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NHS News - July 2005

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Comment by Mike Sobanja, Chief Executive NHS Alliance, Director of Health Direction

The Quality & Outcomes Framework that was such a key feature of the new GMS contract has been a huge success story for British General Practice with an achievement rate of over 90% of all targets now certain.

The cynics will say that the targets were too easy, the GP negotiators too smart, that points have rewarded existing good practice described in a different way, and that the pressure on PCT budgets outstripped available funding by £200 million pounds by the end of 2004/5. The fact remains that the Government set targets and Practices responded. Even the cynics will have to concede that the main aim of demonstrating change in clinical practice by the use of financial levers has worked. As one commentator rather crudely remarked “the pigs are in the pen, now lets change the shape of that pen”.

Now, what next?

Having confirmed that primary care is susceptible to this approach (of course we knew this from vaccination and immunisation and other fee for item of service payments) we need to make sure that the QOF develops in a way that works for patients and practices in the future. This means a number of key issues have to be addressed:

» More targets based on outcomes and not process
» More emphasis on patient experience
» More alignment between the QoF and national priorities and policies
» More recognition that the QoF must change on a regular (probably annual or bi-annual) basis
» More involvement of non GMS Practices (PMS for example) and other disciplines who contribute to QoF achievement

Less exclusions

The review of QoF for 2006 has produced a frenzy of activity channelled through the external reference group whose deliberations will then be tipped into the national (GP alone) negotiations. I would predict this will result in relatively modest changes for next year with obesity and osteoporosis at the top of an ever growing list of potential additions/amendments.

The real challenge now is to develop the QoF into a flexible, dynamic tool that concentrates on real and meaningful outcomes and not just those things that are easy to measure. We must bring a wider range of disciplines into the process, and make sure that all practices are engaged and not just GMS practices (remember 40% or so practices are PMS). Finally, we have to find a way to ensure there is sufficient flexibility in the QoF to allow local needs to be addressed. Meeting national targets at the expense of local needs cannot be an option for the future.

The Pharmaceutical Industry has been keen to chase the QoF and mainly this has been in the interests of patients, particularly when Practices, companies and PCTs have joined forces around specific projects. The industry must also find smarter ways of using the QoF more general features when product based disease areas don’t feature in the clinical domains. All of this requires good, solid market intelligence being turned into knowledge and acted upon within a sound corporate strategy that reflects good account management principles.

England - Local PCT News

Barking and Dagenham PCT - Patient and Public Involvement

The Barking & Dagenham PCT has put PPI high on its agenda - it now has a "Healthy Network" of almost 100 local members of the public who have the opportunity to get involved in a variety of ways and to whatever extent their other commitments allow.

Chorley and South Ribble PCT - Nurse Prescribing

An award for Best Teamwork in Nurse Prescribing in 2005 has been awarded to Jayne McGurran and Angela Brockbank, for their excellent interdisciplinary team work in prescribing, and their work developing a training package for colleagues.

County Durham and Darlington Priority Services NHS Trust - Patient and Public Involvement

The Trust's PPI Forum has written to the Secretary of State for Health protesting against plans to merge mental health trust forums into PCT forums. They believe that the PCT forums will be unable to devote enough time to specialist mental health matters.

Ealing PCT - Supplementary Prescribing

Ealing PCT has created an electronic Clinical Management Plan which can be used with clinical IT systems, particularly EMIS. The PCT believes that developing its own CMP tool has greatly helped its successful implementation of supplementary prescribing.

Gateshead PCT - Diabetes

GPs in Tyneside are showing newly-diagnosed diabetic patients how to adjust and inject their insulin. This is usually done in a hospital, but since September a new initiative has seen 50% of Gateshead practices involved with this diabetes programme.

Harrow PCT - Diabetes

Twenty Harrow GPs, a Practice Nurse, a Podiatrist and a Pharmacist have recently completed the University of Warwick's Certificate in Diabetes Care. GPs from almost 50% of Harrow practices now have this qualification.

Huddersfield PCTs - Health Inequalities

Dr Sohail Bhatti is Director of Public Health for Huddersfield Central and South Huddersfield PCTs. His latest Annual Report says that a balance needs to be struck to ensure health, education and social services in the town are provided according to people's needs - not their demands.

The Annual Report reveals wide inequalities in public health in Huddersfield - statistics show that half of the town's population (about 100,000 people) are living in poverty and deprivation compared to thousands who were affluent.

Dr Bhatti said: "Something has to be done about deprivation. Yes, that means some people who were getting a good deal are going to get a worse deal.

"But some people have been getting a Rolls Royce service while others have been driving bangers. We now have to decide how we are going to address that. I think we also need to look to our partners for help in doing that."

Dr Bhatti said poor people living in affluent, rural areas were the worst affected because services were set up on the presumption of wealth.

Newcastle PCT - Substance Misuse

Nearly £70,000 was spent in Newcastle last year on the heroin substitute, methadone. Prescription rates have more than doubled in the last 2 years and this is seen by the PCT as an indication of how effectively the city is dealing with heroin users.

Newcastle-u-Lyme PCT / SW Staffordshire PCT - Medicines Management

The Medicine Reminder Initiative is a ground-breaking collaboration between pharmacists, social services, the housing department and the two PCTs which is aiming to remind elderly people to take their medication by using an electronic prompting device.

Sedgefield PCT - GP Services

A private company has taken over Hallgarth Medical Practice. IntraHealth was founded in 1999 by a team of GPs, a practice manager and a pharmacist, and is now responsible for providing services to 6,000 patients in Shildon. The existing GP partners and surgery staff have become employees of Intrahealth, and it is hoped that this new way of working will enable them to focus their time on clinical work rather than management.

The Chief Executive of the PCT said: "The practice is seizing the opportunities presented by the new GP contract by developing more practice-based services such as heart disease prevention work.” IntraHealth also provides a range of clinical, managerial and prescribing support services to a number of PCTs and GP practices in the area.

Swindon PCT - Mental Health

"Beating the Blues" is a computer-based self-help programme based on cognitive behaviour therapy, which aims to help people suffering from depression, anxiety and panic attacks. Draft appraisal from NICE indicates that this programme and another called "FearFighter" will be recommended for use in the NHS from September.

Unlike conventional depression treatment, which is based on consultations with doctors and psychotherapists with regimented courses of medication, both programmes require a single guidance session, dramatically reducing both costs and pressure on staff. Swindon PCT has decided to make the package available to all of its 30 GP practices following a 3-month trial period. Peter Crouch was one of the first GPs to trial the programme. He said it had increased capacity more than fivefold.

Tower Hamlets PCT - Project London

Tower Hamlets PCT's "Project London" is due to be launched later this year. The aim of the project is to explain how to access existing health services to people who may need extra help, such as asylum seekers, the homeless and substance abusers. The PCT has been working on the project for the past two years with the charity Médecins du Monde UK, which has similar projects in France, Belgium, Spain and Sweden.

The project has also involved a number of other organisations, including Praxis, which is based in Bethnal Green and has been providing support and advice to refugees and others for many years. It is planned that a clinic will open in Bethnal Green where patients will be given help to register with a GP. There will be an advocacy service to help people communicate with health professionals and the clinic will also offer limited medical services. The initiative is not limited to people in Tower Hamlets but will welcome anyone who needs help to access medical services, especially in East London.

Walsall / Wolverhampton NHS Trusts - Proposed Merger

It is being reported that Walsall Hospitals NHS Trust and The Royal Wolverhampton Hospitals NHS Trust are discussing a merger. Approval is being sought from the Secretary of State for Health, and plans will then be subject to a 3-month public consultation

Wales - Local Health Board News

Conwy & Denbighshire NHS Trust - Social Care Partnership

The Conwy & Denbighshire Adult Mental Health and Social Care Partnership goes live on 4th July 2005. This S31 agreement will mean the formal "coming together" of mental health and social care professionals under a single management structure in the two counties.

The legal agreement is between:

- Denbighshire County Council
- Conwy Borough Council
- Conwy & Denbighshire NHS Trust

and other partners include both Conwy & Denbighshire LHBs, service users, carers and the voluntary sector. This project has taken 18 months to implement, although the initial willingness and development work dates back to 2000. This project is the first of its kind in Wales and in November 2003 it had already won a national award at the Innovations in Care Conference under the category "Whole Systems" for its innovative approach.

Pembrokeshire and Derwen NHS Trust / Pembrokeshire LHB - Merger Consultation

The board of the Pembrokeshire and Derwen NHS Trust has decided not to support a formal full or partial integration with Pembrokeshire LHB at this time, but has decided to aim for a closer working relationship between the two bodies. One reason for the decision was the Trust's responsibility for patients outside the LHB area, in Carmarthenshire and Ceredigion.

The board met following an invitation from the Welsh Assembly Government to apply for a merger with the Local Health Board. Mary Hodgeon is the Trust's Acting Chief Executive. She said: "We provide mental health and learning disability services throughout the three counties in West Wales, as well as acute and community services in Pembrokeshire and we must be responsive to the needs of all our patients." However, she agreed that local people find the current arrangements confusing, and confirmed the Trust's commitment to work for a more "joined-up" NHS.

Scotland - Local NHS News

NHS Ayrshire and Arran - Mental Health

A new drop-in Psychology Project, funded by North Ayrshire LHCC, is offering "hard to reach" men in Garnock Valley the chance to seek help and advice about problems with relationships, bereavements, family life, work stress or anger management.

NHS Dumfries and Galloway - Stroke

A new information booklet/patient-held record for stroke patients has been produced by two Stroke Liaison Sisters at NHS Dumfries and Galloway. Christine Cartner and Gillian Brogan have produced the booklet in conjunction with the Managed Clinical Network for Stroke. It contains information on stroke, relevant investigations, medication and lifestyle advice, as well as personal information such as hospital appointments and blood pressure measurements. Every stroke patient discharged from hospital from June should receive a booklet.

NHS Greater Glasgow - Substance Misuse

The Glasgow Addiction Service Partnership is a joint venture between NHS Greater Glasgow and Glasgow City Council. Its first Annual Report highlights achievements such as the creation of 9 new joint health and social care "Community Addiction Teams".

Northern Ireland - Local NHS News

Causeway LHSCG - Community Pharmacy

The Causeway Pharmacy Locality Group has been involved in a 5-month project whereby GPs could refer patients to their local community pharmacist for an H-Pylori breath test, instead of using the usual blood test to check for stomach ulcers.

Northern HSSB - Wound Care

Northern Ireland has launched a consultation on its new strategy aimed at reducing the impact of respiratory disease. This policy document is the first of its kind for respiratory conditions in the UK. The consultation period runs until 2 September 2005.

Northern Ireland - Major Restructuring

Shaun Woodward, Minister for Health Northern Ireland, has indicated that a major restructuring of the NHS in Ulster should be expected. His speech touched on the recent problems at Sperrin and Lakeland Health and Social Care Trust, and the unacceptable length of waiting lists. He also noted that in Northern Ireland, 1.7m people are served by a Health Department, 4 Health Boards and 19 NHS Trusts, whereas a similar sized population in Kent and Medway had 4 NHS Trusts. He said: "That's a big bureaucracy. It costs a lot of money. But does it deliver? "We need to look at this urgently. And I intend to."

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