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

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

England - Local PCT News

Michael Sobanja, NHS Alliance Chief Executive and a Director of Health Direction, takes a look at the NHS Environment in 2007 providing useful insight for all those engaging with the NHS

In England probably the key news is around money, practice based commissioning and the pressure on medicines management and the pharmaceutical industry, and perhaps these are all interrelated.

The financial picture is confused, on one hand the NHS is heading for a massive overspend in a number of local health economies, but on the other, the centre now predicts a small surplus for the NHS as a whole. This can be accounted for by recognising that reserves, top slices and other accounting “tricks” will be used to balance the books. Whilst the Secretary of State seems to indicate that growth after 2007/8 will be in excess of 3% (Patricia Hewitt was taking part in a question and answer session on the 10 Downing Street website) this is not as good as it looks as NHS inflation is running at around 3.9% currently – leaving a significant deficit at this level of funding.

Coping with this level of financial stringency means that PBC has to work – good service design means good financial management and David Nicholson, the new chief executive of the NHS recently tried to demonstrate that the most efficient can also be high quality. Few will be completely convinced.

All of which means that the pressures on prescribing and medicines management is unlikely to go away, and may intensify. Developments to the performance matrix will now target other medicines than just statins, and there is unprecedented pressure to get clinicians to “toe the line” in prescribing. Link this to the review of NICE and the just released OFT report on the PPRs means the squeeze on pharmaceutical companies is tightening and may be orchestrated across a number of areas.

The Scottish, Welsh and Northern Ireland news demonstrates how different life is in the UK NHS components – now and increasingly independent and different as devolution develops. The abolition of prescription charges in Wales, no overspends in Scotland, and the more traditional agenda in Northern Ireland mean that the only viable UK strategy for pharmaceutical companies is to have local approaches at both country and local health economy level.

Meanwhile we have conservative policy announced – more of same, but harder, faster and better. When will the NHS have room to breath and consolidate? When it does, perhaps the pressure on the industry to reflect will lessen. In the meantime, the changes are biting hard and look to continue in the future.

Pharmaceutical Marketing Supplement - A guide to NHS Reforms

We hope you will forgive a plug for these supplements which run for five months starting with the first insert in the February Edition of Pharmaceutical Marketing. There are lots of thought provoking articles (including ones from Mike Sobanja). If you haven't seen them, then email us and we will send you pdf copies of the February and March supplements.

England - Local PCT News

Bristol Royal Infirmary - CHD

Following a successful year-long pilot, patients who are taken to the Bristol Royal Infirmary with a heart attack will now be treated by angioplasty rather than thrombolysis. Immediate angioplasty will now be available 24 hours a day, 7 days a week.

It is estimated that if all heart attack patients in the UK received immediate angioplasty, there would be 500 fewer deaths per year, 1,000 fewer repeat heart attacks and 250 fewer strokes. Dr Andreas Baumback, Lead Consultant Cardiologist, said the new service would also cut the time patients spend in hospital, as there is less damage to the heart.

The Department of Health has recently approved plans for a new Regional Centre for Adult Heart and Chest Treatment and Surgery.The £65m development is a joint project of United Bristol Healthcare NHS Trust and North Bristol NHS Trust. It includes a new Regional Adult Cardiothoracic Centre to be built at the back of the BRI, plus expanded cardiology facilities at Frenchay Hospital

Cornwall PCT - Out-of-Hours

Cornwall's out-of-hours service was taken over by SERCO in April 2006, but there has been a great deal of local protest about poor service. The 3-year OOH contract is due for review in April and the PCT has given SERCO 20 days to improve their service.

Eastern Kent & Coastal PCT (Shepway) - Medicines Management Team

The Shepway Medicines Management Team was the Kent Regional Winner in the NHS South East Coast Best of Health Awards, for helping to reduce dependence on tranquilizers and sedatives.

The Shepway area had a 14% higher prescribing rate for potentially habit-forming mild tranquilizers and sedatives, with some GP practices two or three times the national average. In 2005, the Medicines Management Team set up a dedicated withdrawal clinic in one of the high-prescribing practices. 56 patients were invited to attend, and 45 have either reduced or stopped their medication.

Hull and East Yorkshire NHS Trust - Chronic Cough Clinical Trials

Professor Alyn Morice runs clinical trials into chronic coughs at Castle Hill Hospital, Cottingham, and is currently looking for people with smoking-related breathlessness or a recent chest infection which has left them with a cough for more than 2 weeks.

Hull tPCT - Home Monitoring Systems

The PCT has introduced the Doc@Home system for 10 patients with long-term conditions. The hand-held portable device allows the remote monitoring of pulse, blood pressure and weight and can alert the Community Matron to potential problems.

Leicester City PCT - GP Commissioning

Two GPswSI in Musculoskeletal Conditions have been held up by the PCT as good examples of how practice-based commissioning can enable GPs to use their clinical knowledge and experience to re-engineer services and benefit local people. Most patients referred to hospital with musculoskeletal problems do not require an operation, so the two GPs were commissioned to provide a variety of services for patients with musculoskeletal disorders.

Dr Patrick Wheeler runs a Musculoskeletal Sports and Exercise Medicine Clinic at his practice in Astill Lodge Road, and Dr Newley runs a Musculoskeletal Medicine Service at his surgery at The Maples, Evington Road. The services particularly aim to make services more accessible for patients from nearby practices, but are open to all practices in the city. Negotiations are currently taking place with other GPswSI with the aim of providing further local musculoskeletal services in the community.

Northamptonshire tPCT - Practice-based Commissioning

As part of the national move towards PBC, almost 60 GPs in Northamptonshire are investing in the Nene Healthcare Limited Liability Partnership (LLP), a new organisation which will enable patients to have minor operations and treatments closer to home.

Nottinghamshire County tPCT - Independent Pharmacist Prescriber

Beth Hird, Senior Practice Pharmacist for Notts County tPCT, has successfully completed the Independent Prescribing Conversion course and will be able to practise as an independent prescriber once she registers with the Royal Pharmaceutical Society. She said: "It is an exciting step forward for the profession to take on the professional responsibility of independent prescribing. It should lead to new roles for pharmacists, especially with the advent of practice-based commissioning, resulting in a more patient-focused NHS.”

Mrs Hird already runs a weekly asthma clinic at a local medical practice. She will now be able to prescribe independently for these patients, and will be able to extend the clinic to include patients with acute exacerbations and those referred by their GP for a diagnosis. She also plans to take on Statin prescribing within the practice.

Wiltshire PCT - 24hr Community Teams

Wiltshire PCT is planning the establishment of 11 new 24-hour Neighbourhood Community Teams across the county, working closely with GPs and comprising community matrons, nurses, therapists and rehabiliation staff. The lack of 24-hour community care means that some patients, whose condition could best be managed at home, have to be admitted to hospital.

The teams will be supported by new primary care centres in Trowbridge, Devizes, Salisbury and Malmesbury, and the replacement of some hospital departments with upgraded community hospitals in Chippenham, Warminster and Marlborough. There are plans for minor injuries units in Trowbridge and Chippenham.

Worcestershire PCT - Cervical Screening Provision

Worcestershire PCT has awarded the contract for cervical cytology screening services to Gloucestershire Hospitals NHS Foundation Trust. Screening services have been provided by the Worcestershire Acute Hospitals NHS Trust for over 30 years. The new out-of-county service was commissioned from Gloucestershire Hospitals after the submission of five competitive bids. The PCT is hoping to introduce liquid based cytology to the county by December 2007 - the deadline for implementation nationwide is October 2008.

Wales - Local Health Board News

Gwynedd / Anglesey LHBs - Proposed Partnership Working

Both LHB boards have proposed a new structure for collaborative working across the areas of Clinical Governance, Medicines Management and Patient/Public Involvement. The first meeting of the Joint Medicines Management Sub-Group should be held this month.

Monmouthshire LHB - Prescribing Report

The LHB's Prescribing Team has visited all local GP practices and has reported on progress towards achieving the All Wales Medicines Strategy Group (AWMSG) prescribing indicators. Now that the budget element has been removed from the prescribing incentive scheme, the Prescribing Team focuses on encouraging audit and education, and uses the AWMSG comparators to allocate points. There is a wide variation in the levels of achievement. The Chippenham surgery has championed the repeat dispensing process, and have worked with the LHB to roll this out to other surgeries in Monmouthshire. Only three practices have not achieved the generic prescribing target of 78%.

With regard to statin prescribing, Vauxhall surgery has championed the statin switch in Monmouthshire, with a simvastatin prescribing rate of 78%. Dr Jarrett's (Usk) has been asked to consider switching to Simvastatin 40mg, but has expressed concerns over gastric side-effects - a small trial is underway. Wye Valley surgery has not adopted the statin switch, and also has the lowest generic prescribing rate in the LHB. Old Station surgery was targeted for the statin switch because it has a large number of patients on statins and could save around £37k pa. Mount Pleasant surgery uniquely prescribes Rosuvastatin, and the LHB is currently working with the practice and Gwent LMC on this issue.

Neath Port Talbot LHB - Respiratory Working Group

A Respiratory Working Group has been set up in Neath Port Talbot, comprising healthcare professionals from both primary and secondary care. Neath Port Talbot has the highest levels of respiratory illness in Wales. A local practice nurse with a special interest in respiratory disease is spearheading the joint LHB and Trust partnership, which is hoping to arrange Respiratory Workshops every quarter. The first COPD workshop was held last November.

Pembrokeshire LHB - Nursing Services

The Director of Nursing at the LHB has reported on the new Anti-Coagulation Pilot in GP surgeries, the Diabetic Link Project and the introduction of the new Chronic Condition Nurse Practitioner. The Anti-Coagulation Pilot will involve practice nurses taking a finger-prick blood sample and using a Coagucheck device with INRstar software to calculate the Warfarin dose. Saundersfoot Surgery is the first to start this service, with Newport Surgery to follow as soon as staff are trained.

The Diabetic Link Project will be co-ordinating practice nurse training in diabetes. Practice nurses will be seconded to work one day a week at Withybush, where Diabetic Services are led by Consultant Dr Paul Underwood. The nurses will work with the Diabetes Team and the Diabetes Specialist Nurse and it is anticipated that this initiative will improve the consistency in Diabetes Services across Pembrokeshire. Fishguard is the first practice to take part in the scheme. Pembrokeshire introduced two Chronic Condition Nurse Practitioners during the winter, in partnership with Health & Social Care services. It is hoped that they will help provide a more co-ordinated service for patients with long-term illness.

Scotland - Local NHS News

NHS Highland - Heart Failure Service

The NHS Highland Heart Failure Service will start in April, with five BHF Heart Failure Nurses helping heart disease sufferers to keep healthy and stay out of hospital. The nurses will work alongside the Direct-Access ECHO service which helps GPs diagnose heart failure, and has been funded for the next five years by the BHF and NHS Highland.

Mandi Smith is Lead Heart Failure Nurse, and the five nurses will work with community staff across the board. One part-time nurse will cover Caithness and Sutherland, two nurses will cover Ross-shire and Lochaber, and one part-time nurse and a full time nurse will cover Inverness, Nairnshire, and Badenoch and Strathspey. Chronic Heart Failure is the most expensive cause of hospital admissions in people over the age of 65 in the UK. In 2004, there were 6,083 bed days for heart failure in the Highlands, 4,004 of which were in the acute hospitals. Most patients are aged between 60 and 70.

NHS Lothian - Renal Website

The Royal Infirmary's Renal Unit has developed a website which offers patients information about their condition, and has become recognised as a valuable teaching tool for patients, staff and students. The website was written and put together by members of the staff of the renal unit, and is available at www.edren.org.

The unit was also one of the first centres to pilot the national website www.renalpatientview.org when it was launched in 2005. This site provides online information to renal patients about their diagnosis and treatment, and allows them to access individual pieces of information, including their latest test results the day after they are done.

Northern Ireland - Local NHS News

Northern Ireland - Regulation & Quality Improvement Authority (RQIA)

The Regulation and Quality Improvement Authority (RQIA) has begun a programme of review visits to every health board and trust area - this is the first independent assessment of the Quality Standards for health and personal social services in Northern Ireland.

In October 2006, each board, trust and agency completed a self-assessment form to examine the first two themes of the Quality Standards:

- corporate leadership and accountability
- safe and effective care

and these themes will be examined in detail at the review visit.

The RQIA was established in April 2005, and is responsible for monitoring, regulating and reporting on the quality of care and services, rather like the Healthcare Commission in England and Wales, and the NHS Quality Improvement Scotland.

Nurse and Pharmacist Independent Prescribing - Implementation Guidance

Guidance has now been published on nurse and pharmacist independent prescribing, providing both information and advice on good practice. Over 200 nurses are currently trained in NI, and the first Pharmacist Independent Prescribers qualified this January.

Sperrin Lakeland Health & Social Care Trust - CHD

A cardiologist at the Erne Hospital in Enniskillen has expressed doubts about the Department of Health initiative to prescribe more generic statins. He said that CHD patients in his locality tended to have very high levels of cholesterol and may need more potent statins. He added that cost should not come into the equation. Dr Mahendra Varma is also vice-chairman of the Northern Ireland Chest, Heart and Stroke Association.

The Department of Health has said that switching the one million patients currently on branded atorvastatin to simvastatin "should have no effect on health" and would save the NHS £1.1bn over five years. It also notes NICE's confirmation that generic versions of statins are as effective for most patients as their more expensive, branded counterparts.

Western HSSB - New Health Centres

The Western HSSB is preparing an outline business case for the provision of new health centres across the region, involving 86 separate projects. The aim of the programme is to provide healthcare as close to local communities as possible, and in a modern setting. There is a particular emphasis on improving existing GP practices, providing new facilities for people with learning difficulties and mental health issues, and increasing support services for children and older people.

Discussions in Fermanagh involve new health centres in Lisnaskea and Irvinestown, a complete refurbishment of the health centre in Belleek, and provision of new services at Enniskillen, initially at the existing health centre but eventually at the Erne Hospital site once the new hospital is built in 2011. A new GP surgery may be sited at Derrygonnelly, and a practice may be re-positioned to cover the Kinawley/Florencecourt areas.

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