The Department of
Health supports the government in improving the health and well being of
the population. Most healthcare is delivered through the National Health
Service (NHS).
The NHS plan was published in July 2000, setting
out the action plan for the coming 10 years. The plan included promises for:
- More power and information for patients
- More hospitals and beds
- More doctors and nurses
- Much shorter waiting times for hospital and doctor appointments
- Cleaner wards and better food and facilities in hospitals
- Improved care for older people
- Tougher standards for NHS organisations and better rewards for the best
As well as reducing
inequalities in access to healthcare, the plan aims to target diseases which
are the biggest killers such as cancer and heart disease and taskforces were
set up to drive forward improvements in these targeted areas.
A
Modernisation Board lead by the Health Secretary advises on progressing the
aims of the plan and the Modernisation Agency drives implementation of the
plan.
Shifting the Balance of Power is the programme of change
introduced by the Labour government and implementation began when they came to
power in 2000. It is part of the NHS plan and its implementation has changed
the structure of the NHS extensively. The main feature of this programme is to
give Primary Care Trusts the role of managingand improving health in their
areas. As the programme progressed further documents followed. Securing
Delivery (April 2001) and Next Steps (Jan 2002) provided further
details on the new NHS structure as well as defining the roles'
responsibilities and specific functions of the various new and revised
organisations.
Who's who?
Primary Care Trusts
(PCTs): Their development is central to Shifting the Balance of
Power. They are the most local NHS organisations. They were developed with
view to:
- improving the health of the community - taking the lead on public health issues and developing and improving Health Improvement and Modernisation Programmes (HIMP)
- securing the provision of high quality services acute and specialist services, Personal Medical Services and Personal Dental Services, Walk- in Centres, local NHS Direct services, emergency ambulance and patient transport services and the implementation of population screening programmes, administration, management, development and integration of all Family Health Services: medical, dental, pharmaceutical and optical. In practice, this will mean maintaining lists of practitioners, admissions to the list, dealing with applications for the siting of new pharmacies and managing the national complaints policy amongst others.
- integrating health and social care locally - PCTs have a responsibility to ensure social care needs are met.
PCTs are briefed to involve patients and the public as well as their own practices and partners. They must manage the co-ordination of all the agencies who deliver local health care, taking the responsibility for creating strong local partnerships. In doing so, they work collaboratively with other PCTs, StHAs and NHS Trusts as well as local authorities.
The typical structure of a PCT will include:
- Board of Professional and lay members
- Professional Executive Committee people from Health and Social Care
- Prescribing Advisor
- Local HIMP Lead
- Public Health, Clinical Governance, Patient Advocacy and Liaison and National Service Framework Leads.
PCTs have a lead role in
Medicines Management, including development of the local formulary governing
which medicines should be used in hospitals and primary care. Most PCTs now
have growing teams of Pharmacists and Pharmacy Technicians to develop and
implement Medicines Management Strategies.
General Practice
Surgeries: These are still mainly independent businesses contracted by the
PCTs to provide General Practice Services. There are 2 types of contract.
Personal Medical Services and New General Medical Services (GMS). From April
2004, most practices will move towards the new GMS contract model. This
provides new flexibilities for practices to determine which services they
provide including opting out of additional services and out of hours care. The
contracts allow the practice to be rewarded for meeting quality and outcome
framework specifications for clinical and organisational performance and for
improving the patient experience.
Pharmacy: This has new roles
in delivering the NHS plan. They must make sure that people can get their
medicines or pharmaceutical advice easily and as far as possible at a time and
place of their choosing. Pharmacy must provide more support in helping people
use medicines properly. The NHS is reviewing arrangements for securing and
paying for generic medicines which has impact particularly on community
pharmacy. Contracts for community pharmacies are revised to reward high quality
services at the expense of those prepared to provide only the basic minimum.
Examples of such services can include provision of medicines such as
anti-coagulant therapies or emergency hormonal contraception under patient
group directions. Local Pharmaceutical Services Contracts are being developed
by PCTs to contract for additional pharmacy services above and beyond those
required by the national contractual frameworks. One stop primary care centres
are being developed and community pharmacies must compete for prime locations.
PCTs now have a growing clinical governance role in pharmacy. Workforce
development in pharmacy includes expanding the roles of technicians and
pharmacists and provision of the appropriate training for these new roles as
well as CPD.
NHS Trusts: These provide Acute and Specialist
secondary and tertiary healthcare services. Their services are commissioned by
PCTs and Strategic Health Authorities. The advent of PCTs has lead to extensive
local hospital service redesign. Hospitals must deliver quality service often
specified in service level agreements. Hospitals have their own national and
local priorities to deliver and the commissioning PCTs are responsible for
supporting this delivery.
In response to the demands of current
policy, some key changes in NHS Trusts include:
- delegating budgetary responsibility and decision making to frontline clinical teams
- engaging frontline staff in service modernisation and improvement
- involving patients and communities in programmes to improve health and healthcare services
- delegating responsibilities for ward staffing budgets to ward sisters and charge nurses
- delivery of services through clinical networks which span institutional boundaries
Care Trust: This
can be a Mental Health Trust, PCT or NHS Trust which has moved forward to the
stage of formal partnership agreement and integration with other public service
organisations in the community. This structure allows greater exchange of funds
between healthcare and other bodies such as social care, councils, etc.
Strategic Health Authorities (StHA): Local PCTs and Hospital
Trusts are held to account through the StHA. The StHA role is to support the
creation of shared strategies. They manage the NHS locally on behalf of the
Department of Health:
- creating a coherent strategic framework;
- agreeing annual performance agreements and performance management;
- building capacity and supporting performance improvement.
They focus on delivery
of service according to specified quality and quantity agreements. Most StHAs
now have a medicines management team and all have workforce development
functions.
Commission for Health Improvement (CHAI): It is
responsible for leading the development of audits and performance frameworks
CHIA inspectors include lay and professional people. They pay one week (7 day)
visits to Trusts to audit all aspects of performance. Reports are published and
available to the public. Star ratings for Trusts have now been introduced and
PCT star ratings are influenced by performance of their commissioned hospital
and other services.
National Institute for Clinical Excellence
(NICE): Nice has been given the role of promoting best practice in
healthcare. It focuses primarily on Cost Effective use of medicines and
services reviewing key areas in order of priority and producing guidelines. A
key, though understated role of NICE is to moderate the pace of innovation so
new treatments can be budgeted for.
NHS Purchasing and Supplies
Agency (PASA): PASA works with around 400 NHS Trusts and manages over 3000
national purchasing contracts for services, medicines and equipment. It acts as
a strategic advisor to the NHS on supply issues. It also contracts for supply
on a national basis where purchases are strategically critical to the NHS or
where aggregated purchasing power will yield greater economic savings. PASA
services are utilized by Trust procurement departments at two levels:
(1) The Trust Procurement team avails of information as well as contract
document frameworks. The Trust purchases locally
(2) The Trust may avail of
PASA’s purchasing services.
PASA regularly looks at NICE
guidelines and prioritized providing relevant pricing information or purchasing
services. IT also monitors Trust procurement performance and provides
performance rating information.
Whether working at the local Trust or
at PASA, Procurement Managers have the following remit.:
- Ensure supply of all products according to planned requirements and manage demand internally.
- Encourage competition and manage relationships with suppliers.
Most procurement
managers are incentivised to reduce costs and this is often their main
priority.
Guide to NHS structure in Wales
Local
Health Boards (LHBs): There are 22 Local Health Boards, which commission
services of hospital trusts, family doctors, dentists. The Local Health Boards
cover exactly the same areas as the 22 local authorities in Wales. The Local
Health Boards and local councils have a statutory duty to work together - in
partnership with other local organisations - to produce strategies for
improving health and social care for the people living in their area. Parts of
Wales have some of the worst health in Europe, and it will take all these
organisations working closely together to tackle this.
Specialised
services and public health: Although LHBs plan and pay for most hospital
and family health services, there are a few specialised services which are
better planned across the whole of Wales. These are the responsibility of
Health Commission Wales (Specialised Services), which was created on 1st April
2003.
The National Public Health Service: This is a single
organisation covering the whole of Wales, the give advice and guidance to Local
Health Boards on a range of issues such as disease protection and control as
well as child protection.
NHS Trusts and Hospitals: There are
14 NHS Trusts in Wales, including one all-Wales ambulance trust. Between them,
the Trusts manage 135 hospitals and some 15,000 beds. Half a million people - a
sixth of the population - will have a hospital stay in any given year.
Community Health Councils (CHC): There is a CHC in each of the 22 local
government areas in Wales and they take up a wide range of health issues on
behalf of the public.
Regional Offices: There are three
regional offices of the National Assembly based in Mid, North and South East
Wales. The regional offices support improved joint working at local levels
monitoring the development of local Health, Social Care and Well-Being
Strategies ensuring that Assembly initiatives are carried out.
For
more information on the NHS in Wales visit
www.wales.nhs.uk
Guide to the NHS in Scotland
In Scotland there are 15 Health
Boards, each supporting local PCTs and Hospital trusts.
Health
Scotland: Health Scotland provides a national focus for improving health
and will work with the Scottish Executive and other key partners to take action
to improve health and reduce inequalities in Scotland.
NHS Quality
Improvement Scotland (NHS QIS): This organisation has a role similar to the
English Commission for Health Improvement to improve the quality of healthcare
across Scotland.
Scottish Medicines Consortium (SMC): The remit
of the Scottish Medicines Consortium (SMC) is to provide advice to NHS Boards
and their Area Drug and Therapeutics Committees (ADTCs) across Scotland about
the status of all newly licensed medicines, all new formulations of existing
medicines and any major new indications for established products. This advice
will be made available as soon as practical after the launch of the product
involved. SMC has formed a sub-working group named the New Drugs Committee
(NDC) which will advise and make recommendations on the issues surrounding
newly licensed products to the SMC. The SMC Process requires pharmaceutical
companies to complete a New Product Submission form. The aim is to make a
recommendation soon after the launch of a product. The timescales involved
require the submission to be made ahead of product launch
For more
information on the NHS in Scotland visit
www.show.scot.nhs.uk
Guide to the NHS in Northern Ireland
There are four
Health and Social Care Boards that are responsible for assessing the
needs of their respective populations and commissioning services to meet those
needs. They are charged with the establishment of key objectives to meet the
health and social needs of their population and the development of policies and
priorities to meet those objectives.
They are supported by four
Health and Social Services Councils, independent organisations which
represent the views and opinions of the general public in all areas of health
and social services.
15 Local Health and Social Care Groups are
responsible for planning and delivering care provision.
For more
information on the NHS in Northern Ireland visit
www.n-i.nhs.uk
FAQs
Q How can I find out more about the current NHS
business environment and how it could effect my products?
A As well
as the resources listed in answers below, consider contacting PDC Healthcare.
The PDC Healthcare consultancy team is made up of experienced pharmacists and
NHS managers as well as people with a highly successful track record in selling
to the NHS. 80% of our consultancy business is directly with the NHS and
General Practices and Pharmacies. With this unique combination of the insider
perspective and commercial skills we are now helping suppliers to thrive in the
current NHS environment.
Q How do I find out more about NHS
policy and plans?
A An excellent place to look is on the department
of health website at www.doh.gov.uk.
Q How do I find out about
my local PCTs, StHAs and Hospital Trusts?
A The website at
www.nhs.uk provides links to
local PCT and Trust sites
Q How can I find local CHAI
reports?
A The may be on the Trust website or the CHI website at
www.chi.gov.uk
Q How can I find out if PASA are planning to purchase our products
nationally?
A www.pasa.doh.gov.uk is the PASA website. You can also look
on the DOH site at
www.doh.gov.uk/purchasing/tenders.htm. Local procurement
managers in your hospital may be a source of information too.
Q
Where can I find out more about the new GMS contract?
A A copy of
the contract and its appendices are available on the DOH website at
www.doh.gov.uk. Talk to GPs
and Practice Managers.
Q Where do I find out more about the
changes in pharmacy?
A Visit the Royal Pharmaceutical Society of
Great Britain website at www.rpsgb.org.uk or the DOH website at
www.doh.gov.uk
