Appendix 2
GPC SECRETARIAT
COMMENTARY ON THE NHS IMPROVEMENT PLAN
The return of fundholding as
Practice-level commissioning:
From April 2005 "GP practices that wish to do so will be given indicative
commissioning budgets. This will provide
GPs with further incentives to manage referrals effectively with any savings
being reinvested in NHS services."
This is based on national development work undertaken in North Bradford
PCT and was trailed in the PMS document last year. No contractual model is specified. (Paragraph
8.9, p 69).
PCTs will control 80% (an increase
of 10%) of the NHS budget locally: There will be have 3-year allocations (instead of annual), fewer
national targets, reduced monitoring and bureaucracy and more scope for local
flexibility in GP contracts. How this
will be achieved is not specified. For
those which receive "earned autonomy" they will see their management
costs limits removed, be given an opportunity to shape and pilot national
policy and have higher delegated limits for spending on capital projects (p
75).
Reiteration that PCTs can
commission from "a range of providers within the new GMS and PMS
contracts". (Paragraph 8.3,
p 68)
On-line booking, the Care Record
Service and Healthspace: which
will enable patients to access their personal care records online in a secure
place on the internet. (Chapter 7, pp 64-67).
New emphasis on "experienced
based learning": References
to Modernising Medical Careers (MMC), foundation and "cadet
courses." References made to a
"skills escalator" which will help attract people to the NHS who
"could not previously access health careers." An explicit link is made between reducing the
long-term unemployed and social exclusion.
Reference is also made to older people looking for second careers,
migrants and refugees. (Paragraphs 6.9 - 6.12, p 60).
Extensive reference to GPs with
Special Interests (GPwSIs):
"1300 GPwSIs providing 700,000 procedures", using accreditation
frameworks developed by the RCGP. In
response to the argument that this would reduce the need for secondary care
referrals. (Paragraph 6.5, p 59).
GPC needs to make a point to the effect that the
1300 GPwSIs means 1300 fewer GPs in the surgery doing routine general practice.
Expansion diagnostic provision in
primary care and "high street" settings: This will be achieved via the letting of one or
more major contracts to new providers. (Paragraph 5.14, p 54).
Further development of emergency
and unscheduled care: By using
minor injury units, NHS Walk-in Centres, ambulance services and out-of-hours
primary care services, with further integration between primary/secondary care.
(Paragraph 5.15, p 54).
PCTs encouraged to make full use of
APMS, PMS and PCTMS contracts for provide primary care services to those who
would not normally get full access: e.g. people in deprived areas and commuters. Six instant access GP-led primary care
centres aimed at commuters will be opened in
Introduction of PCT development
programmes: utilising the skills
of Kaiser Permanente, United Healthcare and pharmaceutical companies with
expertise in disease management.
Pharmacies will be established which will be open more than 100 hours a
week or to operate wholly by mail order or the internet. (Paragraph 5.10, p
53).
LIFT is praised: (Paragraph 5.3, p 51).
GPC should emphasise that there is little money
for such schemes.
Introduction of community matrons: (description is similar to that of Health
Visitors) who will work with patients on complex problems and assess their
needs and then work with local GPs and primary care teams to develop
"tailored personal plans to deliver the best possible care."
(Paragraph 3.14, p 37).
Reform of the GMC and other
statutory professional regulatory bodies to be overseen by the Council for the
Regulation of Healthcare Professionals: no further detail given. (Paragraph 2.29, page 32).
Reform of post-grad medical
training to be overseen by PMETB:
this is a reference to the MMC. (Paragraph 2.29, p 32).
Re-accreditation procedures to be
linked to annual appraisals for staff. (Paragraph 2.29, p 32).
Support to be provided for
employers dealing with poorly-performing doctors: no further detail given. (Paragraph 2.29, p
32).
Reduction of bureaucracy on repeat
prescribing and restrictions on location of new pharmacies. (Paragraph 2.14, p
29).
Extension of over the counter (OTC)
medicines list. (As above).
Promotion of minor ailment schemes: where pharmacies can help patients manage
conditions like coughs, hayfever and stomach upsets, without involving GPs. (As
above).
Increased number of professionals who can
prescribe. (As above).
M Isom – 24 June 2004
PEO, GPC secretariat