National Health Service (NHS), PCT & Local Health Board News - Jan 07

PBC Cluster Update

Health Direction have identified 1105 PBC Clusters in England. This consists of 618 Clusters (containing more than one practice), 463 Individual Commissioning Practices and 24 PCO Commissioning Clusters. There are currently 68 Clusters still finalising their membership.

This is a very fluid situation and requires constant dialogue with PCTs, PBC Clusters and Practices. Health Direction, in partnership with the NHS Alliance, is at the forefront of mapping these changes, so crucial to understanding how commissioning is developing in the England NHS.

Prescribing Performance

Sue Knox, the Business Development Director at Health Direction and a current prescribing advisor to a Gloucestershire practice looks at Prescribing Performance In Terms Of Potential Statin Savings And Forecast Outturn On Prescribing Budget

The NHS Institute for Innovation and Improvement (1) via its NHS Indicator Explorer web tool has made available for each (old) PCT comparative information for the percentage of statins which are prescribed as low cost statins (generic simvastatin and pravastatin) and the potential cost savings if a PCT was to switch 69% of all statin prescribing to low cost statins.

All PCTs are tasked with making savings against the prescribing budget as this has been factored into the PCTs Financial Recovery Plan and so it is interesting to look at the potential for a particular PCT to save money by changing statin prescribing in conjunction with its forecast prescribing outturn and its overall financial performance.

There are 44 PCTs whose forecast outturn against the prescribing budget for 2006/07 is likely to be an overspend or breakeven position (based on prescribing budget outturn data aggregated for the component (old) PCTs for 2005/06) Of these, 36 PCTs have potential to make enormous annual savings by switching to low cost statins.

Conversely, PCTs who have already achieved savings from switching to low cost statins will need to pursue alternative strategies to release cash savings from prescribing, particualrly if they are forecast to overspend against their prescribing budget in 2006/07.

Case Study 1: Lincolnshire Teaching PCT
(pre October 2006: West Lincolnshire PCT, East Lincolnshire PCT and Lincolnshire South West PCT)
Lincolnshire Teaching PCT is likely to overspend against the prescribing budget for 2006/07 but could make £2,360,000 annual savings if 69% of statin prescribing is changed to low cost statins. This is likely to be a key component of any prescribing action plan for the remainder of the current financial year and beyond. In terms of overall financial performance, (old) East Lincolnshire PCT, one of the component PCTs of the Lincolnshire Teaching PCT was one of the Trusts with the worst financial performance who received a letter from the Secretary of State for Health or from the NHS Chief Executive regarding its financial management for the year 2005/6. Lincolnshire PCT is forecast a deficit for 2006/07 although expects to breakeven by 2007/08.

However, achievement of cost savings through implementation of statin prescribing changes is also influenced by other factors within the Medicines Management Team, such as cohesiveness of the Team under the new structure. The component PCTs of the new Lincolnshire Teaching PCT worked well together before structural changes and so are starting to move forward with a cohesive approach to medicines management.

Case Study 2:Middlesbrough PCT
(structure unchanged post October 2006)
Middlesbrough PCT overspent against its prescribing budget in 2005/06 and is likely to overspend in 2006/07 but has no potential to make any savings from switching to low cost statins as this work has already been done. Although the financial performance during 2005/06 was an overall small underspend, against a total budget of £234.214m, cost pressures from the £243,600 prescribing overspend and £186,000 primary care overspend will be key targets for cash savings in 2006/07.

As the structure of Middlesbrough PCT remained unchanged post October 2006, the effectiveness of the Medicines Management Team can be assumed to be as it was pre October 2006 and therefore will continue its input into implementing prescribing change, which, whilst to date has not achieved financial savings, has achieved the prescribing indicator target for statin prescribing as defined by the NHS Institute for Innovation and Improvement.

In conclusion, to effectively target resources and create beneficial partnerships with PCTs, Pharma companies need to fully understand the interaction between forecast prescribing budget outturn, forecast overall financial performance and any cost saving measures that may be included in prescribing action plans and prescribing incentive schemes and use this knowledge to develop personalised strategies.

(1) NHS Institute for Innovation and Improvement at http://www.institute.nhs.uk/ accessed 22 January 2006.

England - Local PCT News

Cumbria PCT - Diabetes Care for the Elderly

A project based at Cumberland Infirmary which aims to improve the lives of elderly people with Diabetes has won the Arun Baksi Award for Team Innovation in Diabetes Care at the annual Diabetes Conference on the Isle of Wight. The project was started after an audit highlighted the prevalence of diabetes in nursing and residential care homes, and the need for extra staff training.

A project team was established and a training plan developed, which has been implemented by a nurse educator (Diane Heeley-Creed) and a community-based dietician (Katrina Brown). Over the last two years, they have delivered diabetes training to 50 nursing and residential care homes in the area, and 313 members of staff have received certificates of attendance for completing the training. The sessions cover all aspects of diabetes care, and suggestions by staff led to further training in hypoglycaemia, blood glucose monitoring and dietary issues. Information and new blood glucose meters have been supplied and each home now has a named diabetes link nurse.

Leeds PCT - Community Cardiac Service

The new city-wide Community Cardiac Service was officially launched in October. This nurse-led service provides support and advice to patients after they come out of hospital following a heart attack, surgery or following a diagnosis of heart failure. Cardiac Services Project Manager, Claire Worsman, emphasised the partnership aspect of the new service, praising Leeds Leisure Services, Leeds Teaching Hospitals and the Yorkshire Ambulance Service, as well as colleagues from the community and voluntary sector. "The service we now offer to patients and health care workers, providing care and support to people following a cardiac episode, is first rate thanks to the fact that everyone involved works so well together. We should be very proud of that."

Leeds PCT - Multiple Sclerosis

The Leeds Community Multiple Sclerosis Team (LCMST) is the only one of its kind in the country. It is jointly funded, until October 2007, by the PCT, the MS Society and the Disability Modernisation Team, and is currently being evaluated so that good practice can be shared nationally. A recent networking event was held with healthcare professionals in Yorkshire and the North East, to encourage joint working and explore ways of implementing the latest NSF for Long Term Conditions. A particular focus was the new links with palliative care services which are developing in Leeds. Another key area of work is the development of an MS Pathway, which will feed into the development of the Neuro Care Pathway for Leeds.

Medway PCT - Nurse-led Community Heart Failure Service

The Medway Heart Failure Team won the cardiovascular category at the recent National Guidelines in Practice Awards, were runners-up in the NICE guidance category and were nominated for the overall national award.

Norfolk & Norwich University Hospital NHS Trust - Link with Sudan

The Norfolk & Norwich Hospital Trust is a partner in the link programme with the University of East Anglia and the equivalent institutions in Gezira, Sudan. Partnership activities will include visits to both hospitals for training purposes. For example, Wadmedani Teaching Hospital has identified a lack of formal training for nurses, so the Norfolk & Norwich Hospital is developing a structured training package both for general nursing and for specialised nursing (infection control, critical care and diabetes). It is expected that two or three training packages will be delivered in 2007. The Norfolk & Norwich Hospital will also host two visits of up to six staff from Wadmenani Teaching Hospital during 2007, to observe medical, surgical and diagnostic procedures.

North Bristol NHS Trust - Respiratory Services

New Community Respiratory Services were launched in October, and are already preventing unnecessary hospital admissions and helping newly-discharged patients to be supported at home. The Respiratory Redesign Project Manager is Ruth Seaton. Patients who experience breathing problems now have access, via their GP, to specialist respiratory doctors and nurses at the new urgent "hot" outpatient clinic, which is held five days a week at Southmead. Appointments are provided on the same or next day, and hospital admissions have been avoided in three quarters of cases.

Referrals are from GPs in Bristol, South Gloucestershire and North Somerset. The majority of specialist hospital treatment is now provided at Southmead rather than being duplicated at Southmead and Frenchay. The expansion of the Acute Respiratory Assessment Service (ARAS) specialist nurse team enables patients to be discharged from hospital and supported in their own homes throughout the week, including at weekends.

North Yorkshire & York PCT - GP Saturday Opening

The Priory Medical Group at Lavender Grove Surgery in York, will be opening on a Saturday for routine appointments from 6th January 2007. The group has 37,000 patients and the scheme is being funded from the group's own cash resources.

Wirral Hospital NHS Trust - Dermatology Proposals

Wirral Hospital NHS Trust's Special Surgery Directorate has presented a business case to develop the Dermatology Service into a Centre of Excellence for skin cancers and major inflammatory skin conditions, covering the population south of the Mersey, including those in North Cheshire, Chester, Wrexham and Wirral (986,000). It is expected that the new centre will attract income from the diagnosis and treatment of complex skin cancers as well as from major inflammatory skin conditions, and work in partnership with Wirral PCT. The PCT hopes both to relocate referrals for less severe dermatological conditions into the community and to improve the new-to-follow-up outpatient ratio.

Plans include: better usage of inpatient beds/daycase unit in order to reduce admissions and length of stay for major inflammatory skin conditions, expansion of current service for children with infantile eczema, the incidence of which is increasing and development of Intermediate Dermatology Service (GPwSI and Dermatology Specialist Nurses)

Investments required include: Skin Cancer Nurse to comply with IOG guidelines Medium Term, A Consultant Dermatologist trained in Moh’s technique and One session of Clinical Psychologist per week.

Wirral Hospital NHS Trust - Haematology Proposals

The Trust has heard an outline business case for the appointment of a third Consultant Haematologist, a Pharmacist, and the expansion of Day Case Facilities. The Medical Directorate currently has two Consultant Haematologists, performing a unique role as physicians and laboratory specialists, and it is hoped that the appointment of a third would both reduce any potential future threat to the lab's continued Clinical Pathology Accreditation status, and support an increasing clinical workload.

A significant reduction in patient facilities from 18 beds to 12 beds is also proposed, with a more concentrated reliance on activity delivered via day case or outpatient services. The Day Case Ward, which currently operates for five days per week, would be expanded to a seven-day-per-week facility. The appointment of a Pharmacist should ensure that cytotoxic treatments are made available in a timely manner and reduce the need for inpatient services. This should be helped by the displacement of non-complex treatments to evenings and weekends.

Wales - Local Health Board News

Caerphilly tLHB - Heart Failure

Rapid Access Chest Pain Clinics with electronic booking for GP practices have been developed at Caerphilly District Miners' Hospital. Early indications show that these clinics have been very successful, the uptake of slots excellent, and the number of slots per week was increased from four to five in November 2006. The introduction of the clinics has also reduced the waiting times for Echocardiography and Exercise Tolerance Testing, and patients requiring further tests are being referred on and seen more quickly.

A meeting in January 2007 will discuss the appropriateness of referrals and the clinics' future. The LHB has also made a successful bid for a BHF Clinical Nurse Specialist in Heart Failure for the County Borough, and details are currently being finalised.

Torfaen LHB - Heart Failure

Torfaen LHB is piloting Rapid Access Atrial Fibrillation clinics in slots currently unused in their Rapid Access Heart Failure Service, and the results will be fed back through the Gwent Cardiology Service Improvement Group.

Scotland - Local NHS News

NHS Forth Valley - Musculoskeletal

Research undertaken by NHS Forth Valley and Glasgow Caledonian University has indicated that patients who self-refer to an NHS Physiotherapist get treated earlier and need less time off work to recover. Dr Lesley Holdsworth and Dr Valerie Webster are now recommending that self-referral be introduced throughout the country.

The findings are based on data collected from more than 3,000 patients in 29 locations, including an island community. They show: back pain and lower limb problems are the most common complaints for self-referral; patients who self-refer are seen more quickly, are more likely to attend, and have an improved absence rate from work; there is no dramatic increase in the physiotherapy workload as less than a quarter of patients choose to self-refer themselves and each episode of care costs on average 25% less than referral via a GP.

Overall the savings to NHS Scotland could be around £2m a year (www.selfreferralphysioinfo.com).

NHS Lanarkshire - Sexual Health

Patients in the NHS Lanarkshire region will be the first in the UK to be offered screening for both chlamydia and gonorrhoea with a new urine test, which is easier for both healthcare professionals and patients than more invasive tests.

NHS Grampian - Scottish Medicines for Children Network

There have been major improvements in the safe and effective use of medicines in adults over the past 40 years, but the optimal use of medicines in children has remained problematic. The Scottish Medicines for Children Network (SMCN), launched in December, aims to address the current knowledge gap and thus facilitate a safer and more effective use of medicines in children.

The network is funded by the NHS and the Chief Scientist Office and is centred on Scotland's four main cities: Aberdeen (Lead Centre), Dundee, Edinburgh and Glasgow.

Within each centre, there will be collaboration between the NHS and relevant Universities and as the network develops this will roll out to all paediatric centres in Scotland and to primary care and community pharmacies. There are also formal links with the DoH Medicines for Children Research Network in England.

Northern Ireland - Local NHS News

Causeway HSS Trust / LHSCG - COPD

Causeway Hospital has received 3 DVD players from a local support group for use with the new Living with COPD DVD. The free DVD, funded by the LHSCG, shows patients how to manage their COPD and demonstrates an exercise programme adapted for the home.

Northern HSSB - Pharmaceutical Network

The Community Pharmacy Palliative Care Service is a network of 12 pharmacies in the Northern Board area providing specialist information and advice, and stocking a range of specialist palliative medicines for patients who are being cared for at home.