Welfare Reform on the Web (June 2006): National Health Service - primary and community care

Changes to Primary Care Trusts

Health Committee

London: TSO, 2006 (House of Commons papers, session 2005/06; HC646)

The report strongly criticises the Government’s plans to reduce numbers of PCTs and Strategic Health Authorities and to contract out community health services in order to save £250 million and to improve commissioning. Such large scale reorganisation of the NHS only three years after the last will set NHS organisations back by 18 months, with patient services likely to be affected in the interim. The authors recommend that in order to improve commissioning a central change agency should be established, enabling the best practice to be shared more widely. They also recommend that the Government should allow PCTs to develop organically, enabling them to evolve into larger organisations where this best meets local needs.

Destination unknown: which way now for hospital referrals?

G. Clews

Health Service Journal, vol.116, May 25th 2006, p.14-15

In order to control the costs of hospital treatment, primary care trusts are introducing mechanisms to manage and divert demand. The most common mechanism used is the referral management centre, which assesses hospital referrals made by GPs and chooses whether to rubber stamp them or to divert patients to alternatives. However, many clinicians argue that financial pressures are distorting the system and run the risk of alienating GPs just as the big push towards practice-based commissioning begins.

Doctors’ late night care system is failing patients

N. Hawkes

The Times, May 5th 2006, p.16

“The Government’s reorganisation of out-of-hours medical care has failed patients and cost £70 million more than was expected.” Primary care trusts (PCTs) took on out-of-hours services after GPs were given the option to opt out, which nine out of ten did. The underfunded PCTs are struggling to meet any of the 13 “qualifying requirements” set out by the Department of Health for out-of-hours care. The National Audit Offices says that better organisation could have saved the NHS up to £134 million in 2005-2006. It claims that:

• “85 per cent of out-of-hours surgeries missed targets for urgent consultations”
• Despite missed targets the National Audit Office “found no evidence of serious incidents or deaths” and claims that the PCTs are starting to “deliver a satisfactory standard of service.”
• PCTs lack the experience and expertise in managing this service. “However direct comparisons [with the previous system] are difficult because nobody really knew how well or badly the old system worked.”
• The National Audit Office found a “discrepancy between patients’ experiences and the PCTs’ views of the care that they are offering, ‘suggesting that providers are currently not capturing negative feedback.”

(See also Telegraph, May 5th 2006, p.10; The Independent, May 5th 2006, p.23, The Guardian May 5th 2006, p.15)

Fears raised that traffic lights rating system could split PCTs

H. Mooney

Health Service Journal, vol. 116, May 25th 2006, p.5

Primary care trusts will be rated as red, amber or green under a new performance measurement system to assess their “fitness for purpose”. Assessment of the 71 PCTs that will not change their boundaries has already begun; 81 new organisations will be assessed as they launch in October. Those rated red or amber will be ordered to develop recovery plans.

Jitters as new providers fear marriage of inconvenience

M.-L. Harding

Health Service Journal, vol.116, May 18th 2006, p.14-15

The government is promoting competition between private and voluntary sector providers and NHS bodies for contracts to deliver primary care services. However, some private firms are withdrawing from the market due to expensive and long drawn out tendering processes. There are also concerns that innovative ideas put forward by private and voluntary providers are being stolen by NHS bodies, and that small social enterprises may be squeezed out of the market by large firms.

Lump sum needed

T. Root

Community Care, May 18th-24th 2006, p.34-35

Article calls for improved ante-natal services for pregnant teenagers and mothers from other disadvantaged groups. Such services should include smoking cessation, emotional support, and promotion of healthy eating. Good ante-natal care can offset disadvantages faced by many unborn babies and reduce the risk of very low birth weight.

‘Menu’ of private clinics in big push to widen choice for NHS patients

J. Carvel

The Guardian, May 31st 2006, p.5

A Department of Health report describes plans that would give patients that require elective surgery the right to free treatment at private clinics or any foundation hospital in the country. The report also describes plans to release success rates of individual surgeons so that patients can make informed choices on their treatment.

The provision of out-of-hours care in England

National Audit Office

London: TSO, 2006 (House of Commons papers, session 2005/06; HC1041)

In this report the NAO examines whether the Department of Health is on the right track towards providing high quality out-of-hours services. The main findings of the report are:

• There were some shortcomings in the initial commissioning process because PCTs lacked experience, time and reliable data. There is also confusion over whether out-of-hours services should be restricted to urgent care.
• Out-of-hours providers are beginning to deliver a satisfactory standard of service but most are not yet meeting all the national Quality Requirements, particularly on speed of response.
• The actual costs of providing out-of-hours are £392 million, considerably more than the £322 million allocated by the Department.
• Commissioners are entering into contracts with multiple providers and the market is maturing.

Towards managed primary care: the role and experience of primary care organizations

J. Smith, N. Goodwin

Aldershot: Ashgate, 2006

The book examines the background and development of Primary Care Groups and Primary Care Trusts (PCG/Ts) in the NHS. It focuses on the practical experience of developing and managing PCG/Ts and on the lessons that can be drawn from this for future policy relating to the management and evaluation of such organizations in the UK and elsewhere. It also analyses the impact of PCG/Ts on the provision of health services and the wider health system.