National Health Service (NHS), PCT & Local Health Board News - Dec 2006

Here is some analysis of PBC Clusters for you - remember if you are a database customer of Health Direction, we will send you complete spreadsheets of which this is a summary, on request.

Types of PBC Clusters being formed around England

There are currently 983 Practice Based Commissioning Clusters/ Individual Commissioning Practices in England, which can be broken down into:

• Number of PBC Clusters with 2-4 practices: 130
• 
  Number of PBC Clusters with 5-10 practices: 256
• 
  Number of PBC Clusters with 11-20 practices: 193
• 
  Number of PBC Clusters with 21-56 practices: 72
• 
  Individual Commissioning Practices: 332
• 
  (Number of clusters where waiting for confirmation of practice inclusion: 50)
  
  Size of the PBC Clusters
  
  
• Average number of practices in a cluster: 10
• 
  Average population in the cluster: 62,269
• 
  The smallest Cluster has a population of: 1,288
• 
  The largest cluster has a population of: 286,155

Practice based Commissioning Priorities

Disease specific priorities for those that have identified their priorities can be split as follows:

Disease Area: Percentage of PBC Clusters citing this disease area as a priority
Anticoagulation: 11%
CHD / Cardiology: 11%
COPD: 16%
Dermatology: 34%
Diabetes: 41%
Gynaecology/ antenatal/ IVF: 14%
ENT: 13%
Mental Health: 8%
Obesity/ weight management: 2%
Ophthalmology: 8%
Rheumatology: 6%
Trauma and Orthopaedics: 28%

England - Local PCT News

Brent tPCT / Harrow PCT - Joint Programme Arrangements

It has been proposed that the two PCTs, Practice Based Commissioners and North West London Hospital Trust work together to develop their individual healthcare strategies through a single programme arrangement. A public consultation process is underway.

County Durham PCT - Smoking Cessation

The PCT's Durham and Chester-le-street locality has now trained 9 local pharmacists and pharmacy technicians to deliver smoking cessation services from their pharmacies. The service can also be accessed at GP surgeries, hospitals and SureStart buildings. All participating pharmacies will display the NHS Stop Smoking Logo:

- M&M Chemists, Meadowfield
- Leaks Chemists in Framwellgate Moor / Belmont
- The Store House, Rainton Gate, West Rainton
- Whitfield Chemists, Coxhoe / Gilesgate
- Co-op Pharmacy, Gilesgate
- Lloyds Pharmacy, Sacriston
- Co-op Pharmacy, Langley Park

It is hoped that the pharmacy at the Arniston Centre Sainsbury’s will soon be involved.

Darlington PCT - Substance Misuse

Darlington is one of three sites piloting a "shooting gallery", where heroin addicts can inject on the NHS and in safety. At the moment, there are 16 addicts on the Darlington scheme, who have to visit a clinic twice a day. The aim of the pilot is to establish whether allowing addicts to inject heroin can help improve treatment Not everyone on the trial receives heroin - six of the volunteers are given heroin, six inject methadone and the remaining four are given a methadone linctus and additional psychological support. The other two pilot schemes are based in London and Manchester.

Ealing PCT - Patient Care Messaging System

A new system of sending appointment reminders and health information via mobile phone text messages is due to be rolled out across 22 surgeries in Ealing,with the possibility of a further 9 joining the scheme in the near future. Two successful pilot projects were conducted in Perivale and Northolt. The Patient Care Messaging System is automated, so there is a reduction in the amount of time spent on administration. The Hillview Surgery in Perivale also reported a 30% reduction in the number of patients who missed appointments.

East of England SHA - CHD and Statins

The East of England SHA has estimated that nearly £24m a year could be saved if 80% of patients prescribed statins were given a generic version. The SHA believes there is no good reason why the majority of patients taking non-generic statins cannot be treated with Simvastatin. The conversion will be phased in by concentrating initially on patients taking Atorvastatin, then Fluvastatin and Rosuvastatin. Pravastatin will be left until last, as it has a relatively low cost.

The projected savings across the three health authorities which make up the new SHA are:
- Bedfordshire & Hertfordshire: £6.1m
- Essex: £8.5m
- Norfolk, Suffolk & Cambridshire: £9.2m

It is estimated that statin prescribing could increase to 14% of the adult population following NICE guidelines on prescribing the drug for those at risk of developing CVD.

Herefordshire PCT - 24hr Community Nursing

District Nurses in Herefordshire will be providing round-the-clock cover for patients from 4 December until March, when the new system will be reviewed. Each nurse will work an evening shift once a week and be on call for one night every three weeks.

Leicestershire & Rutland PCT - Palliative Care

Palliative care is now available at Coalville Community Hospital. This development provides an alternative to a nursing/care home environment, and it is hoped it will ensure quality of care. Referral will be from healthcare professionals.

Newcastle PCT - Diabetes Specialist Nurse

Deirdre Kyne, Clinical Nurse Lead at the Newcastle Diabetes Centre, has been appointed Chair of the Federation of European Nurses in Diabetes (FEND) from April 2007. One of FEND's aims is the development of the role of Specialist Nurses throughout Europe.

North East Essex PCT - COPD Centre

The PCT's five-strong COPD team serves the population of Colchester and Tendring, and is based at what is believed to be the first COPD Centre in the NHS, at Colchester Primary Care Centre. The Centre opened in April 2006 and is part of a Chronic Disease Management Centre. Deb Rampton is a Respiratory Nurse in the team, which comprises four nurses and one physiotherapist. She said: “We provide a one-stop shop for people with COPD, offering a range of services that include a rapid assessment unit taking referrals from GPs and community health staff and nurse-led outpatient clinics.

“We're also able to focus on non-pharmacological management of COPD, linking with rehabilitation and breathlessness management. “We're keen to develop our services so that in the future if an ambulance is taking a known COPD patient to the A&E department at Colchester General Hospital it will be able to divert to us.”

North of Tyne PCOs - New Chief Executive

Chris Reed has been appointed Chief Executive of the three North of Tyne PCOs, that is:
- North Tyneside PCT
- Newcastle PCT
- Northumberland Care Trust

These three organisations have a joint budget of more than £1 billion, more than 4,000 staff and serve a population of 792,000. Mr Reed was Chief Executive of Gateshead Health NHS Foundation Trust until January 2006, became Acting CE for Newcastle PCT in February, and Northumberland Care Trust in June 2006. His new appointment is effective from 1 November.

Professional Executive Committees - Consultation Document

A consultation document has been published on the future of Professional Executive Committees (PECs). The consultation will run until 31 January 2007, with any new arrangements coming into effect from April 2007. This follows a recent review of PECs carried out by the NHS Alliance on behalf of the Department of Health. Health Minister, Lord Warner, said that the need to strengthen PECs was a high priority: "It is also clear we need to move away from the current one-size-fits-all approach so that these committees can better reflect local circumstances."

Professional Executive Committees were originally intended to provide a focus for clinical leadership by introducing primary care clinicians into formal NHS management structures and decision making. However, it has been widely recognised that this role will need to change with the launch of initiatives such as Practice-based Commissioning (PbC). Some PCTs have already begun to change their emphasis. In Brent, for example, the PEC has been in a process of transition since June 2005, and a more streamlined and focused PEC was established from May of this year. In many PCTs, the PBC Cluster Clinical Leads have been appointed as the GP representatives on the PEC.

Sunderland tPCT - Cardiac Rehabilitation

Patients waiting for heart surgery in Sunderland are being offered the opportunity to begin rehabilitation sessions before their operations. It is hoped that this will both boost their recovery and reduce the number of operations cancelled due to patients not being well enough for surgery. The "prehabilitation" clinics prepare patients who are waiting for routine bypass operations or procedures to widen arteries to their heart. The PCT Community Cardiology Nursing Team invites patients to attend the clinic at Grindon Lane Primary Care Centre, following referral from the Cardiologist at City Hospital, Sunderland.

The one-hour sessions give patients, and a friend or relative, the opportunity to meet the Community Cardiology Nurses and Physiotherapists on a one-to-one basis. It is also a chance to discuss the patient's medical history, take blood pressure readings and advise on gentle exercise. Paula Sinclair is Specialist CHD Nurse for the PCT. She said: "We've found that patients who participate in the clinics are less anxious prior to surgery and we can help control their blood pressure better. We are confident the clinics will lead to a reduction in the numbers of operations cancelled and patients having to wait for another appointment."

United Lincolnshire Hospitals NHS Trust - Dementia

The Phoenix Unit at Louth County Hospital has a policy of giving every pensioner who is admitted a test for signs of dementia, thus facilitating early treatment. This could be introduced throughout Lincolnshire next year, and even nationwide if successful

Wandsworth PCT - Mental Health

The PCT has produced and launched a new DVD called Mood Manager, which provides advice and support for people who have been prescribed antidepressants for the first time. The DVD will be given to patients by the pharmacist issuing their prescription. This is a joint project with South West London & St George's Mental Health NHS Trust, and is believed to be the first of its kind in the UK.

Research indicates that more than 75% of those prescribed antidepressants either do not take their prescription, collect it but do not take their medicine, take it irregularly and inconsistently or take it regularly but stop too early to prevent a relapse. Mood Manager is designed to enable patients to take their medication in the most effective way.

Wales - Local Health Board News

Denbighshire LHB - Long-Term Conditions

A Care Co-ordinator for Long-Term Conditions has recently taken up post and will be taking the lead within the new Long-Term Conditions Management Strategic Partnership Group to deliver the five main themes of the LHB's three-year strategy:

- Case Management and case finding
- Review and modernisation of District Nursing and work force planning
- Knowledge Training needs, skills and Competency
- Integrated Care Pathways
- Expert Patient Programmes and other self management programmes

Two areas have been identified for the formal management of patients with long-term condition, one in the north and one in the south of the county, and it is hoped that case management will start in April 2007.

Gwent LHB - Out-of-Hours/Medical Records

The Emergency Health Record (EHR) of patients in Gwent will soon be available to the medical professionals in the Out-of-Hours service via a new electronic patient information service. The EHR will contain informaton on medication, allergies, current problems and diagnoses; information which should improve patient safety and the quality of care. Patients will be asked for permission to access the EHR and it will only be used if consent is given. Seven out of ten GP practices in Gwent have already agreed to the EHR and it is planned to introduce the system during November.

Neath Port Talbot LHB - Asthma

Specialist Asthma Nurse, Rita Ball, is leading a new project aimed at parents of children aged 4 or younger with asthma. Sessions will be held once a week for four weeks and will include information on medication and correct use of asthma equipment.

South East Wales Cancer Network

Changes have been made at the South East Wales Cancer Network in order to address perceived weaknesses in the previous structure. A new Standards and Governance Group will be set up, chaired by Mr Mike Fardy (Consultant Maxillo-Facial Surgeon at Cardiff & Vale NHS Trust) who has been appointed Network Medical Director. A formal Establishment Agreement will be drawn up for the network, and LHBs will retain commissioning responsibility.

Scotland - Local NHS News

NHS Forth Valley - Heart Failure

NHS Forth Valley has been awarded funding from British Heart Foundation Scotland to appoint a Heart Failure Specialist Nurse. This will mean that the palliative and supportive care needs of heart failure patients can be provided in their own homes. In Forth Valley, more than 600 patients are registered with the Heart Failure Clinic. The Specialist Nurses are supported by a multi-disciplinary team which includes Cardiologists, Clinical Physiologists, Physiotherapists and Dieticians. The clinic currently operates a telephone helpline, walk-in access for investigations, and a nurse-led heart function service.

NHS Greater Glasgow & Clyde - Patient Visitor Transport

NHS Greater Glasgow and Clyde, together with other public sector partners, has launched a free evening bus travel service for people visiting hospital patients. All Glasgow city residents are eligible, but the service will prioritise people who are older, disabled or on low incomes.

The Evening Visitor Scheme operates on weekdays between 6-10 pm and covers:
- Glasgow Royal Infirmary
- Western Infirmary
- Victoria Infirmary
- Stobhill Hospital
- Southern General, and
- Gartnavel General

NHS Highland - Telemedicine

The first NHS Highland web cast, held in Glasgow by the Mid Highland Community Health Partnership, has proved that web and pod casting can enable GPs to update themselves with the latest information, even when they are miles apart. Dr James Douglas, GP with the Tweeddale surgery in Fort William, used the web cast to launch a remote and rural web site for NHS Education for Scotland (NES), which organises post graduate training for health professionals in Scotland.

NHS Lanarkshire - New Cancer Centre / Haematology

The NHS Lanarkshire Board has approved plans to establish the new Lanarkshire Cancer Centre at Monklands Hospital. Their decision will now be submitted to the Deputy Minister for Health and Community Care for formal approval. It is hoped that the new centre will develop highly specialised cancer teams, supported by the Beatson Regional Cancer Centre, which will allow more patients to be treated in Lanarkshire.

Specialist outpatient and daycase care for haematology will be provided at the new centre, while haematology inpatient beds for highly dependent patients will be at Hairmyres Hospital - this will include a small satellite daycase unit. Non-malignant haematology outpatients and daycases will be seen at Hairmyres, Monklands and Wishaw Hospitals.

Northern Ireland - Local NHS News

Eastern HSSB - Antibiotic Guidelines

The Antimicrobial Resistance Action Plan group is reviewing the board's Guidelines, which will also cover GP out-of-hours, and Accident and Emergency use. The board would like to appoint a GP and Pharmacist with Special Interest in antibiotic prescribing.

Northern Ireland - NICE

The NI Department of Health has been reviewing NICE guidance since July, to see whether it is applicable and can be implemented locally. Previously, NICE guidance had no formal status in Northern Ireland and only applied in England and Wales.

United Hospitals HSS Trust - Diabetes Managed Clinical Network

United Hospitals HSS Trust is leading the establishment of the Managed Clinical Network for Diabetes Services which will cover the Northern HSSB area. Funding and administrative issues have delayed implementation, but progress is now anticipated