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Introduction
NHS Update
is a brief review of current NHS changes and developments that may impact on
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1. Another Parliament, another
health bill
As Parliament prepares to enshrine in law the latest in
a long line of NHS reorganisations, one is overcome with a sense of
déjà vu. The NHS Reform & Healthcare Professions Bill
provides the legislative framework for Shifting the Balance of Power (STBOP)
and includes new measures to devolve power over NHS resources to frontline
doctors and nurses. But for those who have been around for a while, the changes
in Shifting the Deckchairs, as it is increasingly being called, seem alarmingly
similar to Thatcher's early years - remember the 'primary care-led' NHS?
2. PCTs & stuff
Earlier this year there were several reports on 'resistance' by local GPs to HA
plans for the 3rd wave PCTs. Well, surprise surprise, there are a few similar
reports now floating around as the 4th wave PCTs are being sorted. Apparently
Calderdale and Kirklees HA is recommending the formation of a single PCT for
Huddersfield in the face of strong opposition from GPs in the mainly rural
South Huddersfield PCG. John Hutton announced at the NAPC conference (see
later) that PMS would now be a 'permanent' fixture in primary care. Some 20% of
GPs are now under PMS and the current prescriptive core contract for PMS is to
be scrapped next year to allow greater flexibility, as in the first PMS
contracts.
3. NICE & HTBS
The
DoH is considering ways to fund treatment with the beta interferons despite the
fact that final NICE guidance is still not out. "Our discussions are looking at
a range of options, including the possibility of a 'risk-sharing' scheme in
which the drug would be funded for MS patients." So we have a situation now
where the Department is being criticised for undermining the independent role
of NICE and that it has 'chickened out' over NICE's continued refusal to find
MS drugs cost-effective. Prof Joe Collier, Prof of Medicines Policy at St
George's Medical School said in a BMJ article that the government wanted a
solution with beta interferon so has gone down a route that is not tenable
scientifically or clinically. See
www.bmj.com/cgi/content/full/323/7321/1087.
There are reports that the days of the Health Technology Board for Scotland
(HTBS) are numbered. Apparently Scotland will now set up a new body - the NHS
Scotland Clinical Governance Board - which will take the place of the HTBS and
take on the role of several overlapping bodies. But the fundamental work of the
HTBS is likely to continue, which is the most important thing for companies in
Scotland.
4. Cancer Care
Prof
Karol Sikora, Prof of Cancer Medicine at Hammersmith has pointed out that some
patients continue to be denied new cancer drugs because of local funding
policies. He argued at a conference last month that the UK simply can't afford
new cancer treatments without major changes to funding mechanisms. "The new
treatments that are emerging will be even more expensive than existing ones",
he said. "This will present the government and the NHS with a new set of
ethical dilemmas on which patients to treat. Concentrating on core packages of
cancer care would seem to be the best way - and admitting that we can't have
all the drugs within the package. That would leave people free to buy excluded
drugs"…….
5. NAPC Conference Report
The National Association of Primary Care had their Annual conference
in Birmingham last month. A pragmatic 'can-do' approach was taken throughout
the whole conference. Dr Beverly Malone, General Secretary of the RCN, thought
that this was a time of great opportunity for all healthcare professionals in
primary care, not just nurses. Dr David Colin Thome, National Director for
Primary Care, made the same point. He was confused over why his colleagues (he
is still a practicing part-time GP) did not share his enthusiasm. Eddie Gray,
Chief Executive of GSK UK, addressed the delegates towards the end of the
conference (but many had gone home as it was a Friday afternoon!) and talked
about the challenges ahead, alignment, pharmacogenomics/genetics, trust; and
shared with the audience some learning from the recent merger. A bit too
technical and a bit of a lost opportunity, all in all.
6. CHD
GPs are too
overworked to implement the CHD NSF, according to Prof Larry Ramsay, former
President of the British Hypertension Society. With two other NSFs out and more
to come, perhaps not a good sign. But Heart Czar Dr Roger Boyle has said that
90% of GPs have met the April deadline for setting up CHD registers and results
from the 80 1st wave practices in the Primary Care Development Team (PCDT) have
shown a dramatic effect on mortality achieved by giving practices extra cash to
implement the CHD NSF. But statin prescribing soared by 60% in 12 months and
some practices bust their budgets. The GPC has called on the Government to
abolish prescribing budgets, "Prescribing budgets have seen their day and it is
getting to the point where they are hindering the management of patients and
could be dangerous."!!!….
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