ࡱ>  @ Gbjbj )؝؝?lllllllltD"H:>  GGGGGGG$JR`LNGlY "Y Y GllG)!)!)!Y llG)!Y G)!)!R}Cll9F Co :qDGG0"HDL vL<9FllllLl9FL)!WlGG!  NHS NEXT STAGE REVIEW FINAL REPORT: OUR VISION FOR PRIMARY AND COMMUNITY CARE BMA SUMMARY Background The NHS Next Stage Review, Our NHS, Our Future, was announced in July 2007 and was a wide-ranging review of the NHS in England, both at a local and national level. It was led by Lord Darzi, Parliamentary Under Secretary of State at the Department of Health. A first interim report was published in October 2007 and a second in May 2008; BMA summaries of these reports are available at the following website address:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/DarziReviewsNational" www.bma.org.uk/ap.nsf/Content/DarziReviewsNational A BMA position statement setting out our concerns over some aspects of the review process as a whole and the proposals made in the early stages of the review is available at the following website address:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/Darzipositionstatement" www.bma.org.uk/ap.nsf/Content/Darzipositionstatement The report Our vision for primary and community care was published on 3 July 2008; it is available at the following website address:  HYPERLINK "http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085937" http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085937 This is a BMA summary of the intentions and recommendations of the report. CHAPTER 2 OUR VISION This report sets out a vision for how services will grow over the next ten years. Primary and community care clinicians will provide services that are tailored to individuals needs, accessed easily and conveniently and available in a range of care settings. The public will have greater control over their healthcare choices. There will be increasing access to services that help people maintain and improve their health and wellbeing, and an emphasis on the reduction of health inequalities. CHAPTER 3 PROGRESS SO FAR AND THE CHALLENGES AHEAD This chapter provides an overview of the strengths and developments in primary and community care over the last ten years. Particular reference is made to: The trust patients have in GPs and the high levels of satisfaction patients have with visits to their GP (97%); The strength of the registered list and the continuity of care it provides in individual and family healthcare; The improvements made as a result of the introduction of the Quality and Outcomes Framework (QOF), and the positive growth in the GP workforce under the 2003 contract; Better access to GPs and longer consultation times; and Investment in 100 new GP practices and 150 GP-led health centres, as well as 28 community hospital schemes, the establishment of a Family Nurse Partnership Programme, improved access to psychological therapies, the growing role of pharmacies in healthcare provision and the expansion of dental services. CHAPTER 4 PEOPLE SHAPING SERVICES Listening and responding to patients and local communities Responsive primary and community care begins with systematically listening to patients and communities and developing services accordingly. From 2009, the national GP patient survey will ask a broader range of questions about the quality of services. However, new models of patient engagement are also needed. Practices that respond to patients views will be rewarded. Services that fit together and make sense Patients should not be treated just for individual symptoms, but as a whole person. GPs will help ensure that patients have access to wider and more integrated community-based services, and these services will be available in a greater variety of settings. Integrated care will mean community health professionals working on a collaborative basis. Out-of-hours services will exemplify this integrated approach, and there will be a new measure of patient satisfaction with urgent and out-of-hours care. The introduction of a new 3-digit telephone number for urgent unplanned care is being explored. The ability to choose your GP practice Patients will have a greater and more informed choice of GP practice, allowing the development of fairer rewards for practices that provide quality service and attract more patients. The NHS will work with local GPs to open closed lists and extend practice boundaries, and discussion with GP representatives will see more resources channelled into fair payments based on the needs of the local population Helping people take control of their health By 2010, all people with a long-term condition, including mental health, will be offered a personalised care plan. These will be signed off by patients and their lead professional, and will enable greater patient choice in treatments, settings and providers. Pilots will also be conducted that give greater control over the use of NHS funds to patients with long-tem conditions. In 2008, a Patients Prospectus will be published to help people understand the care that is available and allow them greater control over the management of their condition. A web-based resource, HealthSpace on NHS Choices will allow people to access their personal health record, update it, book appointments and request repeat prescriptions. CHAPTER 5 PROMOTING HEALTHY SERVICES Improving health and reducing health inequalities will be possible through greater partnership working across primary and community health services. A fuller set of health and wellbeing indicators will be developed to support this, and taken down to the level of individual wards and practice-based commissioning (PBC) clusters. Promoting health for all stages of life Health visitors will be at the forefront of improving childrens health, and will lead the new Child Health Promotion Programme. NHS South Central will consult the public on fluoridating in the area around Southampton. Other regions will consider this also. The Royal College of Paediatricians and Child Health has been commissioned to develop training for all doctors and nurses to help them adapt services to be more teen-friendly. Sufficient early intervention for those who would have to stop work for health problems will reduce risks to long-term health. From next year, musculoskeletal services, psychological therapies and other work-related health support services will be piloted. A national programme of vascular risk assessment for people aged between 40 and 74 is being developed. The extension of existing, and development of new, preventative services for older people will be explored. Improved access to wellbeing services Access to healthy living services, such as advice on stopping smoking, control of alcohol use and improvement of diet and fitness, will be improved. The NHS Choices website will develop into a single access point enabling people to get information about all types of health and wellbeing services, including those increasingly provided by pharmacies, community health clinics and third sector organisations. The Choose and Book system will be developed so that GPs can refer patients to a wider set of services. Health trainers will work with people at greater risk of poor health. Promoting equality Primary and community services will have a central role in tackling health inequalities. Proposals have been announced to improve the recording of data on ethnicity and first language so that GP practices are able to assess the degree of equitable uptake of services. The BMA is also being consulted on the introduction of annual health checks for people with learning disabilities. Fair funding for primary care The QOF will be developed, following work with professional and patients groups, to reflect the objective of promoting healthy lives. CHAPTER 6 CONTINUOUSLY IMPROVING QUALITY Transforming community health services Services that promote health and wellbeing and reduce health inequalities are to be accorded an equal status with other NHS services. A programme of professional development to strengthen clinical skills and clinical leadership will be developed. With the NHS Institute, a productive community hospitals programme is being rolled out and a productive community services programme developed, which will review the evidence base for care pathways. Staff will be supported with the best clinical research and key improvements in technology systems that improve data sharing and support evidence-based practice and underpin strategic commissioning. The principles of World Class Commissioning (WCC) will be applied to community health services. Commissioning will be informed by joint strategic needs assessments and services will be developed to meet the needs of the community. From 2009, a set of metrics will be piloted that commissioners can use to measure quality, clinical productivity and patient experience. The aim is to make the best use of professional skills and resources and release more time for direct patient care. Later in 2008, a standard flexible national contract will be published, which will enable PCTs to hold community health services to account for quality and health improvements. PCTs will be supported in making local organisational decisions by the drawing together and publishing of advice on a range of organisational options and their implications for governance, patient choice, competition and employment. Staff will be given the right to request to set up social enterprises to deliver services. If agreed, a contract will be provided to deliver services for an initial three years. A national board has been established that includes community nurses, allied health professionals and staff organisations to drive the transformation of community health services and ensure that staff are engaged in the development and implementation of this vision. Developing the Quality and Outcomes Framework An independent and transparent process will be created for developing and reviewing the indicators in the QOF, to reduce the number of process indicators and focus resources on health outcomes and quality, following discussion with the National Institute for Clinical Excellence (NICE) and professional and patient groups. The potential for greater flexibility in the local NHS in terms of local quality indicators will be explored, as will the use of patient reported outcome measures (PROMs). Improving information on quality The process of collecting, analysing and publishing data on quality of services will be expanded to provide patients with greater choice and better enable quality and excellence to be recognised and rewarded. The use of accreditation schemes will be promoted to assess the safety and quality of services and act as a spur for continuous improvement. The Royal College of General Practitioners will be supported in developing such a scheme for GP practices. Delivering essential standards The new Care Quality Commission will, subject to consultation, regulate all GP and dental services, making them subject to a consistent set of quality standards. The Commission will work closely with professional regulatory bodies to ensure that practitioners are fit to practise. CHAPTER 7 LEADING LOCAL CHANGE Locally designed services Community settings will increasingly be used for some services traditionally provided in hospitals, especially as care moves towards supporting health and wellbeing rather than simply curing disease. However, there will not be a national blue print for how this is done. A collection of resources will soon be published on delivering care closer to home. Access to the NHS Care Records Service will be reviewed so that health professional can provide the best integrated care to patients quickly, by accessing the information they need. A new fund will be created to promote innovation in the NHS, with prizes for ideas that benefit patients and the public. Empowering clinicians: practice based commissioning Working with the professions, practice based commissioning (PBC) will be redefined and reinvigorated. PBC will provide the clinical leadership central to WCC, focussing on high quality services. There will be incentives for clinicians to engage with PBC, so that family doctors and hospital specialists together develop more integrated care for patients. A clearer distinction will be made between the work of GP practices in commissioning care, and the role of practices in providing services for patients. PCTs will be held to account for the quality of their support of PBC, including management support and appropriate data provision to PBC groups. PCTs will be expected to provide a management allowance to PBC groups to support innovation. There will be different levels of engagement with PBC so that there is increasing autonomy for those groups that have demonstrated they can take on increased responsibility and freedoms in managing resources and designing services. PCTs must ensure that these groups have the support they need, and will be able to hold them to account for how they fulfil these responsibilities Piloting new models of integrated care Proposals for pilots that involve clinicians working across primary, community and secondary care will be invited. These pilots will test innovative approaches for transforming patient services, with a strong focus on predicting and preventing ill health. The pilots will test ways for PCTs to commission integrated care organisations, multi-professional groups based around GP practices that can manage healthcare resources for their local populations. Such organisations will be accountable for the quality of the services provided, health outcomes and the satisfaction of patients. The pilots will allow PCTs and clinicians to identify the most effective governance models for integrated care. Developing world class commissioning The skills of PCTs in commissioning primary and community care will be enhanced. PCTs will need to: work with the public, local clinicians, local government and other partners to understand local needs; provide strong clinical leadership and ensure strong clinical engagement; develop primary and community contracts to ensure increasing incentives for investment in prevention and in early identification and management of risk; provide clear information to the public about the range and quality of care available; and develop markets in primary and community health services to stimulate choice and innovation. It will be defined more clearly how PCTs can be held accountable, through the WCC assurance system, for their success in developing primary and community care. Over the next year, the support available to PCTs to transform their skills in commissioning will be improved. These skills will include: the use of modelling to profile the needs of different segments of local communities; developing datasets that allow commissioners to publish information on performance; the better management of contracts; and better estate strategies, using private finance or arms-length property companies where appropriate. Arrangements for partnership working across Strategic Health Authorities and Government Offices of the Regions will be strengthened so that there is a joint approach to planning and prioritisation. A Minister-led group will be established to identify how best to support those organisations that wish to go further in integrating health and social care. CHAPTER 8 NEXT STEPS Each PCT will now develop its own plans for improving the health of people locally, putting into practice the conclusions of the regional clinical pathway groups. The NHS will ensure that these local plans reflect the shared objectives for primary and community care, and that plans are developed in genuine partnership with the public, NHS staff, local authorities and other partners. Nationally, the commitment to create the right environment for change will be followed through. A national clinical advisory group will be established to assess progress against the objectives of the strategy. 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