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Liberating the NHS: greater choice and control. A consultation on proposals - closes 14 Jan 2011

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kevin
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The Government's White Paper, Equity and Excellence: liberating the NHS sets out proposals which envisage a presumption of greater choice and control over care and treatment, choice of treatment and healthcare provider becoming the reality in the vast majority of NHS-funded services by no later than 2013/14.

This consultation explains the proposals in more details and seeks the views of patients, the wider public, healthcare professionals and the NHS on:

  • Proposals for offering more choice for patients and service users
  • How shared decision making can become the norm
  • How it can happen: information, 'any willing provider' and other tools
  • Making safe and sustainable choices

 The consultation closes on 14 January 2011

 

Resources: Greater choice and control engagement and consultation
 

The following resources have been developed to support engagement with the 'Greater choice and control' consultation proposals and questions. These resources should be adapted according to audience.

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http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_119651<

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The Commons Health Committee meets GP representatives and a panel of GPs with differing perspectives today to continue its inquiry into how the new government intends to implement changes to commissioning in the NHS through implementation of policies outlined in the recent white paper.

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  • Watch the meeting: Health Commissioning<

    Issues of particular interest include proposals to replace Primary Care Trusts with GP commissioning consortia, the challenges thrown up by transition to such a system, the role of the NHS Commissioning Board and the impact of these changes upon patient choice.

  • The meeting will take place at 10.30am in Committee Room 8, House of Commons. 

    Witnesses:

    At 10.30am

    • Professor Steve Field, Chair of Council, Royal College of GPs
    • Dr Richard Vautrey, Deputy Chair, BMA General Practitioners Committee
    • Dr James Kingsland, President, National Association of Primary Care
    • Michael Sobanja, Chief Officer, NHS Alliance

    At 11.45am

    • Dr Paul Charlson GP, Hull
    • Dr Peter Davies GP, Halifax
    • Dr Kambiz Boomla GP, Tower Hamlets
    • Dr Jonathon Tomlinson GP, Hackney

    http://www.parliament.uk/business/committees/committees-a-z/commons-sele...<

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    Do the latest plans for the NHS represent radical change or do they simply take us another step towards coming round in a full circle and back to the start again? Calum Paton, who will chair Public Service Events' NHS Reform conference, warns there are both technical and political challenges to be met

    Some commentators have suggested that the coalition's White Paper – Equity and Excellence: Liberating the NHS – heralds the most radical change to the NHS since 1948. I can see their point: 80 per cent of the budget in the hands of local GPs, who are not even (in the main) NHS employees; the biggest cull of managers ever.

    Others see the policy as flogging the same old NHS nags around a well-worn racetrack and ending up at the start – yet again. I can see their point too. We had GP fund-holding from 1991, growing into GP consortia and total purchasing from about 1995 until New Labour got it all abolished by spring 1999; small primary care trusts with their GP-dominated professional executive committees from 2001 until 2006; practice-based commissioning... and now, we start all over again.

    Andrew Lansley became shadow health secretary in 2004 and one assumed that by 2010 he had gone native, an impression reinforced by the pre-election mood music from the Cameronistas which promised continuity in NHS structure despite the soundbites about abolishing targets and creating a non-political NHS. So, what changed in a matter of weeks after May?

    Much reorganisation is symbolic – it suggests decisiveness at the top while actually being easier than the more painstaking cultural change which is not the stuff of high politics. Yet this time around – in the context of a shock and awe budget to confront the scale and scope of the public sector in a manner which makes this government uber-Thatcherite – there is surely not much political mileage in frightening even more horses. The mystery deepens.

    One can only assume that the policy is sincere. Lansley really wants the NHS to be self-improving rather than pulled around by central puppet-meisters, and he has come to see PCTs as a failed reform. He may well be right, but has he reacted in the wrong direction?

    His logic is: we can't give vouchers to individual citizens for unpredictable quantities of NHS care so let's give it to those agents who are closest to the patient – the GPs. The trouble is that many GPs have neither interest nor ability when it comes to commissioning.

    So the test of the policy is not whether it is recognised that GP policy wonks are not typical of the profession at street level, but how it is recognised. For there are both technical and political challenges for the new policy to meet.

    The major technical lesson of the last 20 years is that back-of-the envelope devolution in the NHS ignores the need for many services to be planned and configured for regional populations to achieve appropriate clinical and economic scale as well as integration. It is all very well for GPs to have a major say, but ironically the best means of achieving this may be to leave them unburdened by bean-counting and free to refer to the services they choose – services which are organically planned by those with the expertise so to do, taking account of referral patterns – and desired, affordable new services. This may be more efficient than giving budgets to local commissioning consortia in which the enthusiasm of the few drives out the needs of the many.

    We must ensure that in going round the various racetracks once again we at least have the right horses for the right courses – regional planning for regional services, together with local services jointly planned by GPs, hospital doctors and those with expertise in population need, demand and effective use of resources.

    The political danger with the coalition's policy is that Tory manager-bashing has dovetailed with Lib Dem localism, yet left a gap where both political accountability and economy in commissioning should be. The challenge is for the government to show the NHS that it is serious about cultural change but to rescue some babies as the bathwater of control-freak culture is drained away.

    Calum Paton is professor of health policy at Keele University

    http://www.publicservice.co.uk/feature_story.asp?id=15166<

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    kevin
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    The Government today set out the next steps in its plan to reform the NHS and that £89 billion will go direct to PCTs for frontline services – an increase of £2.6bn in cash, equivalent to a three per cent increase in funding for the NHS.

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    Liberating the NHS: Legislative Framework and Next Steps’, published today, reaffirms the Government’s commitment to the reforms set out in July in its White Paper ‘Equity and Excellence: Liberating the NHS’. It shows how the Government has developed its thinking in the light of the 6,000 responses received, and sets out a timetable for implementation. It also paves the way for the introduction of a flagship Bill in the New Year.

    The reforms will create an NHS that puts patients at the heart of everything it does, focuses relentlessly on improving healthcare outcomes and liberates professionals at every level to take decisions in the best interests of patients.

    The response to the consultation demonstrated support for the principles set out in the White Paper. The feedback has been carefully considered and the Government has listened to concerns, deciding on changes including, for example, that:

    • commissioning of maternity services will now sit with GP consortia; and
    • councils’ formal scrutiny powers will be extended to cover all NHS-funded services, and local authorities will have greater freedom in how these are exercised.

    Already, 52 GP consortia have signed up as pathfinders to manage their local budgets and commission services for patients. In total, the pathfinders involve 1860 GP practices and cover around 25% of the population – some 12.8 million people.

    Also published today are the PCT Allocations and NHS Operating Framework for 2011/12. This package together sets what the NHS must do next year in order to secure a patient-centred, outcome-focused service.

    The Operating Framework sets out what NHS organisations must focus on in 2011/12 to prepare for transition to the new system of GP commissioning. This will include:

    • the need to continue to improve performance, for example on waiting times;
    • Primary Care Trusts (PCTs) streamlined into clusters, working with GP practices and emerging GP consortia on commissioning as well as reducing running costs; and
    • the role of the NHS Commissioning Board, which will operate in shadow form from next year to ensure an efficient and effective transition.

    The Operating Framework also asks the NHS to prioritise the implementation of earlier diagnosis for cancer patients, potentially saving thousands of lives.

    Today’s announcements are backed by £89 billion of funding for PCTs to spend next year on commissioning services for patients – an increase of £2.6 billion from 2010/11. This will include money for commissioning dentistry, ophthalmic and pharmacy services as well as, for the first time, money to support social care.

    This increase of 3 per cent demonstrates the Government’s commitment to protecting health funding in a tough financial climate.

    Commenting on the Operating Framework and PCT allocations, Health Secretary Andrew Lansley said:

    “We believe that the NHS is a great national institution and support its founding principles – that care is free at the point of use to everyone, based on need, not ability to pay.

    “Our commitment means that funding for the NHS will increase every year. I am proud that we are living up to our commitment to the NHS – the total allocations to Primary Care Trusts will increase next year by 3 per cent on average, with not less than 2.5% and up to 4.9% increase for individual PCTs. It provides a strong platform to sustain and improve NHS services.

    “But in order to meet rising demands and deliver improving outcomes for patients, we need to get the best value from our protected health budget and make every penny count for patients. That means cutting out waste, reducing bureaucracy and simplifying NHS structures so that we are able to invest more in improving frontline care.

    “There will be no let up in our drive to improve patient safety, outcomes and patient experience. The Operating Framework is an important roadmap to help the leaders of the NHS realise our ambitious aims to improve patient care.”

    Commenting on ‘Liberating the NHS: Legislative Framework and Next Steps’, he continued:

    “Today is a launch-pad for the NHS we all aspire to. One that is focussed increasingly on what matters: better results for patients.

    “We have listened extensively to all views about our health reforms. And now, with thanks to some 6,000 responses, we are publishing a paper that sets out with clarity and with direction why and how we need to deliver long-lasting reform in the NHS.

    Our reform agenda is on track. We are encouraged by activity taking place at a grass-roots level, with 52 GP pathfinder groups already in place and many more soon to follow. We also expect similar shadow forms of Health and Wellbeing Boards to emerge.

    “‘Liberating the NHS: Legislative framework and next steps’ sets out the policy for reform in detail. It answers the questions and sets the framework for reform. The Health and Social Care Bill will be presented early in the New Year. Its purpose is clear: a more responsive, patient-centred NHS, which achieves outcomes that are among the best in the world. It provides certainty, through a clear legislative framework to support that ambition, with increased autonomy and accountability at every level in the NHS.”

    NHS Chief Executive Sir David Nicholson said:

    “The coming year will demand much from the NHS. The challenge for us is to maintain and improve quality, keep strong financial control and create a new system that improves outcomes for patients. The Operating Framework sets out priorities for the NHS that will support and enable organisations to remain focused on their core purpose of delivering improved quality for patients while creating real energy and momentum for change.”

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    Notes to editors


    1. The NHS White Paper Liberating the NHS: Equity and Excellence and the associated consultations were published in July 2010. All documents including the Command Paper, Liberating the NHS: Legislative Framework and Next Steps can be found at:
      www.dh.gov.uk/liberatingthenhsnextsteps<
    1. More details on PCT Allocations for 2011/12 can be found at:
      www.dh.gov.uk/allocations<

    The NHS Operating Framework for 2011/12 will be available at 4:00pm at:
    www.dh.gov.uk/operatingframework<

    http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=417078&...<

    http://benefits.tcell.org.uk/forums/equity-and-excellence-liberating-nhs...<

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    The Health Secretary Andrew Lansley has dashed the hopes of those who hoped that reforms to the health service would be dropped after the government carried out a health reform public consultation process.

    Changes include scrapping all 151 primary care trusts as well as the strategic health authorities and putting around 80 per cent of the NHS budget into the hands of GPs. At the same time, Lansley warned that hospitals that continue to have mixed-sex wards could be liable to heavy fines.

    "We are not going to pay hospitals for providing a sub-standard service," the Health Secretary told the BBC. "Patients have a right to expect dignity and privacy and if there is a breach of that, that will be published."

    He added that while there has been some negative feedback from the consultation "a very large number of people are happy about change ... [including] giving patients a real share in decision making about their care, giving a focus on the results we achieve for patients, emphasising the quality of what we do for patients and devolving the decision-making to clinical leaders."

    However, critics have suggested that yet another bout of upheaval in the NHS can only be a bad thing and that change could be done more incrementally.

    James Gubb from the Civitas think tank said: "The coalition government needs to stop repeating the mistakes of the past by mandating wholesale structural change. Instead, it should seek to build on the best of what currently exists in NHS commissioning while permitting entrepreneurial GPs to take over in areas where the desire is there or PCT commissioning is failing."

    And yet NHS Confederation clinical director Hugo Mascie-Taylor said that there were many ways to save money while improving the quality of care that the NHS delivers, adding: "The NHS treats millions of people a year and does so with care and professionalism but there are always ways to do things better and to reduce waste at the same time."

    http://www.publicservice.co.uk/news_story.asp?id=15012<

    also covered at http://www.bbc.co.uk/news/health-11993361<

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    Health leaders have issued a stark warning about the risks to services of the government's plan to overhaul the NHS at a time of financial retrenchment.

    The concerns from the NHS Confederation and the Royal College of General Practitioners came as the government announced it was pressing ahead with its plan to scrap primary care trusts< and strategic health authorities and place health commissioning responsibility in GPs.

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    The new system will be implemented over the next two years, despite the £100bn NHS budget facing a real terms freeze. The service is expected to find £15bn to £20bn of efficiency savings from 2011-15.

    "NHS leaders up and down the country are really worried about the prospects for the next two to three years," said NHS chief executive Nigel Edwards. "While we support the objectives of these reforms, we have to get there first."

    He said the government needed to do more to support the NHS to manage the transition and added: "Much of the machinery the NHS has traditionally used to achieve such change is being dismantled, devalued or suffering from reductions in capacity."

    Royal College of GPs president Dr Clare Gerada also raised concerns about the "pace of change" with the NHS having to also make "unprecedented savings".

    http://www.communitycare.co.uk/Articles/2010/12/15/116026/Health-bosses-...<

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    The government will press ahead with its overhaul of the NHS but has responded to concerns that it will disrupt joint working between health and social care by strengthening proposed partnership arrangements.

    Its plan to scrap primary care trusts and transfer their commissioning responsibilities to consortia of GP practices has prompted significant concerns from unions and social care leaders that existing joint arrangements between councils and PCTs could be put at risk<.

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    However, responding to the consultation on its NHS White Paper<, the Department of Health said today that it would implement its reforms through a Health and Social Care Bill, due in January.

    But it made a number of amendments to its White Paper plans, including the strengthening of arrangements for joint working on care between councils and GP consortia.

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    As proposed in the White Paper<, the bill will oblige councils to set up health and well-being boards to co-ordinate health and social care commissioning, which GP consortia would be obliged to join.

    It said councils and consortia would be under a duty to publish health and well-being strategies to provide the overarching framework for NHS, social care and public health commissioning plans.

    But it rejected proposals put forward by the Local Government Association that health and well-being boards would be able to sign off on consortia commissioning plans. The DH said the proposals would give councils power over NHS expenditure without responsibility for it.

    As part of the transition to the new system in 2013, councils and GP consortia would be expected to decide whether to continue with existing pooled budgets and joint working arrangements between local authorities and PCTs. Any arrangements that are not addressed as part of the transition will be continued by default, under the legislation.

    The DH confirmed that GP practices would be free to determine the boundaries of consortia, meaning there is no guarantee that these will coincide with the boundaries of local authorities.

    Currently, most councils share boundaries with their local PCT, which many see as important in promoting joint working.

    However, the DH said: "The government considers that consortia will be most effective if they are not forced to conform with and stick to a prescriptive geographical model. Instead, the intention is to permit communities of GPs to form organisations that best work locally, and for those organisations to adapt and flex over time - spreading, merging, shrinking, dissolving - according to success and failure."

    http://www.communitycare.co.uk/Articles/2010/12/15/116025/nhs-overhaul-t...<

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    The NHS Information Revolution consultation shows that Health Secretary Andrew Lansley has identified one mechanism which really can deliver results in making savings, writes Joel Haspel, CEO of Sentient Health

    NHS leaders are currently being told to focus their ingenuity on achieving the often contradictory challenges of cutting costs and improving outcomes. In many ways this is nothing new, but the current financial situation adds a painful urgency to the need to find a way forward. Many approaches have been tried in the past, both here and overseas, and the results have been mixed.

    One problem tends to be that those on the outside often think there are quick and easy ways to strip out whole layers of administration without hitting services. The reality is rather different – crude cost reduction schemes collide with patient care very quickly. Yet spiralling health bills mean that something has to be done.

    Health Secretary Andrew Lansley, recently insisted the NHS must "make every penny count for patients". His recipe is for "cutting out waste, reducing bureaucracy and simplifying NHS structures so that we are able to invest more in improving frontline care". It's the kind of political declaration that prompts many trust managers and seasoned Department of Health (DH) civil servants to put on their best Sir Humphrey smile and say "Yes Minister". Long experience has shown them it's not quite that simple.

    Nonetheless my experience of working with health services here, and round the world, convinces me that there are ways to reconcile cost cutting with better outcomes. But they can only be achieved with careful planning and some, often modest, investment. Looking through the government's Information Revolution consultation paper provides me with some cheer as it seems that Mr Lansley has identified one of the mechanisms which really can deliver results, patient level costing (PLC).

    PLC is supported by the DH as a means for benchmarking costs and making comparisons between teams caring for similar groups of patients. What's more the services and IT systems are readily available and proved to work. Yet the deeply ingrained public service ethos of the NHS means that using cost as the central means to measure of services, and not simply seeing it as a consequence, still arouses deep suspicion. After all, who knows best about which type of artificial knee should be provided for a pensioner or an otherwise fit, athletic youngster? As a patient you would probably prefer the consultant surgeon to make the choice rather than an anonymous procurement manager. I know I would, and yet I am a big believer in PLC as a vital tool for healthcare providers. They have to keep control of their budgets and eliminate unnecessary spending in order to make the most of finite resources.

    For clinicians accustomed to making up their own minds about ordering certain products, PLC can sound like a nightmare, with bureaucrats effectively making decisions about patients and doing so on financial rather than clinical grounds. While I have real sympathy for the concerns of clinicians who worry about what will happen if cost is king, I also understand the position of management. I recently spoke to David Cole, the head of procurement at The Heart of England NHS Trust, who explained his position succinctly: "The 15% savings target of the next three years represents the start of a huge challenge to procurement in the NHS." He, like everyone else in his position, is deeply committed to finding ways to save money without damaging patient care.

    If PLC is approached in the right way, it should be a plus for all, providing an objective platform to facilitate discussion between clinical and administrative staff. It depends on being able to track every aspect of a process or procedure and attach a cost to each of them. This allows hospitals to identify exactly what resources are used – when, where, how and by which consultants. And while PLC is about much more than this, understanding the actual supplies used on a patient in a procedure is key to gaining visibility and producing accurate costing. We see the gains that can be made once people are empowered with the data to start asking questions about value for money – and I use that term deliberately because it can imply something very different from measuring by price alone.

    When one hospital started to scrutinise the costs per patient of certain procedures it found that consultants were ordering knee replacements from three suppliers and hips from seven. One result was that the cost per patient could vary substantially from one consultant to another. Is that automatically good or bad? The answer is neither. Findings like these raise the potential for savings through standardisation and supplier rationalisation – but only after serious discussion has taken place about the appropriateness of ordering.

    PLC would become an absurdity if it was reduced to insisting that all hip and knee replacements came from the cheapest sources and were of the same type. The fit, young athletic person may need the latest top-of-the-range technology while something more standard suits someone else. Nonetheless, we have seen some fairly idiosyncratic approaches to supplies that have developed for all sorts of reasons. The solution is dialogue, and that is only possible when hospitals are fully informed. At that point it's possible to sit down and look at what is required on a hospital-wide basis, whether orders can be consolidated with fewer suppliers, and whether there are other ways to make things run more cost-effectively.

    The outcome of PLC should be rational decision-making which provides the shortest, most cost-effective route to appropriate care. That has to be in the interests of everyone who is concerned about health service resources. Another aspect of this is the efficient use of time. To this end it would be worthwhile for managers to follow how an item is processed – why not one of those hips or knees – from the stock room, to operating theatre and on into the hospital admin system. Typically each item is manually logged four times. And it's mostly nurses and doctors who are writing down the details of each item as it arrives in theatre, and later typing them into a computer. By introducing an electronic monitoring system which logs, tracks and reports on each item, they facilitate PLC and cut the time and effort used on logging by 75 per cent. The cumulative gains in time available for patient care over a year can be substantial.

    Electronic monitoring saves money in other ways as well. One is the ability to deal with the consignment gap – something health service managers are, understandably, often reluctant to discuss too openly. We have been talking to one hospital which has found itself in a £100,000 dispute with a supplier. The argument is simple to state but tough to solve – the company says items were sent and must have been used, the customer claims they were not used and either never turned up or were taken by the sales rep. While the protagonists and amounts will vary, there are lots of similar wrangles in the public and the independent sectors.

    Getting consignments of clinical goods on a sale-or-return basis looks like good business, and indeed it is if it's properly managed. But the whole idea that you only pay for what you use is completely undermined if you don't have systems in place that track the products from arrival to use. Suddenly you are in a situation where the supplier comes, does an audit and black holes emerge. The worst case scenario is that the hospital ends up paying for items it cannot prove were not delivered or the sales rep removed. The best, and it's not exactly great, is that after a lot of staff time and effort, you do manage to show that the fault lies with the company.

    When it comes to the consignment gap few would disagree that effective cost control is a benefit for all. Likewise I believe that PLC provides a good means of reconciling the contradictions between improving outcomes and reducing costs. But as ever, its effectiveness will depend on how it is used. Investment and planning are essential. Just as important is a determination to use PLC as a tool for delivering clearly defined objectives and never be allowed to make the cutting of cost become an end in itself.

    http://www.publicservice.co.uk/feature_story.asp?id=15510<

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    Questions abound over proposed GP consortia – but co-production will be key to a new world of health services, the NHS deputy chief told Public Service Events' recent NHS Reform conference. Caroline Pennington reports

    I'm not a professional cynic, but why is a new government introducing GP commissioning now?" conference chairman Professor Calum Paton asked delegates. "There must be some political reason which has nothing to do with health policy – because the first thing about health sector reform is that it has nothing to do with health policy. But if you look for conspiratorial reasons, you can't find them."

    The failure of previous primary care trust reform and the urge to have something new were identified by Paton, professor of health policy at Keele University, as key reasons for introducing GP consortia across England. He advised delegates to look at all the previous evidence on advisory roles for GPs.

    "There is some really good evidence out there," said Paton. "Perhaps the best evidence is the evaluation of total purchasing pilots by Nick Mays, from the London School of Hygiene and Tropical Medicine.

    The results are not earth-shattering but they are significant. For example, to do GP commissioning well is expensive. If the benefits out-weigh the costs, what sort of benefits do we get?"

    From this evidence, Paton identified GPs as enthusiastic com-missioners for extended primary care in their local areas. "So my first question to the Department of Health is this: why is the National Commissioning Board going to take that away from GPs and make them do all the secondary commissioning that evidence shows traditionally they have not been very interested in doing?"

    NHS deputy chief executive David Flory said the most radical shake-up of the NHS in its history was on the horizon.

    "We're heading to a world in which patients are at the absolute centre," said Flory. "Patients will be empowered and well-informed, and GPs, through their practices with their local multi-disciplinary teams, working in consortia with partners in other sectors, will take charge of the commissioning and take charge of most of the money. A world where success is measured in terms of higher-quality outcomes, where we deliver that with a more efficient and productive system of provision, and where there are very different terms of engagement between the health and social care sectors."

    Flory urged organisations to work together to design this new world. "We can't continue to do it from the Department of Health; it has to be co- produced by all levels of the system, by people sharing – with ambition – their hopes and fears, and how we need this to work in the future."

    Accountability would be given a harder edge due to health's ring-fenced budget, warned Flory. "There's a long queue of people up and down Whitehall waiting to point out that we didn't need to be given this money, and that we've wasted it now we've got it.
    "It's put the spotlight on us to be absolutely transparent and accountable for the way in which we spend every pound that we've got. So our drive is to improve quality and productivity through innovation and to drive our investment in prevention – and the public health white paper will be coming our way soon."

    Managing transition during the period to 2012/13 was vital in implementing the Liberating the NHS white paper proposals, said Flory. "My job over the next few years is to find a way of steering through this transition period, to enable, to plan and mitigate the risk, but in the end it's going to be our frontline colleagues across the system who have this opportunity to grasp the future."

    Dr Chaand Nagpaul, a member of the BMA's GP committee, questioned whether collaboration could be construed as conflict of interest in terms of the NHS market.

    "We're very clear that what appears to be an ideological commitment to competition is going to be harmful," Nagpaul said.

    The white paper included a reference to a role for foundation trust regulator Monitor to ensure that GP commissioners did not continue referrals to incumbent providers, and that the "any willing provider model" would be an imperative.

    "We are concerned that GPs and local clinicians may not be able to work effectively together if they have the new Monitor breathing down their necks, telling them that they need to be introducing patients to other competitive providers. We think this will be unhelpful."

    And former consultant obstetrician and Keep Our NHS Public campaigner Professor Wendy Savage said: "If GPs accept this poisoned chalice of being the commissioners they are likely to end up rationing, and likely to fail, in which case they are likely to be taken over by the private sector. But GP consortia don't have to happen. We must argue with our MPs to prevent it."

    http://www.publicservice.co.uk/feature_story.asp?id=15508<

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    General practice pathfinders now cover more than half the country

    In his speech today, The Prime Minister will welcome the groundswell of support from general practices that are now at the vanguard of modernising our NHS.

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    General Practice leadership is essential in order to deliver a patient-centred and efficient NHS.

    That’s why we are encouraged by the second wave of pathfinders (a further 89 groups) that have put themselves forward to dry run the Coalition Government’s modern commissioning arrangements. This takes the total to 141 groups of GP practices of various shapes and sizes from across England.

    As a big step towards delivering the plans set out in the Government’s NHS White Paper Liberating the NHS: Equity and Excellence, the groups, known as pathfinders, will work together to manage their local budgets and purchase services for patients direct with other NHS colleagues and local authorities.

    The GP pathfinders announced today include practices providing healthcare to 28.6 million people across England. In addition to the first wave, this means over 50% of the population can start to benefit from their doctors’ proven clinical leadership, good partnership working with local authorities, and innovative ways of engaging with patients and the local community.

    This early progress reaches beyond our expectations – and there will be yet more GP consortia coming forward to join the pathfinder programme, which will enable as many consortia as possible to test out the new arrangements at an early stage before GP consortia take on statutory responsibilities from April 2013.

    Andrew Lansley said:

    “If we want better results for patients and a more efficient NHS, then we must devolve power to General Practices.

    “This second group of selected pathfinders is welcome evidence of widespread enthusiasm for taking these ideas forward.

    “It is clear that GPs and nurses are ready and willing to take on commissioning responsibilities, the pathfinders to date demonstrate this but most importantly, the changes will enable them to make the decisions that better meet the needs of their local communities and improve outcomes for their patients.”

    Patients are already seeing the benefits of local commissioning where consortia have been formed. The Croydon Healthcare Consortium, which serves a culturally and economically diverse population, are already leading the way in improving patient access to diagnostics, treatment and care. In response to feedback from patients, the Consortia was able to introduce a pilot locating mobile screening clinics at six Croydon GP practices to provide heart monitoring and ultrasound.

    This has provided patients with greater choice and convenience, avoided long waiting times, high travel costs and expensive hospital parking, and sped up testing, diagnosis and treatment.

    Also in Somerset, the local NHS identified a strong need for improving the management of long-term conditions. As a result of successful local commissioning, specific initiatives have been rolled out to improve the prescribing for patients living in nursing and residential homes and provide patients with a greater choice in end of life care.

    In the first six months of the pilot, hospital admissions were reduced by 46 per cent. This is not only better for patients, but better use of NHS resources.

    Pathfinders will test the new commissioning arrangements to ensure they are working well before more formal arrangements come into place.

    GP pathfinders will be supported by the National Clinical Commissioning Network, the National Leadership Council, and by national primary care bodies, such as the Royal College of GP's Centre for Commissioning.

    <

    Notes to editors


    1. For further information, please contact the Department of Health press office on 020 7210 5221.

    The NHS White Paper Liberating the NHS: Equity and Excellence was published on 12 July 2010 and the associated consultations can be found at: http://www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm

    http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=417450&...

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    "GPs could take charge of PCTs instead of scrapping them and prevent unnecessary NHS upheaval," two groups of GPs said, adding: "it is not too late to change."

    The two GP leaders at the Royal College of GPs and British Medical Association have intervened ahead of the government's plans to publish the health bill this week

    The government has rejected their suggestion.

    Dr Clare Gerada, chairman of the Royal College of GPs said: "You could have simply mandated to ensure GPs had more of an influence on PCTs boards, and achieved largely the same results. You would probably want a majority of clinicians, mostly GPs but other NHS staff too.

    "By doing that GPs would have become heavily involved in making decisions, we could have still made management savings, but without all the upheaval that the NHS is going through."

    Speaking to the BBC, the two GP bodies argue a "simple tweak" to the governance of NHS trusts could achieve the same results as the government's GP Consortia reforms.

    The government intends to allow GPs to commission services from "any willing provider" and take responsibility for 80 per cent of the NHS budget: 151 primary care trusts will be scrapped by 2013. More than 140 groups of GPs have applied to pathfinder pilots.

    Prime Minister David Cameron said: "I've looked back on the previous government [and] they waited too long before introducing changes that were necessary and that would improve services."

    A Department of Health spokesperson also said: "Primary care trusts are too remote from patients. Simply putting more GPs on a PCT boards would not have delivered the changes that are necessary, and would have simply added more layers to the existing NHS bureaucracy."

    http://www.publicservice.co.uk/news_story.asp?id=15201<

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    Response to the Department of Health Consultation: Liberating the NHS: Greater choice and control - JRF

    The Joseph Rowntree's response to the Government consultation 'Liberating the NHS: Greater choice and control'.

    See also our response to the consultation 'Liberating the NHS: An information revolution'.

    http://www.jrf.org.uk/publications/liberating-NHS-choice-control

     

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    Response to the Department of Health Consultation: Liberating the NHS: An information revolution - JRF

    The Joseph Rowntree's response to the Government consultation 'Liberating the NHS: An information revolution'.

    See also our response on 'Liberating the NHS: Greater choice and control'.

    http://www.jrf.org.uk/publications/liberating-NHS-information-revolution

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    Letter from CMO to follow up Sir David Nicholson’s letter of 13 April on "Equity and Excellence: Liberating the NHS – Managing the Transition".

     

    http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/De...<

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