- Hewitt: spend
practice savings on 'Selbie six'. Patricia Hewitt has said that practices
taking practice based commissioning should do their duty as "members of the
NHS family" and commit any "spare savings" to the government's six national
NHS priorities. Hewitt told a conference on PBC that she did not want to see
practices "making decisions that undermine the services to others. We need
practices making decisions for patients, but which also support the larger
strategy for the healthcare community. So in this difficult financial year we
need to see everyone contributing to the rebalancing of the NHS. We need to
see any spare savings invested in our six national priorities." Previous
guidance on PBC has emphasised the freedom practices will have to choose how
to spend their savings.
Summary by
Keep our NHS Public
of Health Service Journal 18 May 2006
- 'Start small'
says primary care boss. PCTs should "start small" and begin sharing
information quickly in order to introduce practice-based
commissioning by the government's December deadline, according to Gary
Belfield, the DoH's top primary care official has said. Meanwhile Patricia
Hewitt urged practices and new providers to examine a partly privately funded
primary and community service provider in Harlow as a possible best-practice
model for how to attract extra funding in primary care. Harlow Health Centres
Trust has some capital investment
from insurance companies. Hewitt said the model appeared "less bureaucratic
than LIFT" and showed that not everything had to be paid for using "public
money". HHCT owns and manages seven health centres in
Harlow, originally opened in the 1950s. The organisation became a limited
company in 1997, and a charity in 1998.
Summary by
Keep our NHS Public
of Health Service Journal 18 May 2006
- GPs refusing
PBC role will be held to account. GPs will be "held to account" if they
refuse to take part in practice based commissioning, Patricia Hewitt has
warned. Hewitt told an NHS Confederation conference that commissioning was
"not optional" and PCTs would "challenge" any practice that was reluctant to
engage with the scheme. In a speech which revealed growing anxiety in the
Department of Health at the slow take-up of commissioning, Hewitt also warned
PCTs they would be in trouble if they failed to co-operate with GPs. The
department has set a target for all GPs in England to be engaged in some way
with practice-based commissioning by the end of the year. Hewitt said: "The
new PCTs will know from the outset practice-based commissioning is here to
stay, that it is an absolutely essential and permanent feature of the new NHS.
It's not optional."
Summary by
Keep our NHS Public
of Pulse 19 May 2006
- Call to
redirect NHS cash. Staff, medicines and technology are where the NHS
should be putting much of its extra cash rather
- GPs propose
boycott on commissioning. GPs at the annual LMC conference discussed
whether to boycott the 'poisoned chalice' of
practice-based commissioning.
It was argued that the initiative shifts blame for NHS inadequacies from PCTs
to GPs, offloads historic deficits
onto general practice and will deprive patients of meaningful
choice because it can destabilise
local hospitals. Summary
by Keep our NHS Public
of
Doctor Update 15 June 2006
- Inherited debts
pose threat to PBC.
Practice-based commissioning budgets will
inherit PCT overspends, experts
believe. GPs said rolling over debts into commissioning clusters will severely
handicap their ability to redesign services let alone make savings.
Summary by
Keep our NHS Public
of Pulse 16 June 2006
- Watchdog
delivers wake-up call over PBC shortcomings. The Audit Commission has sent
the Government a wake-up call over its plans for
practice-based commissioning,
highlighting inadequate incentives, poor value for money and conflicts of
interest. It said the Government's flagship scheme risks "exacerbating
financial pressures", "widening
inequalities" and wasting money. The criticisms are drawn from an
investigation of four PCTs selected for being "relatively successful"
implementers of the scheme.
Summary by
Keep our NHS Public
of Pulse 16 June 2006
- Labour reforms
are destructive, says GP leader. Dr Hamish Meldrum, chairman of the GPs'
committee of the British Medical Association, has attacked Labour health
policies for lack of coherence and detail and for causing the NHS to
stagger from one crisis
to another. He criticised the recent white paper and said primary care
needed to change, "but not the sort of change this Government seems intent
upon, which is either change for change's sake or, worse still, unproven,
expensive, destructive change. It's a bit like throwing all the crockery in
the air in the hope that not only will nothing get broken, but it will all
land in a nice, neat table setting." He said GPs feel "no confidence in system
reform, no confidence in reformed primary care organisations, no confidence in
practice-based commissioning
and no confidence in choose and book,
no confidence in the chief medical officer and no confidence in the Secretary
of State." The Telegraph says his comments "fuelled the uneasy relationship
between doctors and the Government." Summary
by Keep our NHS Public
of
Telegraph 16 June 2006
- Core GP roles
'will not go out to tender'. PCTs will not be allowed to contract
alternative providers to
expand existing services for GPs' registered lists, under Government rules now
in development on
practice-based commissioning.
Summary by
Keep our NHS Public
of Doctor
Update 21 June 2006
- PBC still
failing to stir GPs. Practise Based Commissioning is failing to take hold
among GPs despite the efforts of primary care trusts, the government, and GP's
leaders. The NHS alliance has reported that delegates to their workshops on
the subject have found that information from PCTs is "typically poor, in the
wrong format, or does not exist." Delegates also reported that they felt PCB
would lead to a more "adversarial" relationship between hospitals and
commissioners while many cited "fear of competition from large corporations
and multinationals" as their reason for taking part in PBC.
Summary by
Keep our NHS Public
of Health
Service Journal 22 June 2006
- GPs "will take on
PBC out of the goodness of their hearts". GPs in cash-strapped PCTs will
initially miss out on the financial benefits of practice-based commissioning,
Sir Ian Carruthers has admitted. He said trusts with large deficits would
struggle to provide incentives for GPs to implement commissioning, but was
confident that GPs would take on commissioning out of the goodness of their
hearts. His comments followed an Audit Commission report concluding that local
incentives were needed to kick-start the scheme and warning that
deficit-stricken PCTs might retain some of the 70 per cent of savings that is
meant to go to practices. He said GPs in these areas would have to work much
harder before they were able to reap the rewards: "It's a problem for those
working in deficit areas. It means you have to do a lot more before the
incentives apply for you, but to me, the incentive of sorting out the deficit is
vital."
Summary by
Keep our NHS Public
of Pulse 23 June 2006
- 'We carry the
can over PBC'. GPs have no confidence in practice-based commissioning in
its current form because it is designed to make them carry the can for NHS
deficits, LMC representatives concluded. But they stopped short of calling for
a boycott of PBC, arguing that the principle of the scheme was sound and it
could be made to work.
Summary by
Keep our NHS Public
of Pulse 23 June 2006
- Demand
management 'not a panacea'. Dr Barbara Hakin, who becomes chief executive
of East Midlands strategic health authority next week, has spoken of her
worries about NHS reforms. Asked about the role of
demand management, the former NHS
acting director of commissioning said: "I'm hugely experienced in
commissioning and in changing the clinical pathway. And that experience does
give me some cynicism. This is not the absolute panacea for the ills of the
NHS. By doing these things you can find unmet need, you can change the way you
do things just because you can - and not necessarily find it's cheaper and
better. I'm really nervous about how much is being pinned on managing demand."
On practice-based commissioning,
she said: "One thing that concerns me about lifting the lid on practice-based
commissioning is that GPs are not corporate creatures, and there are dangers
about changes being made to the way services are being delivered which are not
properly assured, and without proper scrutiny of value for money or patient
safety." She said that looking back to her "early days" leading
Bradford South and West PCT, she could think of "instances where some
invasive treatments might have been carried out in primary care, when the
patient safety aspects may not be properly scrutinised." Summary by
Keep our NHS Public
of Health
Service Journal
29 June 2006
- GPs 'not
embracing key reform'. Only four in 10 GPs have signed up to a government
scheme seen as a central NHS reform. Practice-based commissioning was set up
last year to allow GPs to run local budgets and buy in services - such as
hospital, physio and community care. Some 3,454 of the 8,500 practices in
England have signed up, but the number actually commissioning is much lower.
It is estimated that a little over a quarter are running their own budgets,
although 3,454 have been given the incentive payments to prepare for the
responsibility. The government wants to see all GPs adopt practice-based
commissioning by 2008, but will miss the target if the current take-up rate
continues.
Summary by
Keep our NHS Public
of BBC Online 7
July 2006
- Ministers miss
key deadline for PBC as chaos dogs scheme. Practice-based commissioning is
falling way behind schedule, with more than half of GPs shunning the scheme
due to a catalogue of problems. Only two out of five GPs have so far signed up
amid doubts over their ability to keep savings and unreasonable demands being
set by PCTs desperate to save money. Even those GPs who have agreed local
plans are claiming the process has been a worthless exercise. A Pulse survey
of 61 PCTs covering 2,038 practices has found just 38% of GPs had agreed a
local plan with their PCT by the end of June. The government target by this
time was 100%. Despite having come nowhere near the target, health minister
Lord Warner said the fact 3,454 practices were involved showed the NHS was
"surging ahead" in adopting the Government's reforms. But in
Kent,
Hampshire,
Somerset and Dorset, no GPs had signed up.
Summary by
Keep our NHS Public
of Pulse 7 July 2006
- Two in five
practices have expressed an interest in commissioning. Official figures
show that GPs in England are still far from committed to the system of
practice based commissioning that lets them decide which health services to
buy for their patients. Less than half (41%) of general practices in England
have signed up to practice based commissioning more than a year after it
began, show figures released last week by the Department of Health. The
government hailed the figures as promising, but the BMA has questioned them
and said that signing up to the system was not the same as actually using it. Summary by
Keep our NHS Public
of British
Medical Journal 14 July 2006
- Referral
management shows results in Kingston. In
Kingston PCT all but one of 29 practices have voluntarily signed up to a
clinical assessment service in which every referral is scrutinised through
Choose and Book. Local GPs funded the initiative and employed two of their
number as part-time medical directors before electing an eight-member board.
The founders hope it will become a not-for-profit agency operating under a
specialist personal medical services contract. This agency, called the
Kingston Co-operative Initiative (KCI), is moving to its next phase:
assessment of consultant-to-consultant referrals, a hugely controversial area.
The PCT has an agreement with Kingston Hospital trust which says that all such
referrals, bar some specific exclusions such as cancer, should be reviewed by
the service. Consultants have been hostile to the scheme. The final piece of
the KCI jigsaw is a provider and treatment service, due to be up and running
in the autumn, which would see the PCT stop managing GPs with a special
interest.
Summary by
Keep our NHS Public
of Health
Service Journal 10 August 2006
- PCTs dragging
their feet on commissioning. The government's push towards practice-based
commissioning is being hampered by primary care trusts' delays. Figures
released by the Department of Health show that only 40 per cent of PCTs (120
in total) had implemented arrangements for PBC by the end of June, compared to
the government 'aspiration' of 45 per cent (136).
Summary by
Keep our NHS Public
of Health
Service Journal 10 August 2006
- Dermatologists
hit by referral management. More than half of England's dermatology
departments are facing huge losses of referrals as a result of schemes
designed to keep patients in
primary care. Of 102 clinical leads questioned by the British Association
of Dermatologists (BAD), 56 said their local PCTs were setting up clinical
assessment and treatment services (CATS) schemes. These services 'capture'
non-urgent referrals into hospital and re-route them into primary care. The
respondents said that they expected the schemes to divert away up to half of
their departments' patiients. Many dermatologists expect case-loads to become
skewed towards complex patients, without
increased funding. BAD clinical vice-president Dr David Shuttleworth said
departments that were unable to prove their financial viability risked being
'outsourced'. The survey also reveals that GPs are being given financial
incentives to refer patients to CATS under almost half of the schemes and
referral was compulsory in a further nine per cent. The Skin Care Campaign
says its own figures show most CATS are setting targets for the systems, which
'completely remove patient choice'.
Summary by
Keep our NHS Public
of Hospital
Doctor 7 September 2006
- Community plan
'flawed'. Many policies designed to move care into the community are not
backed by evidence, according to a review of literature on shifting care.
Research by the University of Birmingham's Health Services Management Centre (HSMC)
finds little proof that moves to replace specialists with GPs with special
interests will help movement of services into primary care. Policies such as
financial incentives for GPs could even act as a barrier to shifts in care and
result in inappropriate referrals, the authors say. One study quoted in the
review examines data from six health authorities serving about four million
people. It concludes that financial incentives for GPs undertaking surgery may
encourage cheaper, simpler surgical procedures to be replaced by costly
interventions. BMA seniors' leader Dr Paul Miller said: 'Whatever their
shortcomings, hospitals and outpatient departments are relatively efficient
ways for doctors to see patients. I think the Government will get a nasty
shock when they find the scope for shifting care is much more limited than
they think.'
Summary by
Keep our NHS Public
of Hospital
Doctor 7 September 2006
- Practice-based
commissioning back on track, according to department. The Department of
Health claims take-up of practice-based commissioning is back on track. The
number of PCTs meeting four criteria set by the department to determine
involvement in commissioning was 57 per cent at the end of July against a
target of 56 per cent.
Summary by
Keep our NHS Public
of Pulse 8 September 2006
- Lansley: PBC is
not enough. GPs would be handed direct responsibility to manage demand
under a Conservative government because the party does not believe primary
care trusts are up to the task. Shadow health secretary Andrew Lansley told a
fringe session at the party's conference in Bournemouth that too many PCT
managers were weak on 'leadership and innovation'. He said he would like to
see practice-based
commissioning extended to give GPs real budgets and the ability to draw up
their own contracts - a return to some of the major elements of GP fundholding.
He also indicated he would go further than Labour in giving the
private sector the right
to supply and give foundation trusts freedoms he said had been denied by
chancellor Gordon Brown. He said 'NHS staff need to work within a proper
commercial framework.'
Summary by
Keep our NHS Public of Health
Service Journal 5 October 2006
- GPs say PCTs
must act now to stop PBC failing. New PCTs have only a few months to save
practice-based commissioning from failure, GPs are claiming. The caution came
as latest Department of Health figures showed further slippage against its
target for uptake of practice-based commissioning by PCTs. In August, 69 per
cent of PCTs had plans in place for 'universal coverage' by the end of the
year, against a 72 per cent target. Uptake targets were also missed in May and
June.
Summary by
Keep our NHS Public of Pulse 6 October 2006
- Younger GPs 'might shun commissioning role'.
Private firms could step
in if a new generation of GPs turns its back on
commissioning, the the
annual CIPFA health finance conference was told. Noel Plumridge, author of
CIPFA's guide to payment by results, New financial flows in the NHS in
England, said: "A huge demographic change is taking place. Your GP is more
likely to be female and young and increasingly likely to be a south Asian
woman. Almost certainly they will be more preoccupied with work-life balance
than the previous generation. What if they are not interested in resuming
control of rationing ? The role of the independent sector then becomes more
interesting. In some urban areas of England, supermarkets and pharma companies
are interested in setting up primary care chains because there's money in it."
Summary by
Keep our NHS Public of Public
Finance 13 October 2006
- Warner: 'no
excuses' for delaying commissioning. New guidance telling primary care
trusts how to provide GP practices with information and indicative budgets
leaves 'no excuses' for delaying the introduction of practice-based
commissioning, health minister Lord Warner has said. The guidance says budgets
should be calculated on the basis of actual activity for the last six months
of 2005-06 and first six months of 2006-07, converted into next year's prices.
As a minimum, they should cover all hospital care, all activity under payment
by results, prescribing, community services and mental health costs.
Practice-based commissioners will not have to tender for small-scale service
provision where an expensive tendering process may outweigh the cost of
service. Practice-based commissioners will only have to tender if planning to
take on a large section of acute trust provision. And the guidance says prices
could be negotiated locally for some procedures covered by payment by results,
when they are carried out in the community. Summary by
Keep our NHS Public
of Health Service Journal 30 November 2006
- DoH allows GPs
to undercut hospital tariffs in guidance aimed at kickstarting failing scheme.
GPs have been given the green light to undercut hospital tariffs under a new
set of practice-based commissioning guidelines. The guidance, released this
week by the Department of Health, aims to speed up the shift of services into
the community and kickstart practice-based commissioning. The department has
called on PCTs to set up local enhanced services from next April which give
GPs more incentives to redesign care and make savings. GPs will also not have
to tender to provide services unless they would hold a monopoly in their area. Summary by
Keep our NHS Public
of Pulse 30 November 2006
- Practice based
commissioning shares fundholding's flaws. Labour's policy of practice
based commissioning seems to have similar problems to the GP fundholding
scheme that was abolished in the 1990s, according to an analysis by Greener
and Mannion. Under both schemes, purchasing secondary care out of a primary
care budget increased GPs' awareness of resource economics. But patients'
satisfaction seems to have been reduced in line with increased managerial
responsibilities of GPs. Summary by
Keep our NHS Public
of British
Medical Journal 1 December 2006
- Plan to rejig
GPs' PBC cash. The Department of Health is to commission a new funding
formula for practice-based commissioning that will see funds shifted to
practices in deprived areas. The formula is set to revolutionise the way
commissioning funds are allocated to GPs because it will work out budgets
based on the characteristics of patient lists rather than on historical census
data. Health economists predict that inner city practices could receive a 20
per cent increase in funds at the expense of those in other areas. In the
future the formula could form the basis of a revised allocation formula for
core practice funding, to iron out some of the inequalities in the global sum
formula. The department is putting the development of the PBC formula out to
tender and has set a deadline of 8 March for replies.
Summary by
Keep our NHS Public of Pulse
8 February 2007
- PCT
commissioning privatised. The first private contract for commissioning
support has been awarded to an accountancy firm, setting a new milestone in
the increasing role of the independent sector in the NHS.
South Central strategic health
authority has signed up PriceWaterhouseCoopers to provide commissioning
skills for its nine PCTs. The firm, whose contract is worth £2m over five
months, or 0.5 per cent of the commissioning budget, will be tasked with
creating strategic and operating plans for each PCT, and identifying areas
where capacity can be bought, built or shared. But the SHA has assured GPs
that the initiative will not clash with practice-based commissioning. Rebecca
Clegg, programme manager at South Central SHA's system reform team, said the
scheme would be a 'process of engagement' between PCTs, practice-based
commissioners, SHAs and PriceWaterhouse- Coopers. She said: 'The approach we
are taking is not one where the SHA and PriceWaterhouseCoopers is going to
come in and say this is the right way to do it. The idea is that we're all
working in partnership on this. We don't want to get into a situation where
PriceWaterhouseCoopers will be dictating what's right or wrong.' She said the
SHA had wanted to access 'international experience and best practice', looking
to firms which had worked on commissioning in Europe and the US.
PriceWaterhouseCoopers is also bringing its own clinical expertise, including
an Oxfordshire-based GP. Dr David Jenner, commissioning lead at the NHS
Alliance, said he was concerned that the move showed a lack of confidence.
'You can't do commissioning in a top-down fashion. It's frontline clinicians
who actually make the decisions that commit budget,' he said. The management
consultants will: create a strategic plan for each PCT to 'measure success and
set long-term goals'; create an operating plan to develop the Local Delivery
Plan year by year; create a people, capability and capacity plan to identify
areas for improvement; understand the detail of the commissioning function and
cycle so that the PCTs can assess their strengths and weakness and explore the
benefits of working together; identify areas for building, buying or sharing
capacity and capability from the NHS and independent sector.
Summary by
Keep our NHS Public of Pulse
22 February 2007
- Government
envisions a budget for every patient. Individual budgets as piloted in
social care could be used in healthcare, according to the government's
Commissioning framework for health and well being. The document's vision for
the future sets out how commissioning in health should move from primary care
trust-level to practice-level, using 'individual budgets wherever possible, to
give people more control of their own care and support arrangements'. This
would mirror the system of direct payments and individual budgets that has
already been piloted in social care. The document also details plans for joint
strategic needs assessment by PCTs and local authorities to look at the health
needs of their population and future provision needed. The framework says a
good assessment should be based on joint analysis of current and predicted
health and well-being outcomes, an account of what the local community wants
and a view of the future. The document would provide the basis for agreeing
longer-term priorities in a community strategy that would be reflected in
joint objectives in local area agreements and children and young people's
plans. Announcing the framework, health secretary Patricia Hewitt said:
'Giving people more choice and more control over their lives -creating a truly
personalised service - is the first goal of commissioning for health and
well-being. The second is to enable people to lead lives that are as healthy,
happy and independent as possible, rather than just dealing with the
consequences when things go wrong.' The minimum set of data and analysis that
PCTs and local authorities might expect to carry out to inform the assessment
are: demography; social and environmental context; current known health status
of the population; current met needs of the population; patient/
service user voice; public demands; analysis of current inequalities;
projection of service use; projection of outcomes value for money and return
on investment. The document sets out a 'flexible approach' to resources,
suggesting that practice-based commissioners should be able to commission
social services, such as using carer services to reduce the rise of hospital
admissions. But the Local Government Association expressed some concerns, and
said that PCTs should have to do more than seek views from local authority
partners - as the document suggests - if they were considering introducing
changes. LGA senior policy consultant Trish O'Flynn commented: 'If GPs start
commissioning social care there could be duplication with local services. We
would want it to happen as part of a local area agreement as we would rather
not have duplication or competition with the local authority. Otherwise you
could get some GPs commissioning social care and others referring a patient to
a local authority where they have to pay for services.' NHS confederation
director of policy Nigel Edwards agreed: 'It could undermine PCTs allocations,
which are based on health needs of a population, if money seeped into social
care at the expense of healthcare.'
Summary by
Keep our NHS Public of Health
Service Journal 8 March 2007
- Commissioning
to cut admissions by 4%. Practice-based commissioning will lead to only a
modest reduction in elective admissions, researchers have predicted. The
researchers from the National Primary Care Research and Development Centre (NPCRDC)
predicted it would reduce elective admission rates by 4 per cent, based on the
effects observed for fundholding. The study warns that the implementation of
commissioning must be monitored in order to detect 'negative effects on other
aspects of patient care'.
Summary by
Keep our NHS Public of Pulse
8 March 2007
- No Hewitt
action on PBC. Health Secretary Patricia Hewitt has criticised PCTs for
not helping GPs in delivering practice-based commissioning. But the Department
of Health told Pulse there were no plans to dish out 'sanctions' or
'punishment' for PCTs who do not support GPs. This is despite Ms Hewitt
insisting last year that PCTs would be 'held to account' if they failed to
encourage commissioning. Strategic health authorities will be monitoring GP
participation. Although department statistics show that 94 per cent of
surgeries have signed up to PBC, Ms Hewitt told a King's Fund conference on
commissioning that some PCTs were struggling to get commissioning under way.
She said: 'A lot of practices really want to run with it but some are
frustrated because they are not getting support from PCTs. 'On the other hand
the challenge PCTs face is that some practices are either not interested or do
not have the capacity to do commissioning.' Ms Hewitt urged more GPs to form
commissioning consortiums so that they have access to support and advice from
a network of colleagues. Dr David Schubaker, a GP in Redbridge, London, and
chair of Redbridge and Waltham Forest LMC, said the problem was that many PCTs
were too hard up to help GPs. 'GPs here were pioneers of PBC but now it has
gone down the drain. It is PCT-based commissioning. The PCT wants services in
the community but it has not trained GPs to do them. 'We need nurses and
health visitors to deliver a lot of the services but there are not enough of
them.'
Summary by
Keep our NHS Public of Pulse
16 March 2007
- Trusts to be
allowed to deny GPs PBC savings. The Department of Health has given PCTs
carte blanche to withhold savings from GPs under practice-based commissioning,
after admitting it would not compel trusts to comply with guidance. A new
Pulse survey reveals at least one in seven PCTs is failing to allow GPs the
recommended 70% of savings, but the department made clear it would not hold
them to the deal. The GPC is now recommending that practices do not
participate in practice-based commissioning unless they have a signed
agreement that they will be able to keep at least 70% of savings. Pulse
surveyed all PCTs and five of the 37 that replied said they were not allowing
practices to keep at least 70% of savings as recommended. Some PCTs are
keeping all savings until deficits are cleared while others are handing over
50%. Already
Hillingdon PCT has said it will not commit to handing over any savings to
practices this year.
Summary by
Keep our NHS Public of Pulse
20 April 2007
- Referral cash
may distort patient care. The Government is risking reducing the quality
of patient care by incentivising GPs to change their referral behaviour,
according to leading primary care academics. 'Interventions that change the
referral behaviour of GPs generally reduced outpatient activity but also
risked reducing quality,' the evaluation of care closer to home concluded.
Researchers warned referrals under practice-based commissioning would need to
be carefully audited, to ensure PBC was not acting as a perverse incentive to
reduce appropriate referrals. The National Primary Care Research and
Development Centre team concluded that though financial incentives had been
shown to reduce referral rates, 'there is a high risk that reduction may apply
to both necessary and unnecessary referrals'.
Summary by
Keep our NHS Public of Pulse
27 April 2007
-
Competition or Co-operation - The new Commissioning Dilemma
.
Practice Based Commissioning
(PBC) and Payment by Results (PbR)
offer the promise of significant improvement in patient care, whilst working
within existing resources and introducing tensions into a system leading to
innovative alliances and reform.
Care and Health 15 May 2007.
Report-
NHS commissioning- don’t believe the doom-mongers. Don’t believe the
doom-mongers who claim GP practices are neither up for taking on the
responsibility for NHS commissioning, nor up to it.
Care and Health 17 May 2007
-
GPs committed to making
practice-based commissioning work but lack of support threatens key NHS
reform, says new poll. One of the Government’s central health policy
reforms to devolve greater power to GPs and deliver higher quality services to
local communities may fail to improve patient care unless GPs and others in
primary care receive much greater support from primary care trusts (PCTs)
.
Care and Health 17 May 2007
-
Poll reveals
dissatisfaction with PBC. A poll of over 250 GPs and practice managers by
the King's fund and the NHS Alliance has shown that practice-based
commissioning is not considered to be improving patient care and is suffering
from a lack of support from primary care trusts. Just 18% said PBC had
improved the quality of care "to some extent" and only 1% said it had improved
care "to a great extent". 33% also described the level of support received
from PCTs as "poor" while 37% said it was "not very good". The report -
Practice-Based Commissioning: from good idea to effective practice - said that
there must be mutually agreed budgets, which 70% of respondents lacked.
However 73% of GPs said they were committed to PCB and just over half thought
it would benefit patient care in the next year.
Summary by
Keep our NHS Public of Health
Service Journal 17 May 2007
-
PCTs given two
years to deliver. Practice-based commissioning is running out of time to
'prove itself', a leading advocate of the scheme has warned. Mike Dixon, chair
of the alliance, warned PBC had just two years to win over GPs, PCTs and
politicians, and must start delivering real benefits in terms of services and
savings. 'If within two years it's failed to do that, with elections looming,
people will be saying PBC can't hack it,' he said.
Summary by
Keep our NHS Public of Pulse
24 May 2007
-
PCTs admit
'appalling failures'. PCTs lack the infrastructure or expertise to take
practice-based commissioning forward, senior managers have admitted. Pauline
Quan Arrow, chair of Southampton City PCT, told GPs at the NHS Alliance spring
conference last week that although PCTs were doing their best, they were
struggling to cope with reorganisation, limited resources and lack of staff
expertise. 'We have failed appallingly,' she admitted. 'We're an eight
year-old PCT, we have financial balance - and we're still getting it wrong.'
Lack of accurate information and budgetary detail was of particular concern,
she added. 'We are still financially flawed. We don't have the basic
information of how much things cost.'
Summary by
Keep our NHS Public of Pulse
24 May 2007
- National Library
of Health. Navigate change in NHS, with a new information resource launched.
A comprehensive collection of current knowledge and evidence about NHS reforms
is available in the
Health Management Specialist Library run by the King’s Fund on behalf of
the National Library of Health. The collection was launched at the NHS
Confederation conference in London where the King’s Fund is running a series
of discussions on NHS reform. Managers, researchers and students will be able
to access, free of charge, all the latest information on key system changes
that have taken place over the last 10 years of Labour government, including:
Alternative providers, Patient Choice, PCTs as commissioners,
Foundation Trusts, Payment by results, Practice based
commissioning, Regulation. The aim of the Health Management Specialist
Library is to provide a unique on-line resource of the latest healthcare
knowledge. Each topic has links to guidelines, secondary research and primary
research. In this new strand on NHS Reforms, each topic is introduced by an
article written by King’s Fund’s policy team. The aim of this new resource is
to help managers, researchers, students and journalists to more easily
navigate the complexities of NHS reform.
Care & Health 21 June 2007
- How family
doctors cut hours and still doubled their money. Somehow the Government has
positioned itself as the aggrieved party after a contract - which it agreed and
signed - turned out to offer GPs more than it had bargained for. The contract
can hardly now be rewritten. The alternative, if the Government really wants to
square up to the GPs, is to make their lives a little less secure by the threat
of competition. Private companies seeking to run GP surgeries can be made to
sign up to the Saturday surgeries that the Prime Minister so ardently desires.
GPs aiming to compete would have little choice but to do the same. Private
companies might also be willing to participate fully in practice-based
commissioning, the Health Department's plan to make GP practices the place where
NHS services are planned and ordered. This is rather like the Conservatives'
fundholding policy, but lacks enough incentives to persuade GPs to join. Despite
ministers' claims that GPs are flocking to join, the scheme is in trouble.
Experts believe that about 15% of GPs are truly committed, the rest having done
little more than pick up a bonus for thinking about it. The typical GP's
waiting-room is not filled with people dragged from their desk or workbench, but
with the retired, the elderly, the chronically sick, and mothers with young
children. For them, Saturday has no magic appeal. Among those who do work,
occupational-health schemes or walk-in centres can provide a medical service
during working hours. Indeed, the Government's miscalculation during the
negotiation of the GP contract was that walk-in centres and NHS Direct could do
the out-of-hours job better and more cheaply than GPs. They could not. What is
now proposed is not a return to GPs providing out-of-hours care, but ordinary
care in extended hours. The distinction is important. Out-of-hours care was
always an emergency service for urgent cases. What is in Mr Brown's mind is
ordinary care, provided at a different time. What the Government cannot get away
with is claiming that it wants to go back to something that has recently been
lost. Saturday opening may or may not be a desirable objective, but it has
nothing to do with the 2004 GPs' contract.
Summary by
Keep our NHS Public
of Times
21 August 2007
-
NHS surgery success rates to be made public. A radical overhaul of NHS
strategy which will give patients a right to know the success rates of every
specialist unit in every hospital is being planned by leading surgeons and
government officials. For the first time, patients will be allowed to
compare the
quality of the clinical care provided in each NHS department. People with
a particular medical condition will be able to assess the quality of the
relevant specialist teams at rival NHS hospitals before choosing where to go
for treatment. In some specialties, results for individual surgeons may be
available. The strategy of increased transparency is being driven by three
fundamental changes in the NHS: The medical royal colleges want to find a
reliable method for deciding whether
individual consultants are fit to retain a licence to practise under the
government's plan for regular reviews of doctors' professional standards.
NHS commissioners want to
know the quality of every hospital department so they can purchase more care
from units with the best outcomes and put pressure on under-performers. Health
ministers want to give more data to
patients to help them choose the right hospital on medical grounds instead
of them relying on local gossip or promotional material from trusts about
quality of meals and availability of car parking. John Carvel, social affairs
editor
Tuesday August 28, 2007 The Guardian
-
Are GPs exploiting NHS markets? James Blake of Channel 4 News reports on
concerns in Liverpool about a possible conflict of interest involving local GPs
with a financial stake in a private company. Under "Practice Based
Commissioning" GPs are able to recommend the private company to patients.
Channel 4 News 3 September 2007- Practice commissioning is the answer to Wanless. The NHS Alliance
warmly welcomes the thoughtful review on NHS funding and performance by Sir
Derek Wanless, published today by the King’s Fund.
Care
& Health 13 September 2007
- Practice Based Commissioning GP
practice survey: mind the gap. The IPSOS MORI survey of practice based
commissioning, carried out for the Department of Health and published today,
has confirmed the NHS Alliance's own on-the-ground intelligence, most GP
practices support the policy and one in three have already commissioned new
services as a direct result. Download: Practice
Based Commissioning GP practice survey.
Care & Health 31 October 2007
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