National Health Service (NHS), PCT & Local Health Board News - Feb 2006

England - Local PCT News

Bassetlaw PCT - Organisational Changes

PCT board members have supported a proposal to link Bassetlaw with Doncaster rather than other PCTs in Nottinghamshire, because of the PCT's strong clinical and geographical links with South Yorkshire.

Three proposals were considered at the board meeting:

- one PCT for Nottinghamshire
- one PCT for Nottingham City and one for the remainder of the county
- one PCT for Nottingham City and one for the rest of Nottinghamshire, except Bassetlaw which would be linked to Doncaster

The third option has only recently been introduced. The board also supported the creation of a fourth option, which would retain Bassetlaw PCT as a separate organisation, retaining its links with a range of partners across many geographical boundaries. The public consultation period will run until 22nd March with specific, more detailed public meetings being held in Worksop and Retford in the next two months.

Bristol North PCT - Community Pharmacy

Bristol North PCT has launched a project which aims to improve the use of medicines within local black and ethnic communities. One third of the Pakistani, Bangladeshi, black Caribbean, black African and other ethnic groups live in the top five most deprived wards in Bristol. The PCT believes that cultural barriers can make it difficult for some patients to access the right medicines - although they might speak English well, the use of jargon or medical language may be confusing, and they may not not understand why they need the medicine, how long or how often to take it, and what the possible side effects are.

Two local pharmacists are available to accompany patients when they visit their GP, to give support and help. They also plan to hold their own clinics in the community to give advice on medicines. Information from the project will be fed back to local GPs so they can make improvements to patient care.

England PCTs - Finance

The DoH has announced that "turnaround teams" are to be sent into 18 NHS Trusts to help them tackle financial problems, following KPMG's investigations into 62 organisations in December. Twenty three further organisations will also receive additional expertise to support financial turnaround.

The first Trusts to be targeted are not necessarily those with the highest deficits, but those deemed to need the most help turning their financial situation around. It was also stressed that choice of NHS Trust did not necessarily reflect upon the quality of leadership, as some organisations include those where the scale of the problems would tackle the very best management.

The PCTs involved (with the 2005/6 6-month forecast deficit) are: Cheshire West PCT (£15m), Hillingdon PCT (£26m), Kennet & North Wiltshire PCT (£6m), North Sheffield PCT (£4m), Selby and York PCT (£10m), Sheffield South West PCT (£4m), Sheffield West PCT (£4m), South East Sheffield PCT (£4m) and West Wiltshire PCT (£8m)

Heart of Birmingham PCT - Sexual Health

An expansion programme at Birmingham's largest sexual health clinic, the Whittall Street Clinic, means that staff can now offer more clinics and longer opening times. Last year, people who needed sexual health checks had to wait an average of 25 working days - this has already been cut to 11 days, and the clinic is aiming to provide an appointment within two days by 2008.

The clinic employs 70 staff and last year treated about 22,000 cases with diagnoses ranging from chlamydia to HIV. The Chairman of Heart of Birmingham PCT, Ranjit Sondhi, said: "Poor sexual health and the level of STIs in the city are moving towards epidemic proportions. This expansion will go to help us to further reverse this trend, but the biggest impact we can have is by changing people's attitudes and behaviour." Cases of syphilis recorded in the West Midlands have increased from two in 1996 to 237 cases last year. Cases of gonorrhoea have almost doubled since 1996, from 1,294 to 2,532 last year, and the incidence of chlamydia has trebled during the same period, from 2,560 to 7,643.

Isle of Wight PCT - Intermediate Care

Five GP practices across the Island have now contracted with the Isle of Wight PCT to look after patients discharged from hospital so they can have intermediate care or rehabilitation in nursing homes. Community Nurses have also been employed to look after the patients, and all are supported by Consultant Geriatrician, Dr Dirk Weich. Previously, there was no such clear or formal arrangement, and nursing homes would call GPs on an ad-hoc basis. Patients now receive physiotherapy in the nursing homes and are visited by the participating GPs. The PCT has calculated that this will not only reduce re-admission rates but will save between £10m and £12m a year by freeing up 1,200 bed days in hospital.

Lincolnshire PCTs - Community Matrons

Lincolnshire has 13 Community Matrons working in the Lincoln and Gainsborough area, and it is hoped that this number will increase to 20 by the end of the year. Their work involves treating people and offering advice about long-term conditions such as severe asthma, diabetes and heart disease. Each Community Matron has a specialist focus, and a caseload of approximately 60 patients, which means that 720 people are currently being cared for in the community - this should increase to 1,200 during the year.

Chronic Disease Management in the community generally means fewer emergency hospital admissions, because patients are managing their condition more effectively - it is estimated that 8 of the top 11 causes of hospital admissions are long-term conditions. The NHS in Lincolnshire, which is facing an overspend of £14.8m by April, has said that this has enabled them to close 164 beds at hospitals in Lincoln, Boston, Louth and Grantham.

National Obesity Forum - Resignation of President

Nottingham GP, Dr Ian Campbell, has resigned as President of the NOF. He was instrumental in the creation of the organisation, but believes it has become too dependent on drug company funding and should concentrate on developing a preventative strategy.

NHS England - LIFT

The NHS plans to open around 60 new GP surgeries, health centres and clinics in 2006 under the NHS Local Improvement Finance Trust (LIFT) programme, and rather than simply replacing outdated facilities, the new buildings will offer many services traditionally only found in hospitals. New facilities are planned for Middlesbrough, Colchester, Plymouth, Wigan, Wolverhampton and Waltham Forest. In Colchester later this year, the £18m Colchester Primary Care Centre will provide 20 dedicated renal dialysis beds, reducing the need to travel to London or Ipswich.

In Newcastle and North Tyneside, the Walker, Shiremoor and Kenton Health Centres contain not only GP and Nurse Practitioner services, but also council Housing and Benefits Advice offices. The St Peter's Centre which will open in Burnley in the summer of 2006, is a £31m joint health and local authority sports centre, part-funded by Sport England. NHS LIFT has already delivered over 50 state-of-the-art buildings, and is part of the DoH's major programme to modernise GP premises. In the last four years, over 3,000 GP premises have been improved and over 500 one-stop health centres have opened. It is thought that NHS LIFT projects will provide new primary care facilities for over 50% of the population.

Nottingham Acute Trusts - Merger Confirmation

It has been confirmed that the Queen's Medical Centre and Nottingham City Hospital are to merge in April. The new hospital will be known as Nottingham University Hospitals NHS Trust, and will become one of the largest NHS Trusts in the country.

Plymouth PCT - ADHD

The number of prescriptions for ADHD in Plymouth has doubled in the last five years. A total of 3,365 prescriptions for methylphenidate hydrochloride (Ritalin / Concerta) were written between October 2004 to September 2005 compared to 1,462 between October 2000 to September 2001. However, the PCT has said that this is due to growing awareness of the use of medication for the condition, rather than an increase in the number of children affected.

Plymouth Hospitals NHS Trust, which runs Derriford Hospital, said that more children had been diagnosed with the condition over the last decade. "Treatment for children with ADHD with methylphenidate is initiated by a Child and Adolescent Psychiatrist, or a Paediatrician after a detailed assessment. "When the dosage has been stabilised by the specialist, the child's GP takes over the prescribing, and the child receives a specialist's review at least every six months, which will advise the GP on continuing prescriptions."

Suffolk East PCTs - GP Payments

The Combs Ford Surgery in Stowmarket has informed its patients that it will close for one month, for all but life-threatening emergencies, if the PCT defers its GP payments from March 2006 to April 2006. It is thought the PCT came up with the idea of deferring a month's wages as a way of saving money in the current financial year, which ends in April.

However, the PCT has stressed that no decision has been reached on deferring wage payments and said it still hopes to find an amicable solution: "For the past two months, regular discussions have been taking place with GPs about the financial challenges faced by the PCT and how we are tackling them." Suffolk East comprises Ipswich PCT, Suffolk Coastal PCT and Central Suffolk PCT. The PCTs have a combined budget of £380m and are running at a deficit this year of £47.9m.

Sunderland tPCT - Substance Misuse

The Washington Integrated Project is a scheme aimed at the area's most notorious and prolific heroin addicts. It offers them a unique chance to rebuild their lives, and has seen criminal activity among this section of Wearside's population plummet. Recent figures reveal that shoplifting, burglaries and car crime caused by 59 heroin-addicted criminals has almost halved during the past two years.

The project is a partnership between Northumbria Police, Sunderland tPCT, Social Services and the North East Council on Addictions (NECA), and the project team comprises a Detective Constable, a Sunderland GP and a Specialist Substance Worker. Once the police had identified some of the area's most persistent offenders, those whose daily heroin habits were leading to persistent criminal activities, they were offered substitute medication, support and constant monitoring. It is now hoped that the scheme will expand to tackle other Class A drugs, such as crack-cocaine

West Wiltshire / Kennet & North Wiltshire PCTs - QOF for Asthma

West Wiltshire PCT and Kennet & North Wiltshire PCT have informed GPs that telephone reviews for patients with asthma will not count towards Indicator Six of the QOF for Asthma. This indicator measures “the percentage of patients with asthma who have had an asthma review in the last 15 months”, and payment is made when 70% of those on the register have had a review. Most PCTs are allowing telephone reviews, and this issue has now been referred to the national Implementation Co-ordination Group, which rules on matters of dispute in the new contract between practices and PCTs.

Dr Kevin Gruffydd-Jones is a local GPwSI in Asthma. He has found that telephone reviews allowed practices to see 35% more patients at 37% less cost, and also enables the GP to identify those patients who need to be seen in person. He believes that over 80% of patients prefer telephone review, and that it is most likely to ensure that "hard to reach" patients are reviewed. Dr Nigel Watson is Chief Executive of Wessex Local Medical Committee. He said that while the LMC believed face-to-face consultations were the “gold standard”, the committee fully supported the use of telephone reviews, because the triage element ensured a better use of GPs' time.

Debra Elliott is Director of Primary Care for both PCTs. She said the PCT believed that in order to achieve the target in Indicator Six, reviews should be held face-to-face and include a review of inhaler technique and peak flow. She added that if practices provided the telephone review on top of the face-to-face review, then the PCT would have to consider this as a potential enhanced service, which would then be expected to contribute to a review target over and above the 70% stated in the QOF. Any proposed enhanced service would have to be assessed against all the other PCT priority areas.

Yorkshire Wold & Coastal PCT - Out of Hours

The Driffield Primary Care Centre will not be providing evening GP cover for the next three months. This pilot scheme will see Driffield patients covered by GPs based in Bridlington and Beverley and could save the PCT £54,671 in this financial year.

Wales - Local Health Board News

Blaenau Gwent LHB - Respiratory

Blaenau Gwent LHB is currently making major changes to its local Respiratory Disease Services. A new Respiratory Clinic has opened at Blaina Hospital, and the team there has identified 400 patients who are receiving oxygen therapy but have not had a specialist assessment. These patients are now being contacted and assessed by the team. This is part of the implementation of the new oxygen contract which will result in home oxygen services all being available from one single provider. It is hoped that accurate assessment of individual needs will mean that patients are able to manage their condition more effectively, thus reducing emergency hospital admissions. Blaenau Gwent has one of the highest incidents of lung disease in Wales.

Bridgend / Merthyr Tydfil / Rhondda Cynon Taf LHBs - Sexual Health

A recent report has revealed a dramatic rise in sexually-transmitted diseases in the valleys, which has led to patients either being turned away from Sexual Health Clinics, or being offered an appointment which is several weeks in the future. This does not apply to those patients identified as emergency cases. The report concludes that the LHBs are unlikely to meet the the Assembly Government target of access to sexual health services within two days by April 2006.

The report was presented to Rhondda Cynon Taf LHB, which says that GUM (Genito-Urinary Medicine) clinics covering the three LHBs of Rhondda, Merthyr and Bridgend have reported an 800% increase in the diagnosis of gonorrhoea, compared to an 87% rise across Wales.

Wales - Pharmacist/Nurse Prescribing

The Welsh Assembly is supporting independent prescribing for nurses and pharmacists, and will set up a Project Board take the initiative further. Suitably qualified practitioners will be able to prescribe for patients both in hospital and the community.

Scotland - Local NHS News

NHS Greater Glasgow - "Heart Attack Hospital"

Ministerial approval has been given for the centralisation of heart and lung surgery at Clydebank's Golden Jubilee Hospital. Covering the west of Scotland, it will be the largest specialist unit in the UK and a national centre for heart transplants. It is estimated that 10,000 procedures a year will be performed at the centre, including 15 heart transplants, 1,900 cardiac operations and 2,500 lung operations.

There have been concerns that the hospital might be too far from other services, such as A&E and Obstetrics, but others believe that this is not a problem, and point out the advantages of specialised staff and equipment on a single site. The Golden Jubilee Hospital was bought from the private sector in 2002, and using this site rather than waiting until 2010 when the more central Gartnavel General Hospital could make space, will enable the centre to open five years ahead of schedule, by spring 2007.

NHS Greater Glasgow - Mental Health

NHS Greater Glasgow has formally launched its "Living Life to the Full" website this month. The site contains a free online life-skills course, devised by Consultant Psychiatrist Dr Chris Williams, one of Scotlands leading experts in Cognitive Behavioural Therapy (CBT). The initiative is linked to the health board's efforts to improve the the overall health profile of Glaswegians by helping them to break bad habits such as excessive drinking, smoking and eating unhealthy foods. It is also hoped the availability of therapy online will help shorten waiting times to see psychologists.

"Living Life to the Full" comprises 11 modules, and has already proved useful for those who have wanted to find out more about common emotional difficulties such as anxiety, low mood and how to deal with everyday situations and relationships. As well as these, it gives guidance on, and coping strategies for, improving sleep quality, learning and practising anxiety control training and practical problem-solving.

www.livinglifetothefull.com

Northern Ireland - Local NHS News

Northern Ireland - Mental Health in Prison

An independent review into the suicides of six prisoners has criticised the standard of mental health care in Northern Ireland jails, and has said that more could be done to help prisoners with mental health problems. Health Minister, Shaun Woodward, said that one of the key factors identified in the review was a fundamental weakness in the deployment, management and support of staff delivering health services and a lack of central health co-ordination.

"For this reason, supported by the service's own Review of Health Care Services, I announced my approval in 2005 for the lead responsibility for prisoner healthcare to transfer from the Prison Service to the Health and Personal Social Services (HPSS). Arrangements are being made for this transfer to take place by 1 April 2007."

Southern HSSB - Service Development

The Southern Health and Social Services Board has submitted plans to the DoH for a £228m transformation of its primary and community care services. If approved, the plans will be implemented over the next 10 to 15 years. The plans propose 8 new Health and Care Centres in Armagh, Dungannon, Portadown, Banbridge, Brownlow, Lurgan and Newry. In addition to these larger centres, a number of replacement Health Centres are planned for Bessbrook, Crossmaglen, Newtownhamilton, Richill, Rathfriland and Warrenpoint.

It is hoped that the new centres will improve access, particularly in rural areas, to a greater range of services. The larger centres will offer both diagnosis and treatment from GPs, social workers, nurses or physiotherapists at one location, and will complement care offered by hospitals. The proposals also include a new Mental Health Centre in Newry, and new Inpatient Mental Health Units in Armagh and at Craigavon Area Hospital, with a range of day care facilities for people with learning disabilities, physical and sensory impairment and older people.