to enhanced payments, for instance for working anti-social hours, to staff on sick leave.

Incremental pay rises in the NHS average 2.5 per cent.  Health service deputy chief executive, David Flory, previously has said the issue could leave the NHS broke, if it was not tackled.

In a statement to the press, Dean Royles, Director of NHS Employers, said: ‘All pay systems develop over time and we hope that by engaging early we can do things that refine rather than lead to a radical overhaul.  Without mature national discussion the local appetite for radical change will accelerate.

Trusts already have the ability to used performance to decide whether to approve incremental pay rises, but many trusts lack the human resource capacity or knowledge to do this routinely.

Poor Data Used To Protect Income Claim

Potential falls in income resulting from correcting the way the NHS classifies patients have led it to maintain ‘inaccurate recording and inaccurate payments’, the Audit Commission has reported.

Health service resistance to amending inconsistencies in its classification of short-stay hospital patients is causing wasteful disputes between commissioners and providers, the Commission found.  It warned that the resulting poor quality of NHS datasets would undermine clinical research, the planning and monitoring of healthcare, and the patient choice principles underpinning government health reforms.

The central issue revolves around how to classify patients treated in hospital for less than 24 hours, work which accounts for £6.8bn of the £29bn a year paid out under payment by results. The Commission gave the example of an 18 year old having a lesion removed from his ear under local anaesthetic and recovering in a lounge.  In one trust he could be classified as an admitted day-case, earning the trust £729; in a neighbouring trust he could be recorded as an outpatient, earning just £116.

The auditors found wide variation in how trusts categorised admissions.  In obstetrics, for example, this led to income variations of £6m above or below expected levels for individual trusts.  The NHS has attributed these inconsistencies to poor national guidance from the Department of Health and NHS Connecting for Health.

But the report found that while the guidance needed improvement, it was the disproportionate financial impact that could result from changing how activity was counted that stopped local organisations from implementing the guidance adequately.

The manipulation of data definitions was not usually exploited for financial gain, the report continued.  But trusts preferred to ‘maintain their current financial position, irrespective of whether their approach to recording admissions is correct.’

Audit Commission’s managing director for health, Andy McKeon, said this meant NHS managers were ‘spending valuable time debating how patient treatment is recorded or described – time that would be much better spent focusing on the treatment itself.’

The report warned that these problems would become more acute when clinical commissioning groups took on responsibility for buying NHS care.  The theory behind the government’s NHS reforms was that increased competition would be based on ‘quality, not price’, with payment determined by the fixed NHS tariff, it said.  However, the report went on to say that it was clear from the Commission’s work that hospitals did not charge the same price for the same service, because of the way activity was recorded.

The Commission’s report said that problems with data definitions had delayed the signing of numerous contracts in the contracting round for 2011/12.  Many dispute, some involving significant sums, went to arbitration.  For one trust, activity worth £7.4m was called into question.

Waiting Time Figures No Small Achievement

The NHS continued its strong performance on waiting times in February, achieving all three 18 week referral to treatment measures for the second consecutive month.

Nationally, 91.2 per cent of admitted patients were treated within 18 weeks, against a target of 90 per cent.  This was down 0.2 per cent on January but up from 88.7 per cent a year ago.

Performance on the non-admitted pathway remained consistent with the previous month and year on year, with 97.1 per cent of patients seen within the timescale, against a target of 95 per cent.

In total, 78.5 per cent of NHS Trusts were meeting the target for admitted patients and 92.8 per cent achieved that for non-admitted patients.

The number of people waiting in excess of 26 weeks, 39 weeks and 52 weeks has continued to fall in the past six months. And median waiting times have reduced dramatically form 14.3 weeks in August 2007 to 5.2 weeks in February 2012.

25 Per Cent More Patients Delayed In Hospital

New figures from the Department of Health showed that the number of patients forced to remain in hospital despite being medically fit enough to leave has increased by twenty five per cent since August 2010.