National Health Service (NHS), PCT & Local Health Board News - February 2007

PBC Cluster Sophistication Index

The Practice Based Commissioning Cluster Sophistication Index, designed and scored by Health Direction Consultants is an exciting new development which complements the fully revised, industry standard PCO Sophistication Index. Currently a key change in the NHS is the move to Practice Based Commissioning of services. This is generally happening by groups or clusters of practices joining together to start the commissioning process and redesign services. A key first focus is the stopping of unplanned/emergency admissions to hospitals which cost the NHS an enormous amount of money.

Pharmaceutical companies need to concentrate on the PBC Clusters that are at the forefront of service redevelopment. Health Direction have designed their PBC Generic Sophistication Index to pinpoint these movers and shakers. They are identified by compiling a score for each cluster using up to 18 different criteria from the history of the PBC Cluster formation to the level of emergency admissions. The weighting given to each criteria are discussed and agreed with each client.

This generic or organisation effectiveness analysis is complemented by a disease specific analysis to create a 2 x 2 segmentation strategy, which is simple to understand and act upon but has objective, rigorous intelligence under the hood. The new PCO and PBC Sophsitication Indexes have been delivered to three pharmaceutical companies in their first month of release and we would be happy to come and discuss how this unique offering could support your 2007 NHS market access and engagement strategy.

Northern Ireland Structure – February 2007 Update

At last, how Northern Ireland is planning to manage their health care system is becoming clear. The key changes are:

- The 4 Health and Social Boards will be replaced by 1 Strategic Health and Social Services Authority
- The 15 Local Health and Social Care Groups will be abolished and replaced by 7 Local Commissioning Groups
- The 18 Trusts will be replaced by 5 Health and Social Services Trusts, with the Ambulance Service continuing as a separate Trust
- The 4 Health and Social Services Councils will be replaced by 1 Patient and Client Council

It has taken significant investigation by Lisa Hudson, our Northern Ireland specialist to understand the chronology of these headline changes so we hope the following will be of use!

Immediate Changes

Local Commissioning Groups (LCG) - in shadow form - have now replaced Local Health and Social Care Groups (LHSCGs) which stood down in September 2006. These won’t become fully operational until April 2008. In the interim, the four Health and Social Services Boards (H&SSB) are commissioning for the practices in Northern Ireland. A joint committee of the four existing Health and Social Services Board has been set up to prepare for the beginning of local commissioning.

April 2007

Health and Social Services Trusts

The 18 trusts in Northern Ireland are replaced by 5 Health and Social Services Trusts, which have been shadowing the 18 Trusts since the end of 2006. The five Health and Social Services Trusts are as follows:

- Western Area Trust - Chair; Gerard Guckian Chief Executive; Elaine Way
- Northern Area Trust - Chair; James Stewart Chief Executive; Norma Evans
- Southern Area Trust - Chair; Anne Balmer Chief Executive; Colm Donaghy
- Belfast Area Trust - Chair; Patrick McCartan Chief Executive; William Mckee CBE South
- Eastern Area Trust - Chair; Denise Fitzsimmons Chief Executive; John Compton

April 2008

Local Commissioning Groups

The seven Local Commissioning Groups assume full operational responsibility. They are co-terminus with the new local government boundaries and are as follows:

- Belfast LCG - coterminous with Belfast City Council
- North East LCG – coterminous with Ballymena, Ballymoney, Coleraine, Larne and Moyle Councils
- Inner East LCG – coterminous with Antrim, Carrickfergus, Lisburn City and Newtownabbey Councils
- East LCG – coterminous with Ards, Castlereagh, Down and North Down Councils
- South LCG– Armagh City & District, Banbridge, Craigavon and Newry & Mourne Councils
- North West LCG – coterminous with Derry, Limavady, Magherafelt and Strabane Councils
- West LCG – coterminous with Cookstown, Dungannon & South Tyrone, Fermanagh and Omagh Councils

The Health and Social Services Authority (HSSA)

The Health and Social Services Authority assumes full operational responsibility from the four Health and Social Services Boards (Eastern, Western, Northern and Southern) The role of the HSSA is to implement the Government’s policies for health and social services and to manage performance of the system. The HSSA will also work in conjunction with the local commissioning groups, to commission services in a two-way relationship, meeting the demands of patients. David Sissling has been appointed the HSSA Chief Executive Designate and took up his post from August 2006. In addition, the New Education and Skills Authority and statutory Education Advisory Forum become operational.

England - Local PCT News

Bournemouth and Poole PCT - Heart Failure

The Better Together service is a joint initiative between the PCT, Marie Curie Cancer Care and the British Heart Foundation (BHF) which was launched last September. It aims to provide the best possible care for heart failure patients and allows them to be cared for at home in the final stages of their illness. Elaine Rouse, Poole BHF Heart Failure Nurse, said that one of the benefits of the scheme was that she now felt more aware and confident in dealing with end-of-life issues with patients. The main expense is the cost of a Marie Curie nurse on night shift, and this is split between the local PCT and the BHF. It is hoped that the year-long pilot will pave the way for more joint working on diseases such as COPD.

Cambridgeshire PCT - Medicines Management

A report from Sue Ashwell, the PCT's Chief Pharmacist, will be presented to the PCT board this month outlining the proposed development of the Cambridgeshire Approach to the Management of Prescribing and Prescribing Costs. The introduction of a county-wide primary care Red List is one examples of how the new strategy for appropriate, effective and affordable prescribing will be implemented. There has been a great deal of progress in improving the quality and cost effectiveness of prescribing in Cambridgeshire over the last three years and Medicines Management teams have helped practices reduce costs by around £2m.

However, there are still significant variations in prescribing costs between areas and practices which are not easily explained. This is currently being explored, and the Red List is one step in that process of adjustment. The Red List has been circulated and was implemented from 1st January 2007, operating alongside a Cambs-wide Primary Care Formulary which was developed at the request of the PEC and in partnership with local hospitals. The PEC has agreed to provide ongoing support for the Medicines Management team in engaging practices more actively in managing their prescribing budget as part of Practice- Based Commissioning.

Doncaster PCT - Unplanned Care

Following a 12-week consultation, Doncaster PCT has approved changes to its local unplanned care services which will see the current Accident and Emergency Department at Doncaster Royal Infirmary split between two distinct functions. One section will be based on the American-style Emergency Room, dealing with serious and life-threatening conditions like heart attack and trauma. The Unplanned Care Centre, which will be the first of its kind, will treat less urgent cases such as sprains, cuts and bruises.

Patients will ring a single number (yet to be agreed) and will then be connected to an appropriate healthcare professional (GP, nurse, pharmacist etc). The current 999 number will be retained for emergencies, and assurances were given that the call centre personnel will be well-trained and locally-based. The changes will be introduced over the next two years, and should by up and running by 2009.

Eastern & Coastal Kent tPCT - MS Nurse

MS sufferers in Sittingbourne have expressed their support for Nurse Specialist Sylvie Hurst, who runs an MS clinic at the Memorial Hospital (ex Swale PCT). It is feared locally that the funding for the MS Nurse Specialist is under threat.

Haringey tPCT - Community Pharmacies

Seven community pharmacies in central Crouch End have united against the PCT's proposals to move GPs from the area into the new Hornsey Central Hospital development. The development will also house it's own community pharmacy.

Lewisham PCT - Community Pharmacy Anti-Coagulation Service

Lewisham PCT has been working with local pharmacies for the past 18 months to expand services for patients who take blood-thinning medication. Six pharmacies now provide an anti-coagulation service which saves patients having to attend a hospital. More than 500 patients are using this service, and it is anticipated a further 500 patients will join the programme by May. Kath Howes is Lead Pharmacist for the community-based anti-coagulation service. She said that most patients think the pharmacy is an appropriate place to monitor their condition, and they get to see a pharmacist for longer than they did under the old system. "But on top of that, appointments cost less in the community, so we are using resources more appropriately."

Pharmacies running clinics are:

- Day Lewis Pharmacy, 443 Downham Way
- Lloyds Pharmacy, 48 Randlesdown Road
- Wise Pharmacy, 363 Sydenham Road
- Logans Pharmacy, 465-467 New Cross Road
- Baum Pharmacy, 10-12 Manor Park Parade
- Sheel Pharmacy, 296-298 Lewisham High Street

Milton Keynes PCT - Choose and Book

It is being reported that the PCT has requested all future referrals, with a few exceptions, are to be sent via Choose and Book, and that it has made arrangements for any letter or fax referral to Milton Keynes General to be returned to the referring GP.

Norfolk PCT / Great Yarmouth & Waveney PCT - Out-of-Hours

The PCTs have invited expressions of interest from Out-of-Hours providers for a comprehensive OOH service for their populations, commencing from August 2007. The current GP out-of-hours service is provided by Anglian Medical Care.

North East Essex PCT - Community Pharmacy Weight Loss Programme

The PCT has launched a free weight loss programme which is being provided through eight community pharmacists: four in Colchester and four in Tendring. People taking part in the programme will be seen on an individual basis in a private consulting area, will have their weight, BMI and blood pressure recorded, and will be given information on nutrition, lifestyle and physical activity. The programme runs for 12 weeks. The PCT Health Promotion Co-ordinator is Mel Idroos. She said: “Those taking part must be motivated and committed to making lifestyle changes and they will be supported in losing 5% to 10% of their body weight."

Participating pharmacies are:
(Colchester)

- Alliance Pharmacy, Long Wrye Street
- Sainsbury's Pharmacy, Tollgate West
- Crouch End Pharmacy, Crouch Street
- Day Lewis Pharmacy, St Christopher Road

(Tendring)

- Day Lewis Pharmacy, The Triangle, Frinton-on-Sea
- GP Pharmacy, The Green, Great Bentley
- Day Lewis, The Parade, Halstead Rd, Kirby Cross
- Alliance, North Road, Clacton

North Yorkshire & York PCT - Suspension of Procedures

The North Yorkshire and York LMC has written to the PCT about its plans to limit a wide range of procedures to exceptional cases only. Patients who have been referred to secondary care for certain operations will have their cases submitted to a Prior Approval Panel. The procedures include IVF, epidurals for back pain, lumbar spine x-rays, joint injections, vasectomies and removal of non-malignant skin lesions.

The LMC has already objected strongly to these proposals and voiced fears that any medics who are on this panel could be sued by patients. A spokesman from the PCT said the organisation would be responding directly to the LMC, was continuing to talk to GPs and hospitals, and welcomed their comments. He stressed that there was no outright ban on any procedure.

South Staffordshire Healthcare NHS Trust - Bi-Polar Disorder

Staff in Wombourne were concerned that they were not adequately meeting the needs of the large number of people in the Seisdon peninsula with Bi-Polar Disorder. They arranged a two-day workshop at St David's House, which included information on medication from a pharmacist, and advice on effective self-monitoring of mood disorders. It is hoped this will lead to fewer admissions and greater involvement of patients in their own care, in collaboration with their GP and other members of their care team. The intention now is to provide ongoing support by promoting and organising a monthly Bi-Polar support group.

Suffolk PCT - CHD Prescribing

Orchard House Surgery will save £11,760 pa after changing cholesterol-lowering drugs. Dr Wace explained that he informed around 120 patients of the change to a better value medicine, and then spent a couple of hours over one evening making the switch.

Swindon PCT - Smoking Cessation

The PCT has been working with Yates Bar in Bridge Street to offer drop-in Stop Smoking sessions in the pub on a Tuesday lunchtime. The idea is to help people give up before the ban on smoking in indoor public places comes into effect on 1 July.

Worcestershire PCT - ADHD

Concerns have been raised by the Citizens Commission on Human Rights (CCHR) over the number of children in Worcestershire who are being prescribed psychiatric medication for ADHD. The CCHR is a psychiatric watchdog group, and it reports that during 2005/6, a total of 7,760 prescriptions for ADHD drugs were written across the county, costing £364,000.

Dr Richard Harling, Consultant in Public Health at Worcestershire PCT, said that if a child or adolescent needs treatment with medication for ADHD then these medicines should all be considered as possible choices. "Treatment should only be started after a specialist who is an expert in ADHD has thoroughly assessed the child or adolescent and confirmed the diagnosis. Once treatment has been started it can be continued and monitored by a GP. Clinicians in Worcestershire work to the NICE recommendations to ensure that all children and adolescents get the care that they need."

Wales - Local Health Board News

Conwy & Denbighshire NHS Trust - New Cardiac Catheter Unit

The new Cardiac Catheter Unit has been opened at Ysbyty Glan Clwyd, which will save some patients from having to travel as far as Manchester for treatment. This is one of six new units to have opened in Wales following government and lottery funding:

- Princess of Wales Hospital, Bridgend
- Morriston Hospital, Swansea
- University Hospital of Wales, Cardiff
- Royal Glamorgan Hospital, Llantrisant
- The Royal Gwent Hospital, Newport
- Glan Clwyd Hospital, Bodelwyddan

Swansea NHS Trust / LHB - Chronic Pain Clinic

Morriston Hospital's Chronic Pain Clinic may close because of a reduction in funding - new patients are already having to travel to Cardiff for treatment. The clinic has been funded on an ad-hoc basis for the past four years and has cost approximately £340,000. Sue Heatherington, the Chief Executive of Swansea LHB, has called for more chronic pain services to be sited within the community. It is thought that chronic pain blights the lives of one in five people in Swansea, and ranges from severe back pain and arthritis to migraines and pins and needles following strokes

Wales - Free Prescriptions

Prescriptions in Wales, which are currently £3 per item, will be free from 1 April 2007. Dr Brian Gibbons, the Health Minister, said that one of the main reasons for this policy was to ensure that people are not deterred from getting their medication because of cost - especially those with chronic illness who are on modest incomes. "The move removes all the unfairness surrounding the present outdated 1968 exemption system where, for example, a diabetes patient automatically gets all prescriptions free but a cystic fibrosis sufferer doesn't."

However, he did stress that if patients who usually buy non-prescription medication over the counter changed their behaviour radically, it could have a detrimental impact on the NHS as a whole, and especially those most in need of free prescriptions. People who are registered with a Welsh GP, and Welsh patients registered with an English GP who have an entitlement card, can get their prescriptions free from a Welsh pharmacist.

Scotland - Local NHS News

NHS Grampian - Substance Misuse

Moray CHP is trying to help the growing number of heroin addicts requiring methadone by appointing a new GP who will be able to prescribe the treatment. Newspaper reports have highlighted the case of a patient who has been unable to register with a methadone replacement programme because her local GP in Aberlour no longer offers the service, and because she is not registered with the GPs in Dufftown and Elgin who do.

Andrew Fowlie, General Manager of Moray CHP, has said that the new GP is due to be appointed in the coming weeks. He will not be attached to any particular surgery, but will prescribe the treatment himself and support other GPs who already do so. There are between 50 and 60 people on methadone programmes in the area, nearly double the number three years ago, when there were no more than 30.

NHS Greater Glasgow & Clyde - Substance Misuse

A new treatment, developed at the University of Miami, is to be introduced to Glasgow in an attempt to help young people with addiction problems. The treatment, Multi-Dimensional Family Therapy (MDFT), includes family therapy sessions and involvement techniques as well as traditional methods. Professionals from Miami have been training 10 members of staff from the Glasgow Addictions Service, which is a partnership between NHS Greater Glasgow and Clyde and Glasgow City Council. The service will begin once their training ends in February.

Gemma McNeill is Senior Officer with the Glasgow Addiction Service, which is hoping to include 40 young people and their families in the pilot. If successful, MDFT will be rolled out across Glasgow. Scotland is one of only five European countries to be exploring MDFT - the Netherlands, Belgium, Switzerland, Germany and France are also in the process of training staff.

NHS Tayside - Chronic Pain Service

It is reported that NHS Tayside might stop accepting referrals to its Chronic Pain Service from Raigmore Hospital (NHS Highland) because local patients are experiencing longer waiting lists. The Tayside Integrated Pain Service is run by a team of doctors, nurses and psychologists and deals with both acute and chronic pain. Pain clinics are located across Tayside and can be found at:

- Strathcaro Hospital, Angus
- Ninewells Hospital, Dundee
- Perth Royal Infirmary

Raigmore Hospital, provides an acute pain service for people recovering from operations, but does not offer a chronic pain service for long-term patients such as amputees, those with nerve injuries or complex back problems. Consideration has been given to establishing a clinic in Inverness with a visiting consultant - NHS Highland would have to pay for the service. NHS Highland currently uses the services of both NHS Tayside and NHS Grampian.

Northern Ireland - Local NHS News

Eastern HSSB - Smoking Cessation

Smokescreen is a newsletter published by the HSSB providing information and advice to people who want to give up smoking. Topics include where people will and won't be able to smoke from April, and contact details for specialist support to stop smoking.

Northern Ireland - Reform of Public Administration (RPA) / Commissioning

The final consultation on the Health and Social Services Reform Order has begun and will end on 11 April 2007 - it will create a single Health and Social Services Authority, 7 primary care-led Commissioning Groups and a new Patient and Client Council. Following the public consultation exercise which ended in December 2006, the Minister for Health and Social Services, Paul Goggins, has also announced the formation of a Joint Committee to prepare for Local Commissioning. The committee will include representatives from the four existing Health and Social Services Boards.

Mr Goggins said: "Local health and social care professionals will play a leading role in planning and buying services that are responsive to the needs of the local community".

Southern HSSB - Stroke Services

A report on stroke services within the HSSB area was recently given to the board. Both Daisy Hill and Craigavon Area Hospital have dedicated stroke units with multi-disciplinary teams, and there are community rehab services with Big Lottery funding.

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