NHS News - September 2005

England - Local PCT News

Carlisle / West Cumbria / Eden Valley / Morecambe Bay PCTs - Reorganisation

Cumbria & Lancs SHA has begun a consultation exercise on local reorganisation which will be presented to the DoH in October for implementation 2006. Proposals include the merging of 4 Cumbrian PCTs and the creation of a regional NW Health Authority.

Derbyshire PCTs - Out of Hours

Derby Medical Services (DMS), is a not-for-profit organisation which provides the out-of-hours GP care in southern Derbyshire. It currently receives £4m a year, but has said that it needs £7.5m a year to run the service. Dr Tony Gould is DMS's Medical Director. He said that there was no suggestion that the service could close down, but it might be forced to do fewer home visits, the most expensive and time-consuming part of its service.

Costs have spiralled since October 2004 because DMS now has to pay GPs up to £100 an hour, compared with £15 to £20 it paid previously. The PCTs involved are:

- Central Derby PCT
- Greater Derby PCT
- Erewash PCT
- Amber Valley PCT
- Derbyshire Dales and Southern Derbyshire PCT

East Cheshire NHS Trust - Proposed Changes to Services

The former Chairman of the East Cheshire NHS Trust has expressed his concern regarding proposed changes to mental health services locally.

The proposals include a new third Community Mental Health Team, alongside the closure of 34 mental health beds in Macclesfield, including an Assessment Centre for Alzheimer's Disease. This means that those people with mental health problems over the age of 65 will have to travel to Crewe.

Peter Hayes, who retired in 2000, said: "The effects on patients will be appalling, with a long drive for loved ones to visit. Anyone who knows about the effects of dementia, knows the importance of keeping sufferers in surroundings they know." He added that the changes could be "very, very harmful".

East Elmbridge and Mid Surrey PCT - Locality Commissioning

Two GP-managed diagnostic and treatment services have been set up within East Elmbridge and Mid Surrey PCT. This Locality Commissioning Policy, one of the first in the UK, is being rolled out across the PCT by Epsom Downs Integrated Care Services (EDICS Ltd) for the PCT's northern area and Dorking Healthcare Ltd for those in Mole Valley.

New regulations which enable GPs to treat patients on lists of neighbouring practices also allows them to form an NHS company.

This is a first taste of the "Better Health Care Closer to Home" package which eventually intends to replace services within the Epsom and St Helier NHS Trust's two hospitals. The Sutton, Merton and Mid Surrey SHA has always maintained that the majority of patients attending hospitals could be treated at neighbourhood community hospitals.

Eastbourne Downs / Bexhill & Rother / Hastings PCTs - Heart Failure

BHF Heart Failure Nurses in three east Sussex PCTs have been involved in arranging free Tai Chi classes for local heart failure patients. The team is now building on this success by developing community-based education and rehabilitation services.

Eastern and West Hull PCTs - Merger

The Department of Health has approved the merger of Hull's two PCTs by October 2006. The two PCTs currently work closely together and will share the same boundaries as the City Council.

Hull and East Riding Community Health NHS Trust - Name Change

The Hull and East Riding Community Health NHS Trust changed its name to Humber Mental Health Teaching NHS Trust on 30th July 2005.

NHS Institute for Innovation and Improvement - New Special Health Authority

The NHS Modernisation Agency and NHSU closed on 1 July 2005, and their services transferred to a new Special Health Authority: the NHS Institute for Innovation and Improvement (formerly the NHS Institute for Learning, Skills & Innovation).

Norfolk - Organisational Changes

A recent meeting of PCT and social services Chief Executives in Norfolk has agreed to commission a study on future demands on their services. It is thought that this might help the financial problems they are experiencing.

Options include cutting the number of PCTs from six to three:

- West Norfolk and Breckland
- Central Norfolk
- Yarmouth and Waveney

Another option is to bring services in North Norfolk under the control of neighbouring West Norfolk, and a single all- Norfolk PCT has not been ruled out - this would bring the county back to the structure found in the days of the old Norfolk Health Authority. There have been strong arguments in favour of bringing Yarmouth and Waveney together, but it is thought that this will be dependent upon the agreement of Chief Executives in Suffolk. It is also thought that any changes proposed by the Government would respect existing county boundaries, and that there might be a political battle over returning to a single body or fewer smaller ones.

Nottingham - Choose and Book

GPs in some parts of Nottingham have decided not to fully support the new Choose and Book programme because they are concerned about the time it will take to talk patients through their choices and the costs of extra staff. GPs will set up the referral for patients through the new system, and this will register the need for that person to see a specialist, but the patient will have to use the telephone booking service themselves. However, in north Nottinghamshire, GPs have agreed their practices will talk the patient through the choices and facilitate their booking.

According to the Chief Executive of the Nottingham LMC, this is because the north Notts PCTs have agreed to fund extra staff, whereas the PCTs in greater Nottingham cannot afford it. He said: "PCTs in north Notts are visiting practices to see what they need. Somehow they will find the money. In Nottingham PCTs do not have the money. They have told practices if you want to support this good, but alternatively use the call centre. Some practices might muddle through."

Nottingham Acute Trusts - Proposed Merger

The boards of QMC Nottingham University Hospitals NHS Trust and Nottingham City Hospital NHS Trust are launching a 12-week public consultation on their plans to merge. The results of the consultation will be considered by both boards in December.

Rugby PCT - CHD

Rugby PCT is establishing an Arrhythmia Working Group, and three Warwickshire cardiologists are in the process of discussing immediate priorities relating to the condition. A new chapter on Arrhythmia was added to the CHD NSF in March 2005.

Wandsworth PCT - GP Services

Six surgeries in the south of Wandsworth borough are running early morning, evening and weekend surgeries so busy people can be seen at convenient times. However, the scheme has proved too costly to extend across the whole borough, and Wandsworth PCT proposed that it be ended: it does not serve the borough's five most deprived wards and the PCT felt that their poorest patients were losing out.

One surgery alone, Balham Park Surgery, accounted for half of the project's £100,000 budget. It represents 12,000 patients and said that:

- over 2,000 extra patients had seen a GP during the year
- 48% of those were working people aged 25-34 who couldn't take time off work, and
- one third of those patients were young men, a group notorious for shunning doctors

St George's Hospital also feared that abolishing the scheme would put extra pressure on its A&E department. Wandsworth Council's Health Scrutiny Committee threatened to refer the PCT's decision to the Health Secretary, and the PCT has agreed to continue the scheme until the results of the nationwide review of GP access in September. The scheme will be capped at 2004/5 levels.

Wales - Local Health Board News

Cardiff LHB - Out of Hours

The Auditor General for Wales has reported on Cardiff LHB's selection of Clinical Solutions UK to run it's out-of-hours service in September 2004. He said while the selection process had been "robust and fair", checks into the company's financial background and clinical experience did not go deep enough.

He also said the awarding of the contract was made solely by the LHB's Chief Executive and the Vice Chairman, which " .. was not a wise decision, it was a risky area and it would have been prudent if the whole board had been involved." The Auditor General also criticised the LHB's decision to award Clinical Solutions £59,000 extra to hire additional nurses at weekends - work which the company was contractually obliged to provide from its own budget.

He added that the LHB, which was a new body, could have received more help and advice from Welsh Assembly Government officials. Dr Robert Jones, Chair of Cardiff LHB, accepted there were "lessons to learn" over awarding contracts and assessing claims for additional funding, and said that an action plan would go to the LHB's public board meeting in September. Clinical Solutions UK has since been sold to a new company, Healthcare Services 24.

Scotland - Local NHS News

NHS Argyll and Clyde - Stroke

A 6-bed unit for the acute care and rehabilitation of stroke patients within the Argyll area has been officially opened. The unit, based in Oban's Lorn & Islands Hospital, will mean that stroke patients no longer have to travel to Glasgow or Paisley.

NHS Grampian - Dermatology

The Dermatology Clinic at Woolmanhill in Aberdeen is being relocated to new, improved facilities at Foresterhill. Equipment has been moved, reset and recalibrated, but NHS Grampian has insisted that patient treatment will be unaffected by the move.

NHS Greater Glasgow - Orthopaedics

A pilot scheme involving two Extended Scope Practitioners (ESPs) is reducing Glasgow's waiting times for orthopaedic patients. The ESPs see patients before they visit the consultant, which means that those who don't need major surgery are dealt with more quickly and surgeons are only seeing those patients who need an operation. On average, only 30% of people who are referred to an Orthopaedic Surgeon go on to have surgery. The team aims to see patients within six weeks of their GP's referral (compared with a typical 18-month wait to see a surgeon) and their clinics have already han an impact on waiting times in the north-east and south-west of the city.

NHS Lothian - CHD / Diabetes and Ethnicity

NHS Lothian has launched a "Health Mela" to encourage the South Asian community to access health services. Recently, researchers at Edinburgh University, using ethnicity data from the 2001 population census, have discovered that while people of Indian and Pakinstani origin are 60-70% more likely to have a heart attack, only 30% of them will die after their first attack compared with 50% of the general population. An NHS Lothian spokeswoman said health services for the 800-strong community must be culturally acceptable.

Northern Ireland - Local NHS News

Northern LHSCG - Palliative Care

Northern LHSCG leads on the development of palliative care services for Western HSSB. Following a successful workshop for local practitioners in January, it has produced "Supporting Improvement in Palliative Care: towards a framework for service redesign"

South and East Belfast HSS Trust - Mental Health

Shannon Clinic, based at the Knockbracken Healthcare Park in Belfast, is Northern Ireland's first Medium Secure Unit. The £9m clinic will provide services for up to 34 patients, and will play an important part in the regional network of Forensic Mental Health Services being developed across the province.

The clinic will take referrals from special hospitals, courts and prisons, Psychiatric Intensive Care Units and Community Forensic Mental Health Teams. Its services are for people from throughout Northern Ireland, some, but not all of whom, may have had contact the judicial system. The service will provide assessment, treatment care and rehabilitation with many patients remaining at the clinic for up to two years. High security mental health services will continue to be provided by specialist hospitals in other parts of the UK.

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