National Association of Primary Care - Partners

NAPC GP Bulletin 15 August 2012

Guidance Highlights CCG Collaboration Benefits

The NHS Commissioning Board has published draft guidance highlighting the benefits of  and options for clinical commissioning groups collaborating to share contracts with providers and pool financial risk.

A Framework for Collaborative Commissioning Between Clinical Commissioning Groups, produced with NHS CC, of which Dr Charles Alessi is Interim Chairman, was published recently.

CCGs are required to have considered collaborative working as part of the national CCG authorisation process.  The guidance says arrangements must be in place by October in time for the start of the 2013/14 contracting round.  It sets out several models for collaboration.

CCGs should decide which services they want to collaborate on, with which CCGs they wish to collaborate and how they will do so, the document says.  They can consider whether extra support is required from a commissioning support service.  In some cases, a large number of CCGs might commission a single service that is organised across a large geographical area, such as ambulance services, and in other cases, a group of CCGs, which are geographical neighbours may wish to work together on a contract with a single provider to which the majority of their patients flow, it said.

The guidance does not suggest CCGs will be required to create a funding ‘risk pool’ to help groups that overspend.  But it does say that CCGs may wish to consider whether they will share or pool risk and agree how this will be managed.

PCTs Missing Health Check Targets

Millions of patients are missing out on vital checks for cardiovascular disease and diabetes as PCTS are failing to hit government targets, an investigation by the press has found.

Two thirds (64%) of PCTs in England did not provide enough NHS health checks in 2011/12, according to 118 trusts responding to a Freedom of Information Act request.  A fifth (21%) admitted they would fail mandatory Department of Health targets for 2012/13, despite being given three years to prepare.  Unless provision and uptake improve, 9 million patients are likely to miss out.

GPs and health charities said the failure to prioritise the programme was unacceptable and could cost the NHS billions of pounds.

The NHS health check programme aims to screen 15m people aged 40 to 74  for risk of heart disease, diabetes,, kidney disease and stroke by 2018.  PCTs were given three years to being a phased roll-out before the programme launched in 2012.

GP surgeries and pharmacies are providing checks, including BMI and blood cholesterol tests.  

From April, PCTs should screen a minimum of 20% of eligible people a year.  This was an aspirational target set for 2011/12.

However, the GP investigation found 1.7m checks were offered by 118 PCTs in 2011/12, 14% of all those eligible. A significant postcode lottery exists between areas, as the full programme of checks gets under way.

Three PCTs did not provide a single check in 2011/12 and another provided only four.  A spokeswoman for NHS Cornwall and Isles of Scilly said checks were not prioritised owing to other pressure.

Patient uptake is falling, with only 54% of those invited attending a check in 2011/12, down from 60% in 2010/11.

Despite government funding, six PCTs spent nothing on the programme in 2011/12.

A Department of Health spokesman said PCT performance against targets would be monitored.

NICE To Switch One In Seven QOF Points

NICE has set out plans to replace 14 indicators worth 135 points in the 2013/14 QOF.  The Institute’s QOF advisory committee published its recommendation after potential changes were debated at a meeting in June.

Among the new indicators proposed are four for rheumatoid arthritis (RA), which has not previously been covered in QOF.  The committee’s recommendations will be put to the GPC of the BMA and NHS Employers.

NICE recommended three diabetes and two hypertension indicators for retirement, alongside six other indicators.  It also backed changes to BP targets and to diabetes DM13 indicators.

Birmingham University’s Professor, Helen Lester, who leads the piloting of potential QOF indicators on behalf of NICE, said that the RA indicators had been well received during piloting.

Pilot practices, she said, liked the fact that there was a new domain for QOF.  A third had not been award of the increased cardiovascular disease or fracture risk, or of how many people needed to be referred for a DXA scan or bisphonates.  If you put a QOF spotlight on something like RA, things happen.

Professor Lester said that in several practices, nurses and GP registrars took the RA indicators on and called patients for review.  GPs saw this as a real quality improvement, rather than just fiddling at the edges, she added.

A Quarter Of Patient Death Records Show The Wrong Cause

Doctors are failing to record accurately the cause of up to a quarter of hospital deaths, a study has suggested.

Dr Alan Fletcher, who was appointed to 0 percheck the accuracy of death certificates after Harold Shipman killed at least 250 patients, while working as a GP, said it was unlikely doctors were deliberately falsifying information.  However, he gave a warning that the lack of precision meant that the true scale of some diseases could be hidden.  It also meant that families were often told the wrong cause of their relative’s death.

Cancer Risk Of Patients Who Battle To See GPs

Researchers claim that patients who struggle to get GP appointments within 48 hours are more at risk of being diagnosed with cancer too late.

Up to a quarter of cancer patients only have the disease diagnosed in A&E or after an emergency referral to hospital by their GP.  Academics from Imperial College of London looked at patients at 8,000 GP practices from 2007 to 2010.

The study, in the British Journal of Cancer, found those whose surgeries could usually offer appointments within 48 hours were 30 per cent less likely to be diagnosed with cancer after an emergency presentation.

NHS Could Save £462m On Over 65s

The NHS could save nearly half a billion pounds annually by reducing emergency admissions and hospital stays among older patients, according to a King’s Fund report.

The report, which analysed the use of emergency beds by over 65s across England, found huge variation in performance among primary care trusts.  It concluded 2.13 million hospital bed day were used by over 65s every year, when patients could instead have been supported at home or treated in the community.  If all PCTs performed as well as the top 25 per cent, 7,000 fewer hospital beds would be needed, freeing up £462m a year to reinvest in community and primary care services, the report said.

Older People and Emergency Bed Use  showed there was a ‘big opportunity’ to make real improvements in this area, said lead author, Candace Imison, King’s Fund deputy director of policy.

The scale of difference, she said, was really striking.  ‘It is absolutely crucial for everyone to understand where they sit on that spectrum.  This is an area that has significant opportunity for improvement if there is genuine collaboration.’

The analysis found marked differences between PCTs with high bed use and others with lower or falling bed use when it came to length of stay for over 65s who previously lived at home but were in hospital before moving on to supported accommodations.  

The average length of stay among those with highest bed use was 36 days, at least nine days higher than the best performing PCTs,

The report found areas with well-developed, integrated services for older people had lower rates of hospital bed use.  However, analysis of the performance of care trusts showed ‘organisational integration alone will not deliver improved performance’, and a prioritisation of older people’s care was required.

Children Risk Asthma If Parent Of Same Sex Have It

New research suggests that children are twice as likely to develop allergic diseases, including asthma, if a parent of the same sex is a sufferer.

The research, published in the Journal of Allergy and Clinical Immunology, and funded by the National Institute of Health in the US, also showed maternal eczema led to a 50 per cent increased risk of eczema in girls, while paternal eczema did the same for boys.

Professor Hasan Arshad, a consultant in allergy and immunology at Southampton General Hospital, said: ‘We have known for decades that allergy runs in the family and many thought that maternal effect was greater than paternal effect due to a mother’s closeness to her child, but we have discovered the inheritance is from mother to daughter and father to son.’