ࡱ> MOL .bjbj .>hh&,!)))))~!!!!!!!$"%!!))!"))~!~!r> T>!)"FR& j!!0! W&DTW&>!W&>!,!!!W& : Summary of GPC guidance on the NHS next stage review The GPC review document briefs LMCs on the proposals relevant to General Practice form the main document. The individual proposals have been grouped along thematic lines and this summary follows this grouping. The summary of the Government proposals precede the GPC comments that will be in italics where I gave quoted direct albeit shortened. CHOICE AND QUALITY Open close lists and extend practice boundaries. Fair payments based on the needs of local populations. The Government believes that it is Practices that are most powerful in terms of choice and provision of services offered to patients and is determined to change this so that it is in favour of Patients. To meet the challenge of APMS providers, practices will need to ensure that they are responsive to their patients. Develop QoF to reduce the number of organisational and process indicators and refocus resources on new indicators of prevention and clinical effectiveness following discussions with NICE. PCTs will have greater flexibility in selecting quality indicators. Quality indicators are independently developed and based on thorough evidence. If this independent function were passed to NICE then we fear evidence would be interpreted differently. The development of preventative indicators is also concerning (it) depends on the willingness of patients to engage with their care. Local QOF indicators will undermine the fundamental principle of a National Health Service and potentially (create) a postcode lottery. PCTs should offer a LES if there are local care issues. Although we support in principle the use of patient reported outcome measures, it is very difficult to interpret them usefully. This concerns screening and vaccinations programmes. We are concerned that there is (a move) away from DESs for such programmes. Developing a LES undermines the uniform approach of a National Screening Programme. All patients will have the right to NICE approved treatment and drugs. Patients should expect local decisions. This will shift the responsibility for making these decisions onto PCTs and PBC groups and they may come under attack if they have insufficient resources to fund treatments. NICE will be expanded to set more standards and NSFs from April 2009. A new website, NHS evidence, will manage the spread of knowledge. The development of NHS Evidence is a positive step. Clinical Dashboards will be developed by the DOH to present selected quality measures to inform daily decisions. Three pilots are underway (patients attending A&E and OOH service) More information is needed to understand the role (these) will play NHS Choices website will be developed. Choose and Book will be developed. Health trainers will work with people at greater risk of poor health. The website must be fit for purpose. The information would be misleading (if it turned into) some form of practice league table. Also continue to have concerns regarding the ability of patients to post their opinion of the primary care they receive into NHS Choices. Payments to hospitals will become conditional on the quality of care given to patients on outcomes of patient-reported outcome measures (PROMs). Proposals largely aimed at secondary care. Positive proposals Regarding projected tariff uplifts and efficiency gains. Not appear to be relevant to general practice (but) may have implications for PBC. If secondary care rewarded for Quality with funding where will it come from? Efficiency gains should also be seen as demands to do more work without extra funding. DEVELOPMENT OF NEW AND EXISTING PROPERTIES Health checks aged 40-74. Pharmacies will have a key role. Vascular screening welcomed but should be GP-managed. We do not believe it would be cost effective for pharmacists but more effective if the clinician has access to the full patient record. Mass screening will need to be properly resourced. It would result in a significant increase in general practice workload. Prevention service under six key goals. Helpful proposal. Already a mainstream element of General Practice. Important to acknowledge that each affected by external social circumstances and to provide funding based on outcomes counterproductive. LMCs may wish to seek clarification from their PCTs on how they intend to implement this proposal. (?LES) Sufficient early intervention for those who would have to stop work for health problems. Positive steps but hope that available for those people not in employment. Establish a Coalition for Better Health. Initial priority will be combating obesity. Aim to establish voluntary agreements between the government, private and third sector organisations. Health visiting will be at the forefront of improving childrens health. The provision of health visitors needs a radical revision for this proposal to be effective COMMISSIONING Incentives for PBC so that family doctors and hospital specialists together develop more integrated care for patients. (the GPC comments that many PCTs do not engage with PBC and have poor information on which to work e.g info re hosp referrals. They suggest that: LMCs should consider challenging them with the sentiments expressed in the passage from HQCFA,5.28-29. PCTs commissioning skills will be enhanced. We do not believe that developments of markets is the best way to achieve this goal. 16. As above - related to transforming skills in PBC to action Appears similar to External Support for Commissioners (FESC). Evaluation of this initiative should take place before further roll-out. From 2009 a set of metrics will be piloted. To measure quality, clinical productivity and patient experience. Clarification will be sought from the DOH regarding these. Where PCTs demonstrate improvement on health outcomes they will be given greater freedom over the priorities they set and methods and people they employ. Freedoms will be set in the Autumn. As national targets are achieved they will become minimum standards. We welcome the move away from a target-driven culture. SERVCE PROVISION AND RECONFIGURATION personal care plans will be offered to those with long-term conditions over the next 2 years. Positive idea in theory. There is no guarantee that care plans will benefit all patients with long term conditions. Important to consider resources. National pilot programme for personal health budgets. Budget will be held on behalf of patients. Raises many serious questions. Raises the spectre of budget rationing and the restricting of treatment. Will provide some scope of alternative treatments. Methods will need to be found to measure this. Pilots will need to determine whether personal health budgets provide better care, and whether they are cost effective. Three-digit phone number for urgent, unplanned care. Further details later this year. We do no believe that the addition of a new three-digit number will improve the current situation. Acceleration of existing NHS trust to foundation status. The DOH will explore community foundation trusts. The spread of Foundation trusts into primary care is concerning. NHS staff will have the right to request to set up enterprise organisations. Very positive proposal DOH will pilot integrated care organisations (ICOs) These proposals will be explored to gain a proper understanding of these new bodies CLINICAL ENGAGEMENT AND CLINICAN DEVELOPMENT 25. Establish SHA Clinical advisory Groups to support clinical leadership within SHAs. SHAs will establish quality Observatories. A national Quality Board will be established to provide strategic oversight and leadership in quality By April 2009 will be SHA Medical Directors. Will work alongside regional directors of public health and closely with PEC chairs. For these posts to be effective they need to the confidence of local clinicians. LMCs may wish to approach PCTs and seek further information about the local processes About clinician involvement in commissioning. We firmly agree that stronger clinical engagement in commissioning is necessary. Keen to know what changes will be made to achieve (this). PCTs should seek to engage LMCs in this matter while LMCs should utilise the WCC assurance process to provide 360degree appraisal of their PCTs. Leadership training for medical and nursing undergraduates. New Leadership for Quality Certificate. Establish MHS Leadership Council. More detail is needed but the intention is welcomed. Expansion of GP training by 800 places. We support this but have concerns regarding the capacity of GP trainers to deliver the training About adapting service to be more teen friendly in General Practice. It is unclear why the Royal College of Paediatricians and Child Health is better placed than the RCGP to develop this programme. REGULATION AND ASSESSMENT From April 2010 Quality accounts will be published by providers. It is expected that this will apply to GMS and PMS but not clear (and no) indication of workload to produce these reports. Data can be very subjective. Effort must be made to ensure that this is not a tick box exercise. Development of CPD and re-validation. Accreditation schema developed by the RCGP may be adopted nationally by 2010. The GPC remains heavily involved in the RCGP Scheme. The Care Quality Commission (CQC) will regulate all GP and dental practice to a set of quality standards and work with regulatory bodies to ensure that practitioners are fit to practice. The development of the CQC marks the increasing duplication of regulation. This will increase the extent of the bureaucracy that GPs face. IMPLEMENTATION PCTs to publish a five-year strategy by Spring 2009. The involvement of LMCs will be crucial to this process. We suggest that LMCs make early contact with their PCTs to explore how these proposals will be implemented locally. 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