Healthcare News UK


Five minutes with ... a men's health consultant

Guardian Healthcare - Fri, 21/02/2014 - 10:05

Peter Baker is dedicated to raising the profile of men's health, which he says has traditionally been overlooked

Describe your role in one sentence: To support all kinds of organisations – NHS, private businesses, local government and charities – to begin or continue working to improve the health of men and boys.

Why did you want to work in healthcare? I believed that men's health was unnecessarily poor but largely overlooked. There was a prevailing fatalistic view that men were somehow programmed to die young and nothing could be done to stop that. This was – and still is – totally incorrect.

How do you want to see the sector change in the next five years? Work to improve men's health should be seen as normal and no longer a marginal, underfunded or short-term activity. To give one example, high-street pharmacies should address men's huge under-use of their services by focusing on everyone, not just women.

My proudest achievement at work was ... when I was chief executive at the Men's Health Forum from 2000-12. In 2009, I secured the organisation's role as a strategic partner of the Department of Health (a position it still holds). This reflected just how much the forum's influence had grown since it became a charity in 2001.

The most difficult thing I've dealt with at work is ... persuading funders and commissioners that men's health is worth investing in.

The biggest challenge facing the NHS is ... governments' almost total failure to address the social determinants of health – including income, gender and race inequalities.

The people I work with are ... increasingly anxious about whether they can do the job expected of them.

I do what I do because ... the evidence shows that we can do much, much better for men.

Sometimes people think that I ... should join some others involved in men's issues in blaming feminism for men's problems. I actually see feminism as part of the solution, not least because it shows us that gender roles are not fixed. Just as men have become more involved fathers, they can also take better care of their own health.

Right now I want to ... convince the UK government to introduce HPV vaccinations for boys to reduce their cancer risk, encourage European health organisations to address men's ineffective use of most primary care services, and to persuade global public health organisations like the World Health Organisation that they should address men's, as well as women's, health.

At work I am always learning that ... men don't just cause problems for society – they also face problems and help to solve them.

The one thing always on my mind at work is ... should I tweet about that?

If I could go back 10 years and meet my former self I'd tell him ... not to waste so much time tweeting.

If I could meet my future self I'd expect him to be ... still trying to make a difference for men, whether or not that's about health.

What is the best part of your job? When I'm making the case for men's health and seeing people comprehend the problem for the first time. One statistic that never fails to make an impact is that men are more likely to be overweight than women – most people think it's the other way around.

What is the worst part of your job? Hearing people talk about men's health as if it's just about prostates and penises – it really is much more than urology. Obesity, heart disease, diabetes, mental health, all the cancers men can get, use of primary care services – these are the major men's health issues.

What makes you smile? People in meetings using phrases like "going forward", "ticks all the boxes" and "no brainer" without irony.

What keeps you awake at night? My cats, when I forget to lock them in the kitchen.

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Categories: Healthcare News UK

Future of the health service: the era of community care has arrived

Guardian Healthcare - Fri, 21/02/2014 - 08:29

Quality for patients at home or in the community is becoming a reality, but success depends on investment in staff and services

It is well known that there is growing pressure on the health and social care system. There is a rising and ageing population that, if our care system does not change, will require an additional 13,500 hospital beds to soak up demand.

There is already a tendency for patients to end up in hospital when they could be cared for elsewhere. The ambition to move care closer to home is not new – it has been our ultimate goal for many years – but major change is needed to achieve it.

A great deal rests on community services: they could transform chronic disease management, support reductions in the number of people admitted to hospital and how long they stay there, and help primary care meet a growing demand.

Government initiatives, including the grandiosely-named 2008 'Transforming community services programme', have all failed to achieve this aim, remaining largely concerned with the structure and ownership of community organisations while the services themselves were neglected.

There is now an emerging consensus about what we need to do next, and there are some common features to the new service models being developed. The first step is to reduce complexity of services. Confusing, overlapping and unclear provision, with many professional silos working in isolation, needs to be unravelled and multi-disciplinary teams with mental health and social workers created.

We also need to wrap services around primary care practices and natural local communities. A common problem is the lack of contact between community staff and GP practices. They will both work more effectively if this is reversed. In some areas social services have changed their team structures to match this.

To make the most of these stronger ties, teams need support from specialist medical and nursing experts. This implies some changes in how consultants work – particularly among those caring for older people and patients with chronic conditions.

Another key step is to create services that offer an alternative to hospital stay, and that can respond more quickly than many currently do. At least 20% of admissions and half of days in hospital can be cared for in other settings, including the home. Where new models are developing, community care teams are intervening quickly to prevent admissions, diverting patients away from A&E or working with hospital wards to speed up patient discharge.

GP services are also changing, with more practices working together in federations and networks and sharing records between health professionals and social care teams. Together, these changes should provide better care, especially for people living nursing or residential homes.

A shared care plan for each patient that is available to the ambulance service can also help prevent trips to hospital.

To be successful, howerver, there will need to be significant investment in developing the workforce and dealing with the impending shortage of community nurses. Hospitals will also need to adapt and find new ways to work with these more responsive providers.

Most importantly, all these services will need to find ways to increase their reach – working with the voluntary sector and local government to harness the power of the wider community to help keep people connected and supported.

Nigel Edwards is a senior fellow at The King's Fund

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Nigel Edwards
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Categories: Healthcare News UK

Funding change could force rural GP practices to close, BMA warns

Guardian Healthcare - Fri, 21/02/2014 - 00:01

Large areas of rural England could be left without any GP services for local residents as a result of cuts in national funding

About 100 GP practices could be forced to close because of cuts in national funding, leaving patients in rural areas without a GP, doctors' leaders have warned.

Changes to how practices are paid mean some could no longer be viable, despite the fact that some "provide vital services to thousands of rural patients", the British Medical Association (BMA) said.

It warned that large areas of rural England could be left with no GP practice for residents.

The government has decided to phase out a funding arrangement called the Minimum Practice Income Guarantee (MPIG) over a seven-year period, beginning in April.

MPIG means many smaller GP practices are guaranteed a minimum level of funding that is not dependent on the number of patients on their list.

NHS England has published an anonymised list of 98 "outlier" practices that could lose more than £3 per patient per year. Some practices on the list will lose more than £100 per patient per year, while others will lose £20 or £30 per patient.

The BMA said that in addition to the 98, there were a "significant number" of other practices that would be severely affected.

Dr Chaand Nagpaul, chair of the BMA's GP committee, said: "The government has seriously misjudged the potential impact of its funding changes, especially on rural GP services.

"It is likely that a few hundred practices will lose noticeable levels of funding, with 98 practices identified by NHS England as being at serious risk from severe cuts in their financial support that could threaten their ability to remain open.

"This comes at a time when GP practices are already under pressure from rising workload and declines in overall levels of funding.

"The government has not confirmed where these practices are or the extent of their financial difficulty, however some will be smaller GP practices in rural communities with comparatively small numbers of patients registered with them.

"These GPs provide vital services to patients in areas where accessing healthcare is already not easy because of the large distances patients have to travel to get to their local NHS services. If these practices were to close it could leave large geographical areas without a nearby GP practice.

"The situation has not been helped by NHS England's decision to devolve responsibility for this issue to local NHS managers without a framework on how these GP practices should be supported. We are without a national plan of how to tackle this problem and safeguard GP services.

"Ministers have to get a grip on this problem urgently, given these funding reductions are just weeks away from being implemented. We need to ensure no practice closes and that there is a co-ordinated approach to deal with this issue."

Dr Katharina Frey, who runs a rural practice in Cumbria, said: "My practice is a very small one that cares for just under 1,000 patients in a rural south Cumbrian area.

"We have for many years provided a real family-orientated service for patients and I believe we are a really vital service for our local community.

"We are under real financial pressure already and can't, because of the current funding climate, afford to employ a practice nurse.

"We are also having to think very carefully about how we replace senior staff. This situation will become even more pressurised when we lose the MPIG support that currently accounts for around a third of our current core funding.

"We are already working at full capacity with declining resources – I just don't know how we will cope with this additional financial blow."

An NHS England spokesman said: "NHS England is committed to making sure patients have access to high-quality GP services wherever they live and the GPs are properly funded to deliver these services.

"MPIG is not an equitable way of funding practices, which is why we are supporting its phased withdrawal. We believe it is fairer to allocate funds based on the numbers of patients practices serve and the health needs of those patients.

"We have looked very carefully at how the changes to MPIG, together with other changes to the general medical services contract, will impact on practices and we estimate that the majority will gain extra funding as a result.

"We also know that some practices will lose funding and we have asked our area teams to work with them to see how they can be supported. It may be that an alternative arrangement may be appropriate.

"This decision will be made by area teams after a full assessment of all the local circumstances."


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Pseudo at source 'not ready' - Kelsey

EHI News - Fri, 21/02/2014 - 00:00
NHS England's director of patients and information Tim Kelsey says 'pseudonymisation at source' technology is not ready for use on the care.data programme.
Categories: Healthcare News UK

London clinic shares ultrasound images

EHI News - Fri, 21/02/2014 - 00:00
A Harley Street clinic is introducing an online portal called FetView to share ultrasound images, reports and video with pregnant patients.
Categories: Healthcare News UK

Authorities accused of cover-up over death of patient killed by German GP

Guardian Healthcare - Thu, 20/02/2014 - 12:35

UK, Germany and EU body accused of covering up details of failed attempts to extradite doctor to face charges in UK

The family of David Gray, who was accidentally killed by a German doctor on his first UK shift as an out-of-hours GP, have accused British and German authorities and the EU's judicial co-operation unit Eurojust of covering up details of the failed attempts to extradite the doctor six years ago.

Eurojust said it would be against the public interest to publish them. One of Gray's sons, Rory, who has failed in his latest attempt to establish how Daniel Ubani was convicted in his own country rather than face criminal proceedings in the UK, said British prosecutors were "complicit" with their German counterparts in keeping secret what had happened.

Stephen Barclay, the MP for North East Cambridgeshire , the constituency in which David Gray lived, said the family had been "badly let down" by decisions to keep confidential the minutes of a meeting of UK and German prosecutors held months after a furious row over Germany's handling of the case.

Rory Gray told the Guardian: "The CPS is complicit with the Germans after their covert meeting held into the obstruction of the European arrest warrant and removal of UK justice. Germany wilfully acted to prevent the UK applying UK law in Britain.

"Germany licensed Ubani … who killed my father, then acted to cover up its grievous medical regulatory failures by preventing the UK from holding a public trial. The CPS reaction has been to try to prevent this from surfacing. The CPS is impotent if a foreign prosecutor chooses to make them so."

Ubani was convicted of causing death by negligence in Germany in 2009, more than a year after he killed 70-year-old Gray in Manea, Cambridgeshire, by a massive overdose of the painkiller diamorphine. He never appeared in court, was given a nine-month suspended prison sentence and ordered to pay €5,000 (£4,200) legal costs. Britain's European arrest warrant aimed at taking Ubani to Britain on a possible manslaughter charge was formally rejected only after the Guardian broke the story.

Cambridgeshire police and prosecutors had not expected German authorities to take action themselves. The Cambridgeshire coroner later said Gray had been unlawfully killed and Ubani was struck off the UK medical register in June 2010. He is still a doctor in Germany.

The fresh accusations came after Rory Gray, who works as a scientist for the German weather service, lost his attempt to persuade the European ombudsman, Emily O'Reilly, to make Eurojust release meeting details.

She said the German and UK members on the body had refused to divulge the "case-related" minutes, decisions by which Eurojust was bound.

Eurojust, based in The Hague, , also said disclosure would "undermine the public interest as regards … national investigations and prosecutions in which Eurojust assists" and break secrecy rules.

There has never been any public government report on the failed extradition, in contrast to investigations into the failures by medical authorities in the case and big changes in the way out-of-hours GP services are run and monitored and EU doctors are checked before being allowed to work in Britain.

Rory Gray's attempts to see minutes, which had been supported by UK health ministers, were dashed by the ombudsman closing her inquiry into Eurojust's refusal to release details of the meeting, which had depended on the UK promising confidentiality.

Both the UK and German members at Eurojust wanted continuing secrecy, although a veto by the German member alone would have been enough to prevent publication.

Barclay said the Gray family "have been badly let down by the continued refusal of officials to disclose what went wrong in the handling of their case.

"This cover up compounds the original failure whereby my constituent was killed through medical incompetence, has meant that the guilty party continues to escape justice, and the family remain in the dark as to what the CPS and police did wrong. It is difficult to see how such a blatant lack of transparency is in the public interest."

The CPS says it has done all it can to help the Gray family. It told Cambridge MEP Robert Sturdy earlier this month: "There was no comprehensive explanation provided by German contingent at the Eurojust meeting, so none could be given to the family."

The CPS told the Guardian it had "endeavoured to keep Mr Gray informed of issues as far as possible in relation to this case and we understand his frustration, but there is little more we can do to assist him at this stage."

German prosecutors started their own criminal investigation in June 2008, just weeks after British authorities had asked for assistance. German law obliged them to do so against citizens suspected of involuntary manslaughter, even when the offence was committed abroad, said a spokesman for the North Rhine Westphalia ministry of justice. "This didn't, as a matter of principle, rule out the possibility of proceedings by a foreign (British] body."

However, once Ubani had been sentenced, extradition was out of the question. As to keeping the Eurojust minutes secret, the spokesman said: "An application for inspection of files was never made to the justice ministry of North-Rhine Westphalia. The justice ministry of North-Rhine Westphalia never ruled on such an application. Eurojust alone is responsible for ruling on applications for file inspection regarding Eurojust's processes."

Ubani is pursuing legal action in Germany against Rory Gray and his brother Stuart, a GP, alleging they disrupted his appearance at a conference on plastic surgery in Lindau, in 2010.

James MeiklePhilip Oltermann
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Shambolic record-keeping by NHS wastes money and endangers patients | Jenny Rohn

Guardian Healthcare - Thu, 20/02/2014 - 08:02

Jenny Rohn: Is House perennially grumpy because he can’t read his own patient records?

Jenny Rohn

Categories: Healthcare News UK

Mentally ill children treated on adult wards far from home

Guardian Healthcare - Thu, 20/02/2014 - 06:35

Senior NHS official admits situation ‘totally unacceptable’ as investigation finds children sent hundreds of miles to find a bed


Categories: Healthcare News UK

North Tees picks InterSystems

EHI News - Thu, 20/02/2014 - 00:00
North Tees and Hartlepool NHS Foundation Trust has chosen InterSystems as preferred bidder for its electronic patient record system, making it the company's first major English EPR site.
Categories: Healthcare News UK

CCG tenders for £3m-£4m GP IT support

EHI News - Thu, 20/02/2014 - 00:00
NHS Dorset Clinical Commissioning Group has gone out to tender for a GP IT support service worth £3m-£4m.
Categories: Healthcare News UK

Frimley extends use of therapy EPR

EHI News - Thu, 20/02/2014 - 00:00
Frimley Park Hospital NHS Foundation Trust has extended its use of electronic patient record system Tiara9 to a new therapy outreach service.
Categories: Healthcare News UK

Draft guidance from NICE asks for more information on multiple sclerosis treatment

The National Institute for Health and Care Excellence (NICE) is calling on Biogen Idec to provide more information on its multiple sclerosis drug, dimethyl fumarate (also called Tecfidera). In draft guidance published for consultation, NICE has requested a series of clarifications on the evidence submitted by the manufacturer.
Categories: Healthcare News UK

Medical v financial reasons for Papworth's move | @guardianletters

Guardian Healthcare - Wed, 19/02/2014 - 21:00

The Treasury's suggestion that Papworth hospital should be relocated and joined with the loss-making Peterborough and Stamford NHS Foundation Trust is deeply disturbing and clearly based on financial aspirations rather than sound medical considerations (Report, 15 February). When I was appointed consultant cardiothoracic surgeon to Papworth 42 years ago, I was told by the regional medical officer that we'd be moved to the Addenbrooke's site within four years. Events conspired against this. However, after my retirement I served as a non-executive on the Papworth board and, following lengthy discussions with Addenbrooke's, it was unanimously agreed that we should move to its site in Cambridge. There we would have our own building and retain our own management and identity as a separate trust, but would share some expensive services that would be used by both hospitals.

Our reason for wanting to remain independent was because of our success. We had excellent management and, being a single-specialty hospital, were able to focus efficiently on treating patients with heart and lung disease without being subjected to the demands and pressures of being part of a large general hospital. We were in agreement that both hospitals would benefit from the proximity of our respective clinical services and, for Papworth, the presence of world-class research-based organisations and the medical school on the same campus were added attractions. This still has to be the best option for the patients of East Anglia and for those who attend our supra-regional services from further afield. It is intolerable that this should be put at risk by this late intervention from the Treasury.
Terence English
Oxford

• The real iniquity associated with the Papworth hospital PFI bid is not with Mr Osborne's decision to reject it but the rush to PFI by successive governments, saddling the country with massive debt. The NHS is a publicly funded body, bound by statute to provide healthcare free at the point of delivery from taxpayer's money. Implicit within this must be the provision of hospitals and facilities for the delivery of that care. Instead of wasting vast amounts of money on foreign expeditions, our politicians should be prioritising care for our own population first. This should include the building of modern hospitals for the delivery of state-of-the art healthcare for our people.

Papworth has been at the forefront of cardiothoracic surgery and medicine for half a century and is recognised around the world as a top institution. It is a jewel in the NHS crown and yet visitors from other countries are appalled at the facilities within which this work has to be carried out. To cause years of delay in its rebuilding on the Cambridge University hospitals campus (one of the largest and most advanced in the world), its rightful site in the 21st century, demonstrates nothing if not political blindness to the importance of the scientific developments in medicine.

For a mere £150m, the UK would be delivered of a fine state-of-the-art facility that patients and staff deserve. There can be little doubt that the populace, whose taxes should be used appropriately, would support such a move. After all, if a new cardiothoracic institute can be built with 100% government funding at a previously unrecognised site such as Basildon, surely it should be shamed into funding this worthy project. PFI-developed projects cost the taxpayer a factor of three to four times the cost over a 30-year period and, at the end of it, the builders retain control. Millions of pounds are being poured into the pockets of developers , with additional income streams generated for them by the excessive running costs of these institutions that they control.
Francis Wells
Consultant cardiothoracic surgeon, Papworth hospital

• I can empathise with Stephen Bridge, the chief executive of Papworth, and his anxiety over its future, but I think he is being naive on at least three counts. First, the quality and levels of medical services and care are determined by the teams of clinicians and support staff, not the location or the name on the door of the hospital. Second, he raises the question of the financial problems facing the Peterborough hospital caused largely by its PFI debt, but in the same breath says Papworth would be raising £80m through that same facility. PFI schemes have been one of the biggest sources of financial problems to beset the NHS in recent years. Third, he argues that location in the Cambridge biomedical campus is vital. Given the facilities of modern communications and the proximity of Peterborough to Cambridge – only 30 miles – it is difficult to accept this as a strong argument.

Having served for 10 years as a patient governor on the councils of both Moorfields and now University College London, I am well aware of the benefits of hospitals being a part of academic health science centres, as I am also of the problems of financing the building of new hospitals and the use of PFI to do so. Moorfields is facing a move to a replacement facility and UCLH used a PFI loan for its Euston Road premises. Stephen Bridge would do well not to confuse "NHS politics" with economic probity.
John Bird
London

• It could be amusing, were it no so wretched and destructive, to point out that the possible "shotgun partnership" of Papworth hospital ("at the forefront of medical innovation") with Peterborough and Stamford NHS foundation trust ("the NHS's most loss-making foundation trust") would be a stark example of the fallacy of the second accident, popularly known as a "secundum quid".

Jeremy Hunt has it in his secretary of state's power to nip this in the bud and insist that Papworth should realise its move, 10 years in the planning, to the 310-bed hospital in the Cambridge biomedical campus, next door to Addenbrooke's, where Roy Calne pioneered liver transplantation and much more. In this situation, the Department of Health should stick to its decision to back Papworth's move and tell Hunt to tell the Treasury to get lost. If the Treasury decides against and Hunt gives in, then Papworth will drown and decades of British and global medical transplant care and advance will be matters of history and, yet again, the fallacy of the second accident will have prevailed.
Bruce Ross-Smith
Oxford


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Concern over number of girls admitted to hospital for stress

Guardian Healthcare - Wed, 19/02/2014 - 14:37

Figures show that girls aged 15 to 19 had one of the highest number of admissions for stress, behind only middle-aged men

There were nearly 300 incidents of girls aged 15 to 19 admitted to NHS hospitals for stress over a 12-month period, figures have revealed, prompting a charity to call for earlier intervention to help children with mental health problems.

The statistics, published by the Health and Social Care Information Centre (HSCIC), showed that girls in the 15-19 age group had one of the highest numbers of hospital admissions for stress in the year to November 2013, behind only middle-aged men.

Sam Challis, information manager at the mental health charity Mind, said: "[This] underlines the concerning scale of severe mental health problems amongst young girls. Hospitalisation in itself should be a last resort when it comes to mental health treatment. It is an indication that a patient has reached crisis point, that they have nowhere else to turn and need urgent help.

"These figures emphasise the very real need for early intervention. Schools and colleges, as well as family and those in a child's wider support network, need to recognise the role they can play. Creating a culture of openness where young people feel able to talk about their mental health is vital, to ensure they get the right support and at the right time. In turn, appropriate services must be accessible, long before hospitalisation becomes a necessity."

The overall number of admissions for stress fell by almost 14% on the previous 12 months, from 5,610 to 4,840, but the number of admissions of girls aged 15 to 19 remained almost static, dropping by one to 295.

HSCIC's chief executive, Alan Perkins, said the figures showed "interesting age and gender patterns for stress cases".

Eight out of 10 admissions for stress across the different age groups were emergency admissions, while one in four of those admitted – 1,230 people – had a history of self-harm.

The HSCIC figures also showed that almost three out of 10 admissions to NHS hospitals for anxiety over the same period were women aged 60 and over. Overall, the number of hospital admissions for anxiety also fell on the previous 12 months, by 2% from 8,930 to 8,720.

HSCIC said the pattern of admissions for anxiety or stress by age and gender was similar to the previous 12 months.

• This article was amended to reflect the fact there were 300 reported incidents of young women being admitted to hospital, and not 300 women, as we reported earlier.

Haroon Siddique
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Categories: Healthcare News UK

'More resources to the frontline' slogan damages the NHS

Guardian Healthcare - Wed, 19/02/2014 - 08:30

Rallying cry is attractive but reinforces beliefs about the health service that are simplistic, naive and probably incorrect

In the often heated debate about the future of the NHS, there is one thing that politicians seem to agree on: both sides are happy to use the slogan "more resources to the frontline". The slogan is not just naive, it damages the service.

The slogan effectively captures the public mood. When a UKIP politician on BBC Question Time claimed that the NHS has two managers for every nurse, he was overestimating the manager count by a factor larger than 20 (see useful analysis of the real numbers here and here).

The slogan reinforces beliefs about the NHS that are simplistic, naive and probably incorrect. But the slogan is so attractive almost nobody looks beyond it.

This wouldn't be a problem if the people running the system didn't share the belief. But the slogan was written into the health bill. Despite the whole thrust of the bill being to free up local NHS organisations from central control to help them decide how to run the system, a centrally imposed target on how much could be spent on management has been built in. This target was derived from the idea that we should move more resources to the frontline, even though the best evidence available at the time suggested the system was undermanaged before the changes.

The second reason the slogan is so dangerous is that it affects how well the services run, damaging their quality and productivity. The slogan discourages us from thinking of a hospital as a system. Instead, people casually accept that all that matters is how many doctors or nurses there are.

It never seems to occur to people that a hospital is a complicated system of interacting people and components that requires a lot of coordination to function at all. There is no point having a doctor in the operating theatre if the anaesthetist hasn't turned up, the theatre hasn't been cleaned, the hospital has run out of AB-ve blood and there is no bed available to receive the patient when the operation is over. The slogan just diverts thought from those complexities, dissuading us from asking how many supporting people we need to enable surgeons to do their work well.

A recent estimate from one doctor suggested that perhaps three hours a day are consumed in paperwork. We might have more staff on the frontline, but we are not spending it in front of patients; instead, we are wasting medical time doing badly designed administrative tasks that should mostly have been automated and computerised. More resources to the frontline is leading to less frontline time with patients.

If we lived in a world where our attention were not distracted by a beguiling political slogan, we might ask more intelligent questions about how the NHS works. A hospital is a complex machine where all the parts must work in harmony. It needs a lot of cogs other than doctors and nurses to function and sometimes it doesn't work well because there isn't enough support of the frontline. Sometimes, investing in better systems and investing in more support staff (and managers) is the way to improve the effectiveness of doctors and nurses. Maybe, for example, better organised A&Es are more pleasant places to work and therefore find it easier to recruit the doctors they need to function well (but this might mean they need to invest in managers or systems first). This isn't just speculation; we have strong evidence that good management dramatically improves the quality and cost effectiveness of what doctors and nurses do.

A more nuanced view of how the NHS actually works might give managers a better sense of their role. They should be making sure the systems and processes make it as easy as possible for the frontline staff to do their work. They should be supporting the front line. We might even choose to invest in more managers or more computers or more support staff because that is the best way to make the whole system work better. But we won't, because we are all befuddled by the slogan: "more resources to the front line".

Dr Stephen Black is a health management expert at PA Consulting Group

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Categories: Healthcare News UK

Health thinktank urges further shakeup of GPs | Denis Campbell

Guardian Healthcare - Wed, 19/02/2014 - 07:00

King's Fund report says primary care must restructure to keep the NHS sustainable

GP practices must start working together in federations and delivering far more services in a restructuring of healthcare that is vital to keep the NHS sustainable, the King's Fund urges today in a report that has attracted high-level government interest.

Major changes are needed in how primary care and both hospital and community-based services are funded, delivered and co-ordinated so that the health service can cope with the huge pressures caused by ageing and long-term conditions, the thinktank argues.

Its report on the future of general practice comes less than a year after the coalition's unpopular and far-reaching overhaul of the health service in England. It accepts that it would involve "a radical departure for the NHS" and yet more upheaval, especially for GPs. But it contends that without family doctors hugely expanding their roles – including a controversial resumption of responsibility for out-of-hours care – the NHS will fail to cope with rising demand, years of expected tight budgets and a growing shortage of GPs.

If implemented, the ideas could produce the long-sought integration between health and social care that ministers agree is crucial to long-term sustainability, reverse general practice's diminishing share of the service's £110bn budget and see many services delivered outside hospitals – another big shift that, although widely supported, has not yet happened.

"We argue that GPs should take the lead in developing care out of hospital by taking responsibility not only for their own services but for many other services used by patients in the community", say co-authors Professor Chris Ham, the thinktank's chief executive, and Rachael Addicott, a senior fellow.

Ham says: "There needs to be a radically different model of general practice in the future because of the ageing population and changing burden of disease, especially the fact that more people have more complex needs. And such people are not being well served by the current model of general practice, because what they need is not what their practice can prove. What they need is access to other expertise and staff in the community, such as community nurses, physiotherapists and occupational therapists, and also social care – and sometimes they need access to these services 24/7 rather than during surgery opening hours. At the moment, general practice isn't sustainable."

The key to the report is the suggestion that between four and 25 GP practices join up to become a federation, each of which covers between 25,000 and 100,000 people. They are the bodies that would be the hub of "family care networks" (FCNs). Each would get a population-based budget, but from one of NHS England's local area teams and not from the 211 local clinical commissioning groups (CCGs)created by last year's reorganisation. This raises serious questions over the purpose and viability of CCGs, which were meant to symbolise GPs being put in the driving seat of healthcare.

While patients would remain registered with their own GP, Ham says FCNs would give them access to a much wider range of expertise than any practice can currently provide alone.

"I think that over time CCGs would no longer be needed to commission care as they do today, and would wither on the vine," Ham admits.

In her foreword to the report, Dr Maureen Baker, chair of the Royal College of General Practitioners, points out that it first floated the idea of federations a decade ago and that some already exist, and work successfully. However, Dr Chaand Nagpaul, chair of the British Medical Association's GPs' committee, says general practice does not need another reorganisation: "Instead, we should be focusing on tackling the serious workload and financial challenges facing GP practices, and supporting them … rather than wasting resources rearranging the NHS's already complicated bureaucracy."

GP Michael Dixon, president of NHS Clinical Commissioners, which represents most CCGs, says their local and clinical knowledge will be crucial to support and manage future NHS changes. "I can't see why CCGs would be redundant," he says.

Denis Campbell
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NHS in England delays sharing of medical records

Guardian Healthcare - Tue, 18/02/2014 - 18:33

GP and patient groups hail decision to put launch of care.data back six months to give more patients more time to evaluate opt-outs

NHS England is to delay the introduction of a system to share medical records after medical and patients' groups called for more time to raise awareness of how people can opt out and have confidence in the scheme.

Under the original timetable, patients had until the start of April to opt out of the records-sharing system, which the NHS says will improve research into the outcome of treatments and allow drug and insurance companies to buy "pseudonymised" medical information. Last month, all 26m households in England were sent leaflets about the scheme, setting out the possible benefits and explaining how to decide whether to take part.

In a statement, NHS England said the collection of data from GPs' surgeries would begin in the autumn – it did not give a more precise date – to permit "more time to build understanding of the benefits of using the information, what safeguards are in place, and how people can opt out if they choose to".

During this time NHS England will work with groups including the British Medical Association (BMA), the Royal College of General Practitioners (RCGP) and the consumer body Healthwatch to promote awareness, as well as looking to new means of building confidence in the scheme, formally known as care.data.

In the meanwhile, NHS England would work with a small number of GP practices on a voluntary basis to test the quality of the data collected, the statement added.

Tim Kelsey, national director for patients at NHS England, said it wanted to listen to patients' views. He said: "We have been told very clearly that patients need more time to learn about the benefits of sharing information and their right to object to their information being shared. That is why we are extending the public awareness campaign by an extra six months."

Anna Bradley, chair of Healthwatch England, said: "This is a really positive move by NHS England. They have shown a willingness to listen to what the public have to say about the way their health and care services are run.

"Crucially they have agreed to Healthwatch England's request to see the roll-out of care.data delayed to allow more time to ensure the public are fully informed. Over the coming months the Healthwatch network will continue to play a key role listening to the concerns of local communities, helping to inform them about what's happening and working with NHS England to improve their communications with the public so each of us can make an informed decision."

Professor Nigel Mathers, from the RCGP, said: "We would like to thank NHS England for listening to the concerns of RCGP members and for acting so quickly to announce this pause. The extra time will provide it with the chance to redouble its efforts to inform every patient of their right to opt out, every GP of how the programme will work, and the nation of what robust safeguards will be in place to protect the security of people's data."

The RCGP has sent a letter to NHS England arguing that the delay should be used to clarify issues such as what data can be disclosed and who will decide this, and for a national campaign that highlights the option to opt out.

Chaand Nagpaul, chair of the BMA's general practitioner's committee, said: "With just weeks to go until the uploading of patient data was scheduled to begin, it was clear from GPs on the ground that patients remain inadequately informed about the implications of care.data.

"While the BMA is supportive of using anonymised data to plan and improve the quality of NHS care for patients, this must only be done with the support and consent of the public, and it is only right that they fully understand what the proposals mean to them and what their rights are if they do not wish their data to be extracted."

The scheme's rollout has been beset by criticisms about the clarity of the information provided to the public. Earlier this month, the information commissioner's office criticised the campaign for failing to adequately explain what data was involved and how patients could avoid their medical records being shared. At the time, Kelsey agreed with some of the critics, saying: "Maybe we haven't been clear enough about the opt-out."

Peter WalkerJames Meikle
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