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NHS
Call for DoH
inquiry into the appointment of non-medics as PCT DPH's
Last month we
reported on the growing number of non-medics being appointed as PCT DPHs. At
the recent BMA conference, there was a call on the DoH to undertake an inquiry
into the appointment of individuals without 'formal' public health
qualifications. This area was also picked up by the HSJ (11/7/02 p.18) in an
inflammatory article, which got quite a postbag! The view of the author was
that for 'drains doctors' the party is over and that it does not take a medic
to do the number crunching required - but we should never forget our debt to
them in steering us out of the Victorian sewers. Note that Barnet PCT has
recently advertised for a Specialist in Public Health Medicine to help develop
the public health role of pharmacists.
This year's star-ratings for
Acute Trusts have been published
In all 166 Trusts were evaluated with
46 3*, 78 2*, 35 1* and 8 no stars. Last year there were 35 3*, 103 2*, 23 1*
and 12 no stars. So overall, against higher benchmarks, the proportion of
three-star Trusts has risen from 20% to 28% and the figure for no-star trusts
has fallen from 7% to 5%. But the number of two-star Trusts has fallen from 60%
to 46% and the one star's have risen from 13% to 21%. For the first time
Ambulance Trusts, Mental Health Trusts and Specialist Trusts were rated. Only 4
of the 80 Mental Health Trusts secured a three-star rating. Full details are in
the HSJ (25/7/02 pps. 6-9). The response by the NHS to the star ratings was a
bit like Big Brother. Everyone thought it was bad - but for different reasons.
Local sales teams do need to know this list and where their own hospitals rank.
Local politics could be very relevant to local business planning.
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NICE
HSC inquiry -
first independent evaluation of the Institute's work
Published at the
end of last month, the HSC Inquiry report on NICE makes fascinating reading.
This is the first independent evaluation of the Institute's work and there's
some good news and there is some bad news for just about everybody -
government, NICE and the Industry. MPs generally praised the work done by NICE,
acknowledging that many of the difficulties it faced were outside its direct
control and that the creation of an organisation to end postcode prescribing
was a 'brave move'. However, the report calls on the government to address
concerns about the focus, organisation and implementation of NICE guidance,
including a shift away from isolated technology appraisals towards broader
guidance - this pertaining to guidance related to classes (or relevant groups)
of drugs or the treatment of particular conditions. The report's 32
recommendations reflect many of the criticisms made by clinician witnesses
during the Inquiry. Please see
www.parliament.uk/commons/selcom/hlthhome.htm. The
Department of Health is expected to respond to the committee's recommendations
in the next three months.
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ABPI welcomes HSC recommendation of
NICE focus on clinical guidelines
The ABPI has welcomed the HSC's
recommendation that the government should shift the emphasis of NICE's work
from technology appraisals to clinical guidelines (long called for by the
industry). The ABPI said that as medicines made up only a small part of the NHS
bill (13%), NICE's resources would be wasted by appraising individual products
when greater impact could be made by addressing the overall treatment for a
specific condition. "The NHS would be better served if the focus of NICE's
appraisals was redirected to interventions that are thought to be 'ineffective
or out of date' rather than those where there is a simple lack of certainty as
to the extent of their benefit because they are new", said the ABPI.
Primary Care
PCT star ratings for 2002 delayed
Although this year's star ratings for Acute Trusts have been published, the
publication of PCT star ratings for 2002 seems to have stalled with no final
verdict for PCTs now expected until next year. PCTs have in fact been assessed
against a range of 21 indicators and the ratings would have covered all PCTs in
existence on March 2002 - so only 164 of the 302 PCTs would have been rated.
The indicators used fall into 3 groups:
- Improving health Contains seven indicators
which look at deaths from circulatory diseases, people who have quit smoking
for four weeks, folk vaccinated against flu and some sexual health measures.
- Access to quality services Includes inpatient
and outpatient waits.
- Service provision This looks at issues such as
satisfaction with GPs, emergency admissions for chronic conditions and
prescribing levels of generic drugs, antibacterial drugs and PPIs.
So this is all very relevant to
companies, with both opportunities and threats.
The first four PCTs
have been 'CHI-ed'
North Peterborough, Hillingdon, Fenland and Central
Manchester are amongst the 'oldest' PCTs and yet CHI raised concerns about
commissioning and management capacity. The clinical governance reviews also
'exposed' a very interesting issue. Four more PCT CHI reviews are expected this
month in this first pilot stage. Feedback from the evaluation of these 8 will
be used to refine the reviews which will be rolled out to all PCTs from October
this year, with an expected further 12 reviews completed by April 2003. It
might be worth local sales teams having a good look at these.
The
British Medical Association is to push for a substantial increase in general
practice funding
Including significant pay rises for GPs - after a
ballot voted three-to-one in favour of continuing negotiations on the GP
contract. Nearly two-thirds of GPs voted on whether the new contract was an
acceptable basis on which to continue negotiations, with 75.8 per cent in
favour and 24.2 per cent against. The BMA point out that over 80% of patient
contacts with the NHS are in general practice whereas only 20% of NHS spending
is in GP-land. Also hospital funding has risen by 60% in the past decade whilst
the equivalent figure for general practice is probably nearer 20%. And, there
is one nurse for every 2.3 GPs and 4 nurses for every hospital doctor (121 for
every consultant) whereas one in three doctors is a GP and one in 20 nurses
works in general practice. Get the picture?
Nurses as new
customers
For over 50 years, UK companies have focused most of their
marketing efforts at the prescribing physician. With up to 10,000 independent
nurse prescribers by 2004 and more supplementary nurse and pharmacist
prescribers shortly to swell the ranks on non-medic prescribers, companies will
need to develop new strategies towards nurses (and pharmacists!). At least they
should carefully examine some of the NHS developments concerning nurses. For
instance, the Chief Nursing Officer (CNO), Sarah Mullally, hosted a major
conference last month for PCT lead nurses. Some of the issues explored were
areas like the role of nurse leads and the PCT Professional Executive Committee
(PEC) and professional development for lead nurses (some nurse are already PEC
Chairs). There must be significant opportunities here. John Hutton, Minister
for Health, made a major speech and talked about developing the leadership role
of nurses in primary care as well as how to continue to expand the roles and
responsibilities of nurses in delivering primary healthcare services There is
also a special CNO Bulletin in July on this. Please see
www.doh.gov.uk/cno/pctbulletinspecialjuly02.htm. I note
from the HSJ that SW Peninsula StHA and Teignbridge PCT are making a joint
appointment for a Director of Nursing/Director of Clinical Governance &
Quality. This is an interestingly development. So do please think right now
about developing new customer commercial strategies to deal with the increasing
influential role of nurses as they continue to extend their roles and
influence.
Breaking the Mould: Nurses working in PMS Pilots
Nurses running groundbreaking alternatives to GP practices face a raft of
financial, legal and political problems in their work, according to a report
from Birmingham University's Health Service Management Centre, commissioned by
the government. This report suggests that there is serious resistance in
general practice to nurses taking a greater role, despite what the BMA says.
Surprisingly one of the biggest problems was that other nurses, particularly
nurse managers, were often hostile to nurses working as independent
practitioners. This also seems to apply too nurse prescribing/prescribers.
Again, big opportunities here to help nurses overcome such
obstacles.
A focus on General Practice in England
A national
nursing strategy for general practice is vital to meet the government's primary
care targets on quality and access, according to the Audit Commission's - 'A
focus on General Practice in England'. This also suggests improving the 'use'
of community pharmacists. "Some areas are spending six times as much as others
on drugs that are known to be less effective", the report warns. It finds
considerable variation too in the quality of care and in prescribing. Most
areas are now meeting the national standard of 72% of items to be prescribed
generically but a few practices in some areas are reaching less than 40%. See
www.audit-commission.gov.uk/home.
About the author
Therapy
specific - corporate newsletters, written by
Alan Jones of AJC Healthcare, are used by Sales Teams
throughout the UK Pharmaceutical Industry, as a source of crucial NHS
intelligence.
To discuss how your team could benefit from regular
up-to-date analysis of the NHS changes and issues that directly impact on your
business, please contact
Alan Jones of ajc healthcare (alan.jones28@virgin.net)
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