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Money makes the world go around!
Gordon Brown may have supplied the billions, but pressure on
NHS managers to demonstrate that they are achieving seems never to be greater.
And as we approach the midway point in this financial year, the NHS in England
could already be heading for a deficit of up to £300m, despite repeated
warnings from the Department of Health that there will be no extra cash. This
prediction of a possible overspend comes from the Healthcare Financial
Management Association, which says that specific cost pressures, particularly
'the vastly increased prescribing costs', are to blame. Present estimates from
around the NHS show expenditure on drugs is running at up to 13% over last year
- well ahead of the 10% budgeted in most areas for 2002/3. Despite folk saying
that the extra prescribing costs are for all the right reasons (NICE decisions,
NSFs, etc), there is a sense of 'blame' here…. One of the other key issues
here is that there is money for waiting list targets and other key government
objectives but that those services not directly related appear to be suffering.
It also seems that money set aside for cancer, CHD and IT is being used to fill
in the financial gaps as well as the never-ending search for 'cash-releasing
savings'.
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Public Health
We
have mentioned before the now scattered nature of the NHS public health
function. One home for public health is within the nine regional Government
Offices. The Government Office for the West Midlands (GOWM) is being very
proactive and its Public Health Group (WMPHG) now have a little site on the
main DoH website explaining what they are up to. There are also links to other
addresses that will be very useful to local industry teams - such as maps, West
Midland PCT & Acute Trust profiles and information on the local Directorate
of Health & Social Care (Midlands & Eastern Region DHSC). See
www.doh.gov.uk/dhsc/wmphg/background.htm. The other home of
public health apart from the PCT is of course the StHA who fully assume their
new responsibilities from the 1st of this month - so the 'StHA' acronym can now
officially be used. StHA DPHs will need checking out.
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Who is Driving?
Surprise, surprise - GPs are not being involved enough in
decision-making within PCTs, according to a report from the Health Services
Management Centre (HSMC) at the University of Birmingham. The report Driving
seat or back seat? GPs views on involvement in primary care groups and trusts
reflects views between 1999-2001. If anything things are likely have worsened
since…….. There are moans also about PCTs now acting like mini-health
authorities and that the influence and control that GPs were promised (or
experienced under fundholding or as part of commissioning groups) has now
disappeared. More moans from hospitals too with the acute sector openly talking
about how they will operate once the primary care focus is abandoned as a
worthwhile, but futile experiment….. And moans too from PCTs at the moment
- the job is too big, resources too small, control too tight, targets too many
and the space to innovate and reinvent services driven by primary care concerns
almost non-existent. The next phase of the National Tracker Survey of PCGs/PCTs
being carried out by the National Primary Care Research & Development
Centre at Manchester University should be interesting. Expect this to be
published as we go to press. The previous report was a must
read.
Nurse Prescribing
The DoH is set to evaluate
independent nurse prescribing and is offering this out for tender through the
Department's Policy Research Programme. The research is aimed at evaluating
this expansion of nurse prescribing to assess implementation, costs &
benefits, good practice and to inform future developments. To remind folk this
is all about improving patient's access to medicines (see the NHS Plan); the
better use of nurses skills; the better use of doctor's time and of course
improving the quality of care. But Prof. Alan Maynard has a go at nurse
prescribing in September's PharmaTimes (p.48). "The rapid expansion of nurse
prescribing is a social experiment that may seriously damage both the health of
patients and the profits of the industry."…. For a useful Appendix listing
the historical background to independent nurse prescribing please see
www.doh.gov.uk/research/callsforproposals.htm. The point
here is that Alan Milburn has said recently that nurses are likely to be able
to prescribe most pharmaceuticals in the near
future.
Pharmacists
The General Practitioners
Committee (GPC) of the British Medical Association (BMA) is warning pharmacists
not to get too big for their boots. A recent systematic review on medication
review in the elderly by pharmacists shows that pharmacists do it safely and
more cost effectively than GPs - almost good enough for a car sticker!
"Pharmacists have a role in reviewing medication but not more and more clinical
involvement," said GPC Prescribing sub committee Chair Dr Peter Fellows. Peter
what about supplementary prescribing by pharmacists next year and the PCT MMS
pilots?
Watch Out!
Folk may like to know that on
the 28th November the Health Service Journal will be publishing a guide to the
pharmaceutical industry. This will be aimed at providing senior NHS managers
with an overview of the range of companies working throughout the industry, the
specialist disease areas that they tackle and the joint working partnerships
that are being developed. The range of features to be covered includes:
- An overview of the pharmaceutical industry examining
who the main players are, the disease areas they specialise in, the role of
medium size and small companies, generics (who produces them, size of market
etc), drugs being developed for rare diseases and a look at how the market is
changing (mergers between big players).
- A look at the process undertaken for drugs getting to
market - from the research and development undertaken through to clinical
trials and then approval from industry bodies before drugs are commissioned and
distributed.
- A look at how pharma companies are structured and how
they interact with the NHS. The feature will also look at how structures have
changed in response to NHS reform (e.g. development of clinical outcomes
divisions and the increased overlap and integration between sales, marketing
and clinical divisions).
- A look at what is happening on the ground between the
NHS and pharma industry. What sort of new 'partnerships' are emerging, what
does the NHS look for from the drugs industry in terms of joint work, and what
does the pharma industry itself want? Case studies of joint working, ranging
from collaboration with the DoH on NSF areas to pharma support at PCT level.
I have contributed to this but folk
might want to check out what this sometimes very independent journal actually
prints. There actually might be useful stuff here that you could use with your
customers.
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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