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

England - Local PCT News

Cambridgeshire PCT - Community Foundation Trust Application

Cambridgeshire PCT Provider Services has submitted an application to become one of 50 pilot sites across England to develop the model framework for community foundation trusts. PCTs are now both commissioners and providers of services, and it is felt that this requires an "arm's length" arrangement, with some formal separation between the two aspects of the organisation. The "stand alone" options considered by the PCT included:

- Trust
- Industrial and Provident Society (IPS)
- Limited Company
- Charitable Incorporate Organisation (CIO)
- Social Enterprise
- Community Foundation Trust
- Community Interest Company

Cambridgeshire PCT prefers the Community Foundation Trust option for several reasons, including increased freedom and flexibility (distance from DoH and SHA), the ability to focus on its core business, and the ability to compete in the health and social care market.

Heart of England NHS Foundation Trust / Good Hope Hospitals NHS Trust - Merger

A three-month public consultation has revealed that 85% of respondents are in favour of the proposed merger of the two hospital trusts. The final decision from Patricia Hewitt is due in April. This is an unusual merger, in that only Good Hope Hospital NHS Trust will be dissolved and its assets, liabilities and staff will be taken over by the Heart of England NHS Foundation Trust, which has been running Good Hope Hospitals on a management contract for the past year.

The new organisation would serve about a million people, from Solihull through Birmingham and into south Staffordshire. The Financial Times recently reported that this was likely to be the first of a wave of a dozen such acquisitions during the next two years.

Hounslow PCT - GP Services

The contract to run six GP practices was put out to tender in November 2006, and the PCT has announced that Greenbrook is the preferred bidder. The practices will continue to be run under the guidance of the Specialist Personal Medical Services (SPMS) team at the PCT until the contract details are finalised. They are:

- Bedfont
- Broadwalk
- Chinchilla
- Heston
- Isleworth, and
- Manor

Greenbrook is a Hammersmith company whose Clinical Director, Dr David Wingfield, is a member of Hammersmith & Fulham LMC, GP Representative on Hammersmith & Fulham PEC, and a GP at Brook Green Medical Centre (an NHS training practice).

Isle of Wight NHS PCT - Formal Joint Working with Local Council

The IoW NHS PCT is uniquely both a commissioning and providing organisation. It has now formalised its joint working arrangements with the local council with regard to the care of the elderly and vulnerable.

A Memorandum of Understanding will be launched in April which will see both organisations reviewing their property assets and agreeing a plan for property disposal. It is hoped that this will enable budgets to be used more efficiently to provide better care for the island's increasing elderly population while also helping to initiate a shift away from acute care to care in the community.

Norfolk PCT - Generic Prescribing

The PCT has received complaints about statin-switching and children's asthma medication following the introduction of its new computer script programme which suggests the most cost-effective drug each time a prescription is written. One patient claims to have been switched from Atorvastatin (£18.03 per month) to Simvastatin (£4.23 per month) without consultation, and believes the higher price is indicative of better quality and fewer side effects.

GPs are also being encouraged to prescribe Symbicort turbohaler (£16.30 per month) instead of Seretide (£31.19 per month), but a local paediatrician has voiced concerns that changing medication in a stable asthmatic child is not wise. The PCT has explained that no specific drugs are being targeted, but that GPs are being asked to consider cheaper drugs which are therapeutically the same across the prescribing spectrum.

Peterborough & Stamford Hospitals NHS Foundation Trust - Consultation

The Trust has proposed that Stamford Hospital be jointly managed by local GPs and the Trust, and advised by a board of governors made up of external partners. This would greatly increase GP influence on the provision of major new services and equipment at the hospital. The hospital was earmarked for closure in 2005, leading to a number of protests. However, the hospital argues that the government’s drive towards community-based care requires a reconfiguration of services, and it wants GPs to lead the reforms.

Simon Parkes is Practice-based Commissioning Manager at Lincolnshire tPCT. He said that as well as examining the proposed new management arrangements, they have been "analysing patient pathways and which new services we may be able to offer for patients at the hospital”.

This new partnership is thought to be the first of its kind in the UK, and comprises:

- Peterborough & Stamford Hospitals NHS Foundation Trust
- Welland Practice-based Commissioning Group (PBC)
- Lincolnshire Teaching PCT

The 12-week public consultation programme will run until June.

Shropshire County PCT - Statin Prescribing

Statin prescribing is a major component of the PCT's prescribing incentive scheme and several practices have agreed to switch to Simvastatin. Non-dispensing practices are more enthusiastic than dispensing practices as dispensing profits can be affected.

Southampton City PCT - Royal South Hants Hospital

Southampton PCT will assume ownership of the Royal South Hants Hospital site from Southampton University Hospitals NHS Trust on 31 March. The PCT is leading the strategy for the future development of the site, with plans to establish GP surgeries, dentists, nurses, dieticians and physiotherapists alongside community hospital services such as elderly care rehabilitation wards.

An Independent Sector Treatment Centre will also be developed, and Hampshire Partnership NHS Trust has plans to rebuild the Department of Psychiatry as an Adult Mental Health Unit under LIFT. Work on this scheme will start in 2007/2008 and the new facility should open in 2009/2010.

Suffolk PCT - New Practice-based Commissioning (PbC) Group

A new group has been formed to co-ordinate the 7 PbC clusters across the county. Leaders from the clusters will be finding the best commissioning strategies, checking hospital activity and costs, and will report to future board meetings.

Suffolk PCT - PMS/GMS Contract

It is being reported that Suffolk PCT has sent letters to its PMS practices informing them that the PMS contract will be terminated on 30 September. Options include signing a new PMS contract, returning to GMS or "withdrawing from NHS primary care". Currently, 46 of the 69 practices in the Suffolk PCT area are signed up to the PMS contract. Some health professionals fear that a new contract which results in a substantial drop in income would tempt some GPs to enter the private sector, and they are worried that there is no indication of what any new contract will involve.

Melanie Craig is Head of Performance at the PCT. She said that the reason for the review was to introduce fairer payments and make more service improvements. “The PCT proposes to phase-in the new payment structure over a three-year period so that the change is not destabilising for some GP businesses.”

Sunderland tPCT - Anti-Depressant Prescribing

Recent figures show that there has been an increase in the prescription of anti-depressants in Sunderland. Last year, 201,692 prescriptions were written - an increase of 15,000 within 3 years. However, the cost of this medication has fallen, so that last year's figure of £1.9m is much less than the £2.6m which was spent in 2003/4.

Dr Geoff Stephenson (Medical Director for Sunderland tPCT and a GP in Washington) said that this was probably because practices are more attuned to the treatment and management of depression, particularly in the light of the 2004 NICE guidance.

Concord (in Washington) and Southwick (in Sunderland) are the areas where the most anti-depressants are prescribed, followed by Pallion, Bunny Hill, and Springwell. The most commonly prescribed anti-depressants are: (no of items)

- Amitriptyline Hydrochloride (12,005)
- Fluoxetine Hydrochloride (Prozac) (11,105)
- Citalopram Hydrobromide (11,090)
- Venlafaxine (Efexor) (4,260)
- Paroxetine Hydrochloride (Seroxat or Paxil) (3,668)

West Hertfordshire PCT - Mental Health Services

An Enhanced Primary Care Mental Health service was established a year ago which provides anxiety, mood and anger management. It has proved so successful that waiting times can be up to eight months for one-to-one treatment, and only slightly shorter for group sessions. The PCT has said that more than 700 people have been referred, 450 already seen, and that it is investigating ways of reducing the waiting times.

Another pilot, a Primary Care Mental Health Team, has also been runnning for a year at five practices in St Albans and Harpenden. This offers access to computerised cognitive behavioural therapy (CBT) and there are plans to extend the service to all practices in the district. Waiting times for this service are around one month.

Wales - Local Health Board News

Monmouthshire LHB - Pharmacy Practice Development Scheme

The LHB Prescribing Team has received funding to train community pharmacists in brief interventions for early problem drinking. The scheme will commence within the next 6 months and will be run by the Alcohol Action Group and the local Public Health Team.

Neath Port Talbot LHB - Substance Misuse

A report on the local substance misuse services managed by Bro Morgannwg NHS Trust has been presented to the LHB. Staffing problems within the Community Drug Action Team (CDAT), coupled with the failure of the LHB to commission any GPswSI to prescribe for more stable patients, has caused the waiting list to increase to an unacceptable level.

There is also concern over the fact that, whereas the West Glamorgan service uses the abstinence model, the service model used by the CDAT is based mainly on maintenance - individuals can be receiving services for an average of seven years. It is felt that this is a critical issue for the LHB and an action plan has been agreed which will involve all appropriate agencies.

Scotland - Local NHS News

NHS Lothian - Kaizen Workshops

NHS Lothian has been working with GE Healthcare to introduce new "lean management" techniques such as Kaizen Workshops, which help staff at all levels to identify opportunities for service improvement. The Kaizen management principles were invented by Toyota and are now being used widely in healthcare.

CT scanning and delayed discharges were the first two areas targeted - waiting times for CT scans at the board's three main acute hospitals have been reduced to six weeks, the reporting of results to within 24 hours, and discharging patients earlier in the day has led to more beds being available for new patients on the same day.

NHS Shetland - Dementia Services Consultation

Forecast changes in Shetland's demography in the next 20 years have forced the health board to undertake a major review of services provided for people with dementia. The services are currently provided by the NHS Board, Shetland Islands Council, and the voluntary sector.

Stephen Mullay, Project Manager, said: " ... it is expected that the number of individuals with dementia will nearly double in the next 20 years. With the working population also in sharp decline, we will simply be unable to offer the service in its current form in the future and changes need to be made". It is conservatively estimated that approximately 290 people in Shetland currently have dementia.

Northern Ireland - Local NHS News

Armagh & Dungannon HSS Trust - Out-of-Hours Service

The first phase of a cross-border GP Out-of-Hours pilot project was launched in January, which means that people living in the border areas of Inishowen, Co Donegal, may now use the GP Out-of-Hours Service (Western Urgent Care) in Derry. The pilot will be closely monitored to address any issues which may arise and to determine how it could be extended further in the border region.

This is a Co-operation And Working Together (CAWT) project which is supported by the DHSPPS in Northern Ireland, the Dept of Health & Children in the Republic of Ireland, and which is part-funded by the EU. CAWT works towards health gains and social well-being in the border areas.

Northern Ireland - Review of Public Administration

The current Health & Social Services (HSS) Trusts will be dissolved at the end of March to be formally replaced by five area trusts in April. These new trusts have been shadowing the HSS Trusts since August 2006. This is part of the continuing Review of Public Administration (RPA). The new Health & Social Services Authority will be operational in April 2008, as will the seven shadow Local Commissioning Groups, which will mirror the new council boundaries.

The new Trusts are:

Western Health & Social Services Trust Trust
- Sperrin Lakeland
- Foyle & Altnagelvin

Northern Health & Social Services Trust
- Homefirst Community
- Causeway
- United Hospitals

Southern Health & Social Services Trust
- Craigavon Area Hospitals
- Craigavon & Banbridge Community
- Newry & Mourne
- Armagh & Dungannon

Belfast Health & Social Services Trust
- Belfast City Hospital
- Royal Group of Hospitals
- Mater Infirmorum
- Greenpark
- North & West Belfast (incl Muckamore Hospital)
- South & East Belfast

South Eastern Health & Social Services Trust
- Ulster Community & Hospitals
- Down Lisburn

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