ࡱ> [ GGbjbj (ΐΐ>=%BB8[J`cc">>>IIIIIIIL]OIs!">s!s!IJ%%%s!I%s!I%%RrDRG`%ċ"fEIJ<[JEcPy#0cP<RGcPRG>`%P\>>>II$^>>>[Js!s!s!s!cP>>>>>>>>>B K: AUGUST 2008 BMA involvement in implementation of the SHA visions published under Lord Darzis NHS Next Stage Review (England only) Distribution: UK & Regional Councils, National & Regional Branch-of-Practice Committees, Local Medical Committees.  CONTENTS Executive summary Page 2 Introduction Page 3 Implementation of SHA visions Page 3 The London review Page 4 Ensuring adequate BMA and doctor involvement Page 4 Branch-of-practice-specific issues Page 4 Cross-branch-of-practice issues Page 4 Methods of communication Page 5 Appendix 1 : template letter to SHAs from BMA regional councils Page 6 Executive summary Lord Darzis Next Stage Review reports repeatedly emphasise the importance of securing strong clinical engagement and leadership in decisions around the delivery of NHS services, at a national, regional and local level. Implementation of SHA visions under the NHS Next Stage Review will be conducted at a local and/or regional level. In order to ensure adequate BMA involvement in regional implementation of the review, the associations regional structures (i.e. regional councils and regional branch-of-practice (BoP) committees) will need to engage with and endeavour to influence this process. Effective liaison between the different regional structures in an area, as well as between the regional and national structures, will be required. This will enable the BMA to maintain a national overview of developments, to offer guidance where appropriate and to try to influence nationally where necessary. SHAs in England (except London) published their regional visions for healthcare for the next decade as part of the NHS Next Stage Review in May-June 2008. PCTs are using the SHA visions to inform the development of their commissioning strategies over the summer, for publication by Spring 2009. New SHA Clinical Advisory Groups and Medical Directors will be responsible for overseeing implementation of the SHA visions. There is likely to be variation in how different SHAs and PCTs conduct the implementation process. In London, a different process and timescale has been followed. However, individual or groups of PCTs in London, like their counterparts elsewhere in the country, are now in the process of developing detailed proposals around services, following a public consultation earlier in the year. BMA regional councils are writing to SHAs to express an interest in being involved in the development and implementation of the vision and seek information on what opportunities there will be for local doctors to continue feeding into the review process. BMA regional branch-of-practice (BoP) committees and local medical committees (LMCs) are advised to endeavour to keep abreast of BoP-specific developments arising from the SHA visions. Regional committees and LMCs should keep each other informed of BoP-specific issues and developments via regional councils. Regional councils are advised to endeavour to keep abreast of cross-BoP developments arising from the SHA visions as well as maintain an overview of any BoP-specific issues. Regional councils comprise membership from the different regional BoP-committees and LMCs; regular communication between the different constituent parts of regional councils is essential. Following on from the series of meetings held in May-June 2008, regional councils will set aside time at meetings later in the year to discuss the developing strategy of the SHA and PCTs. Introduction Through the NHS Next Stage Review, the Department of Health in England has signalled its intention for future changes to NHS services and the implementation of health policy to be increasingly decided and led at a local and/or regional level. In order to respond to this move towards greater devolution of healthcare decision-making, the BMAs regional structures will need to play a leading role in engaging with and influencing decisions around local/regional NHS services. Effective liaison between the regional and national structures will also be required, to ensure that national guidance and support can be offered to the regions where appropriate. This guidance seeks to clarify the lines of accountability between regional and national BMA structures as well as set out a model of good practice for how the different regional structures should function and interact. It also sets out the respective responsibilities with regard to monitoring regional and local implementation of the NHS Next Stage Review. The BMA acknowledges that the level of regional committee/council activity and expertise differs from area to area and that for some, this model may appear particularly ambitious. However, it should provide an indication of the direction in which regional committees/councils should be travelling, even if over a period of time. Furthermore, the BMA centrally is currently looking at ways in which regional councils in particular can be supported to fulfil their functions. Implementation of SHA visions SHAs in England published their regional visions for healthcare for the next decade as part of the NHS Next Stage Review in May-June 2008. Also in May-June, a series of eight extraordinary BMA regional council meetings open to all BMA members took place to allow doctors the opportunity to learn more about, discuss and consider SHAs proposals and their implications. PCTs are responsible for the next stage of implementation of the proposals made under the regional reviews by using the SHA visions to inform the development of their commissioning strategies; work that starts over the summer. The final national review report High quality care for all published in June 2008 says that PCTs will publish their 5-year strategic plans by spring 2009. Once PCTs make more specific proposals based on the SHA visions, it is possible that further consultation will need to take place. This will particularly be the case where the proposals envisage a significant service change. The interim, interim review report Leading local change published in May 2008 said that the Department of Health had asked each SHA to develop plans to harness the energy and enthusiasm of the Clinical Working [or pathway] Groups to be the guardians of the pledges made in this document and oversee the implementation of each strategic vision. The final review report then announced the (competitive) appointment of SHA Clinical Advisory Groups and of new, dedicated SHA Medical Directors by April 2009, who will be responsible for overseeing implementation of the SHA visions. Beyond the above, there are no further indications of the process that will be followed by SHAs and as has been the case from the start of the review, each region is likely to follow its own process and timescale to a certain degree. As such, BMA regional councils are writing to the relevant SHA(s) asking for more detail on the implementation process and timescales they intend to follow. The London review The London review is distinct from the wider NHS Next Stage Review and has followed a different timescale and process. In December 2006, NHS London (the Strategic Health Authority) asked Lord Darzi to carry out a review of Londons healthcare. The subsequent report Healthcare for London: A framework for action was published in July 2007. A few months later, an executive London Commissioning Group was established to oversee coordination and implementation of the London review. The membership is derived mainly from PCTs and the SHA, but also includes some patient (up to 3) and clinician (1) representation. In addition, a Clinical Advisory Group (30-strong membership) was set up to support and advise the London Commissioning Group and Londons PCTs. A public consultation on the reports proposals took place from December 2007-March 2008. In May 2008, Londons 31 PCTs considered the consultation findings and in June, a public meeting of the Joint Committee of PCT's was held to agree recommendations for the Capital. Individual or groups of PCTs are now in the process of developing detailed proposals on services based on these recommendations; these proposals will be subject to further discussion and consultation. Ensuring adequate BMA and doctor involvement BMA regional councils are writing to the relevant SHA(s) to express an interest in being involved in the development and implementation of the SHA vision over the coming months. The letter also seeks information on what opportunities there will be for local doctors to continue feeding into the review process. For information, a template of this letter is attached at appendix 1. This does not preclude regional Branch-of-Practice (BoP) committees and/or local medical committees (LMCs) from developing their own links with SHAs and/or PCTs, but wherever possible, there should be some form of coordinated approach. Branch-of-practice-specific issues Regional BoP committees and local medical committees (LMCs) are advised to endeavour to keep abreast of BoP-specific developments arising from the SHA visions. Where BoP-specific problems or concerns arise, regional committees and LMCs should feed this back to the relevant national committee secretariat, via the usual communication channels. The national committee and secretariat are to take action and/or offer guidance as appropriate and according to the usual procedures. The relevant BMA Industrial Relations Officer (IRO) should be kept in the loop at all times and where appropriate, asked for guidance directly. The national committee secretariats should maintain liaison with other BMA departments including the Health Policy and Economic Research Unit (HPERU) and, where relevant, keep them up to date with BoP-specific developments locally and seek advice as appropriate. Regional committees and LMCs should keep each other informed of BoP-specific issues and developments via regional councils. Cross-branch-of-practice issues Regional councils are advised to endeavour to keep abreast of cross-BoP developments arising from the SHA visions as well as maintain an overview of any BoP-specific issues. As a new initiative, regional councils are to submit a brief report in time for each UK council meeting, through which any cross-BoP problems or concerns at a regional level can be highlighted nationally. In addition, all UK council members are expected to be active members of their regional councils. The relevant IRO should be kept in the loop at all times and where appropriate, asked for guidance directly. Regional councils comprise membership from the different regional BoP-committees and LMCs. Regular communication between the different constituent parts of regional councils is essential. Methods of communication Regional councils will set aside time at meetings later in the year to discuss the developing strategy of the SHA and PCTs, in terms of both BoP-specific and cross-BoP issues. A few regional councils may hold meetings specifically for this purpose. Four regional councils have dedicated BMA listservers at present; there is the opportunity for all regional councils to have a dedicated listserver if requested. The London regional council is creating a webpage on the BMA website, which will incorporate a contact us facility for doctors to submit feed back on their experiences of SHA and PCT activity in relation to the London review. Communication between different regional council chairs and honorary secretaries may also be of use; a dedicated listserver has recently been set up to serve this purpose. In the absence of a dedicated listserver, electronic working groups can be set up easily as long as all members use the reply to all function. Such a group could be set up for the regional committee, LMC and regional council chairs/secretaries for example. APPENDIX 1 Template letter to SHAs from BMA regional councils regarding clinical engagement INSERT introductory paragraph if necessary, tailored to local circumstances/relationships. As you know [delete if n/a], the [insert name] regional council met in [insert month] to discuss the SHAs vision for healthcare for the region; your contribution towards this meeting was much appreciated [delete if n/a]. Since then Lord Darzi has published his final review reports. We are aware that PCTs are responsible for the next stage of implementation of the proposals made under the regional reviews by using the SHA visions to inform the development of their commissioning strategies, work that starts this summer. Furthermore, the final national review report High quality care for all published in June 2008 states that PCTs will publish their 5-year strategic plans by spring 2009. We would however be grateful to receive a more detailed outline of the process that will be followed by the SHA and PCTs, as well as the intended timeframe. The interim, interim review report Leading local change published in May 2008 said that the Department of Health had asked each SHA to develop plans to harness the energy and enthusiasm of the Clinical Working [or pathway] Groups to be the guardians of the pledges made in this document and oversee the implementation of each strategic vision. The final review report then announced the (competitive) appointment of SHA Clinical Advisory Groups and of new, dedicated SHA Medical Directors by April 2009, who will be responsible for overseeing implementation of the SHA visions. We would be grateful to receive further detail on how and when the SHA plans to implement these recommendations. The BMAs regional councils comprising membership from the different regional branch-of-practice and local medical committees provide a portal to an extensive group of grass-roots doctors and from which we would be able to put forward a number of nominations for involvement in the advisory and implementation process. The Clinical Advisory Groups must be truly representative, properly appointed and their membership should be made aware of their duty to remain in touch with the views and experiences of their grass-roots colleagues. Whilst we acknowledge that it would not be possible for everyone who shows an interest to be directly involved, this does not preclude there being in place a transparent and inclusive system that allows for a continual feeding-up and feeding-down of ideas and views. As such, we would be interested to know what ongoing opportunities there will be for local doctors to engage with and feed into the review process. Lord Darzis review reports repeatedly emphasise the importance of securing strong clinical engagement and leadership in decisions around the delivery of NHS services, both at a national and regional level. The BMA fully supports this aim and believes that it is vital that the medical profession, in partnership with the public, is integrally involved in this agenda. To this end, the [insert name] regional council would like to work more closely with the SHA and local PCTs over the coming months and in the future. In the first instance, I would be happy to meet with you in order to discuss how we can develop a system of meaningful and ongoing clinical engagement and involvement for the region. [Insert sentence about a further regional council meeting later in the year to discuss progress with implementation of the SHA vision and request SHA attendance if appropriate.] I look forward to hearing from you at your earliest convenience.  Five of the SHA visions are formal consultations, for three, comments have been encouraged and for one, there is no mention of feedback/comments. NHS London did not publish a vision.  A template report has been devised for this purpose, as circulated by email to regional council chairmen and honorary secretaries in July 2008.  The meeting dates for the 2008-09 session are as follows: 25 September 2008; 26 November 2008; 22 January 2009; 18 March 2009 and 20 May 2009.     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