Bulletin 26.02.2013
Patient Group Directives Post April 2013
The Department of Health (DH) is making changes to PGDs to reflect the organisational structures that will be in place from April 2013. The NeLM website highlights planned changes to medicines legislation to enable CCGs, local authorities and the NHS Commissioning Board to authorise PGDs. It also outlines the transitional arrangements that the DH aims to put in place to support transition of services to the organisations that will be responsible for authorising PGDs from that date. These arrangements will allow PGDs to remain legal after the authorising body has been abolished, and until expiry or authorisation by the new body responsible for the service in question. It will be essential that organisations ‘inheriting’ PGDs (e.g. CCGs) put in place arrangements and a timetable for review and adoption/authorisation of all existing PGDs. The NHS PGD website team is updating the current guidance, and the existing PGD guidance document produced by the National Prescribing Centre (now the Medicines and Prescribing Centre at NICE), is also in the process of being updated, expected to be published in June. As the principles and legal requirements remain the same, organisations will still be able to use the existing document to guide them through the legal framework governing the use of PGDs, and as a practical guide on their use.
N3 Next generation Access
The N3 network is being upgraded under the GP Next Generation Access programme, which will help ensure that many GPs in England are equipped with faster broadband technology to help improve access to clinical applications and services. All practices under this scheme will have access to broadband of at least 2mbps (megabits per second). Funding has been made available for every practice in England to be upgraded under the programme, but we understand not all have been registered for the upgrade by their PCT. Practices should now have heard from their local IT service or the N3 service provider (BT) about their upgrade, and indeed many will have already had a new router. If you are not clear on this you should check with the PCT to ensure that the order for an upgrade has been implemented or requested prior to the end of March 2013. If you have any problems please contact Janice.foster@tees.nhs.uk.
PIP Breast Implants
Following the advice given last year in a letter by the CMO (England) and in the report by Sir Bruce Keogh that NHS patients who have decided against having an PIP breast implant explanation should have an annual follow up by their GP, the GPC has highlighted concerns in a number of meetings and letters. Although the advice in the guidance from the surgical associations remains unchanged, and still suggests that GPs need to see all those women who have a PIP implant annually, the GPC advice would be to refer any eligible patients to a consultant breast surgeon for review. This view is also shared by the Department of Health. Carrying out PIP breast implant reviews are outwith a GP’s remit and should a patient attend a practice and the GP feel assessment of their implants is outwith their skills and experience, they should be referred to secondary care.
Francis Report & GPC Response
The GPC have had an initial discussion about the Francis Report into the care provided by Mid-Staffordshire hospital and its implications for general practice. The committee was particularly concerned about the report’s conclusions on target-driven cultures in light of the government-proposed changes to the GP contract, as these proposals would introduce an even greater focus on targets and box ticking and damage patient care. Key points raised in the discussion were:
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Suggestions that a regulatory body was introduced for NHS managers.
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The need to develop tools and systems to enable clinicians to draw together and report on concerns about patient care and the importance of a duty to listen to go alongside the duty to speak out.
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The need for patient-centred holistic care was an important factor in the findings.
The Committee will discuss the report in more depth at March’s meeting. The BMA has posted this response and as a whole is also reflecting on and considering the findings of this report very carefully, pledging to work with others in developing a new NHS culture where doctors feel supported and protected to raise concerns.
Latest NHSCB Guidance for CCGs
The latest commissioning guidance from the NHS Commissioning Board (NHSCB). ‘Everyone Counts’ outlines how the NHSCB will hold CCGs to account, including the financial allocations CCGs will receive in 2013-14 and the incentives and outcome measures the NHSCB will use to measure commissioning performance. The NHSCB will focus on five areas, which are drawn from the NHS Outcome Framework:
• Preventing premature mortality;
• Long term conditions;
• Reducing hospital readmissions;
• Improving patient feedback;
• Reducing the incidence of MRSA and C Difficile.
The GPC expressed fears that the proposals in this guidance will foster a target driven culture that would also be contrary to the aims and recommendations of the Francis Report. Whilst it is important that commissioning bodies are accountable for how they spend public money, the GPC was of the view that the outcome measures identified were too detailed and often without the remit of commissioning bodies.
Quality Premiums
Further proposals for the Quality Premium – the financial incentive for CCGs to reward commissioning performance – were also published by the NHSCB. The Quality Premium will be based on four national measures and three local measures, to be determined by CCGs and the NHSCB Area Teams. Award of the Quality Premium will be dependent on CCGs achieving financial balance. Some of the BMA’s initial concerns about proposals for the Quality Premium have been taken on board in these latest proposals, including the need for local targets to prevent the Quality Premium to become a lever for central control. However, GPC is strongly of the view that an incentive based on financial performance has serious potential to exacerbate health inequalities. The GPC will continue to raise these concerns with the NHSCB and government.