Articles

NAPC Bulletin 15 May 2012

News From NAPC

Dr Charles Alessi attended a meeting and dinner in Liverpool last week at which the Secretary of State was present.

On 10 May, Dr Penny Newman gave a presentation at an RCGP workshop on sessional GPs and commissioning, outlining for the first time the results of a sessional GP survey.

This work was precipitated by a NAPC paper to the Department of Health and has been supported by all primary care organisations, including the BMA. A full report will be available shortly.

Dr Peter Patel attended on behalf of NAPC a Department of Health meeting in Sheffield and also attended events ‘Changing NHS Landscape and the Role of Disruptive Innovation in Healthcare at which he led a workshop.

Plan To Halt Tsar Exodus

The NHS Commissioning Board is attempting to stem the rapid drop in the number of senior clinical advisers by bringing in more expertise from primary care, Sir Bruce Keogh, NHS Medical Director, has said.

Since January, five national clinical directors, who act as senior advisers to the Department of Health, have left. Meanwhile, the remaining 22 have had their contracts extended temporarily, mostly from March until the end of October. Some of the advisers have previously indicated to the press their concern about the future of national clinical leadership, as the roles moved from a Department of Health base to the Commissioning Board..

Recently, Sir John Oldham, national clinical lead for quality and productivity announced he would leave his post later this year and not seek a Commissioning Board role, while national ambulance director and London Ambulance Service, chief executive, Peter Bradley, said he would quit after the Olympics to take up a role in New Zealand.

It has also emerged that the national clinical director for health and work, Dame Carol Black, is no longer in post; nor are the directors for transplantation, Chris Rudge, equality and human rights, Surinder Sharma, pharmacy in primary care, Jonathan Mason, and pharmacy in hospital care, Martin Stephens.

Sir Bruce, who is the Board’s medical director designate, said he planned to review the entire complement of national clinical directors. Extending the contracts on a temporary basis meant the Board would have the freedom to really ‘think it through’. He wanted a ‘broader spectrum’ of clinical representation, with increased focus on primary care.

Announcing his decision not to transfer to the Commissioning Board, Sir John Oldham said he wanted to focus on improving the quality of GP provision and he considered he could do that better from ‘outside’.

He warned the Commissioning Board should make sure it did not recreate the ‘balance of inputs’ found in the DH, with its heavy bias towards secondary care.

His belief, he said, that a set of affiliates at front line should be created around the country, nurses, allied health professionals, doctors and managers, who continued their day job but could be brought in for ‘task and finish’ work so there was a current between the centre and the front line.

Strong Interest In Tariff Trial

More than 90 sets of commissioners and providers have shown strong interest in becoming one of the six trial sites for year of care tariff trials. Full expressions of interest must be submitted by 25 May.

The Department of Health hopes the system will encourage health economies to cut hospital demand and provide more care closer to home by paying providers to care for a patient with a long term condition for a year, rather than per episode of care. The Department invited applications last month for early implementers to test the payment system.

Applications are being prepared by clinical commissioning groups alongside their local acute and community providers. Ambulance services, primary care and council funded social care are linked to the trials but not directly involved.

The successful bids will be selected within a week of the deadline and will begin using the payment system from June. Year of care tariffs are scheduled to be implemented nationally from April 2014.

NHS Confederation deputy chief executive, David Stout, said there was an appetite among commissioners to move away from episodic payment by results. However, he added that a year of care tariff was not a quick fix and that while the current system was a barrier to designing better healthcare, ‘local leadership was absolutely essential’ to improve services.

Seeing Preferred GPs Could Cut Admissions

Significant hospital savings could result from ensuring patients see their doctor of choice when they visit their practice, latest research findings suggest.

Practices with more patients who are able to consult a GP of their choice have fewer elective hospital admissions, according to a study in the East Midlands.

The authors of the study in the Journal of Public Health suggested increased continuity of primary care could lead to significant savings for commissioners. But they highlighted that changes in the health system in recent years had tended to reduce continuity.

The researchers, from Leicester University, examined data for 2006/7 and 2007/8, during which the cost per non-emergency hospital admission was £2,641 and £2,892 respectively. They compared this with referral data and survey results for the same period from 145 practices across two primary care trust areas, NHS Leicester City and NHS Leicestershire County and Rutland.

Researchers found a 1 per cent increase in the proportion of patients able to see a particular doctor was associated with 7.6 fewer elective admission per year in 2006/7 and 3.1 fewer in 2007/8. These figures were for an average practice with a list size of around 6,000 patients.

These figures would be associated with savings in elective admission costs of £8,965 - £20,071 a year per average practice.

Study author, Richard Baker, director of the University’s department of health sciences said the association might be explained by continuity of care enabling ‘decision on not referring to be more readily made.’

Extra Support For Revalidation

A support service has been launched in London to offer assistance to doctors at all stages of their careers ahead of revalidation, which is due to begin later this year.

The London deanery’s professional support unit has been contacted by 143 doctors in its first month of operation. It aims to support 1,000 doctors and dentists in its first year.

Although many deaneries offer support to trainees, London is the first to bring all of its professional support together in one place and offer it to clinicians at all stages of their career.

The unit is open to doctors and dentists working in the capital and can offer training, advice and mentorship, as well as help with communications, linguistics and psychological support.

The deanery will also offer support after General Medical Council and National Clinical Assessment Service assessments appraise performance and devise development plans.

Julia Whiteman, Director of Appraisal, Revalidation and Performance at the deanery, commented: ‘We wanted to make sure the workforce we have is able to deliver. If you trained ten years ago, the way you were trained would have been very different to the way you are expected to work now.

Maternity Services Facing Shake Up As Birth Sites Cut By Half

Maternity services in East Kent are to be reconfigured, with births taking place at only two of four sites.

East Kent Hospitals University Foundation Trust’s midwife-led units at Dover and Canterbury will no longer provide birthing facilities but will still offer community support services.

Meanwhile, birthing capacity will be expanded in Ashford, where there is a midwife led unit and a consultant led ward.

A new £300,000 midwife led unit in Margate will be opened to join an existing consultant led facility. The unit has been mothballed since its completion in 2011 but is now expected to open in September.

Moves to reconfigure services were sparked by staff shortage, which led to the temporary suspension of some deliveries there.