Primary Care - In this month's newsletter we are focusing on Primary Care - there is so much is happening in Primary Care at the moment. It is of interest then, that an article in a GP publication last month, reported that hospital consultants' leaders are to lobby the Government over their fears that Primary Care is now wielding too much power within the NHS. The Joint Consultants Committee (JCC) is asking hospital doctors to relay their experiences of dealing with PCTs following anxieties over the 'power' they now hold - PCTs that is. Apparently, GP-led PCTs are ignoring hospital issues and the whole future of hospitals is now at stake.

The NHS Alliance has reminded the DoH that PCTs have three equal leaders at the top of the organisation:- a Chief Executive, a lay Board Chair, and a GP or Nurse Professional Executive Chair. They say that the DoH has failed to support the new structure. There was an echoed yelp of pain, too, from the National Association of Primary Care (NAPC), who are worried that devolution of power stops at the management boards of the PCT.

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A major PCT Conference was organised last month by the DoH for PCT Chief Executives, Chairs and PEC Chairs to get together. See www.doh.gov.uk/conferences/. A number of PEC Chairs were very keen to stress that they wanted to be seen, nationally, as having an important role in management. Some are obviously feeling that the move from PCG to PCT has seriously downgraded their influence. Ten key topics were selected for discussion and details of the key challenges facing PCTs are available at www.natpat.nhs.uk.

There is major tension in the Service at the moment, as PCTs across the country are being forced to produce service and financial frameworks (SaFFs), which cannot be met. This is because PCTs have picked up some inherited debt from HAs. Prescribing is seen a particular high-risk area. NAPC Chair Dr Peter Smith said, "The nonsense of it is, this is a new NHS and people are actively talking about cutting services."

The DoH has now agreed to fund the initial training programme to train 900 GP appraisers- approximately three per PCT. Clearly, for some PCTs, three appraisers may not be sufficient to meet local needs and it will be necessary therefore for PCTs to provide any additional training that they need themselves. See www.doh.gov.uk/gpappraisal/appraisertraining.htm. The DoH is also producing a CD-ROM on GP appraisal that is intended to demonstrate the right and wrong ways to conduct an appraisal and is aimed at both the GP being appraised and the appraiser. Each practice will receive a copy.

The NHS Plan set out clear targets for improving access, by reducing waiting times in Primary Care and extending the range of services available in Primary and Secondary Care settings. Recruiting a GP with a Special Interest (a GPwSI - note the new acronym - they were previously named Gypsies) is one of a range of options available to PCTs to help to achieve these aims. See www.doh.gov.uk/pricare/gp-specialinterests/index.htm.

The Health Service Journal is still carrying a lot of 'bulk' ads for Directors of Public Health. The Thames Valley, Greater Manchester and County Durham & Tees Valley have all recently advertised for posts. It was interesting to see that the Trent Workforce Development Confederation (WDC) has advertised for a Primary Care Development Facilitator. As well as being the main Primary Care advisor, this post will be the lead on implementing the extension of Nurse Prescribing.

More and more has emerged recently on the proposed GP GMS contract, and it would now be worth starting to have a look at this. At least ten diseases form part of the 'quality payments' under the new, tiered system outlined in the contract framework - asthma, depression, dyspepsia, epilepsy, etc. Information about disease registers, adequate treatment and follow up, is very good news for the Industry.

NICE Update - NICE has now received its seventh shopping list from the DoH. 12 service and clinical guidelines have also been referred - including the management of Parkinson's disease, osteoporosis and depression in children & adolescents.

NICE's Board meeting last month was held in Swansea. If you haven't been on www.nice.org.uk for a while, go and find the board minute papers. There you will find an update on the appraisals and guidelines programmes with current timelines and a useful table.

NICE has responded to the DoH's consultation on the timing and selection of topics for appraisal. There are several references to the need for a (better) balance between topics where there is a prima facie case for both investment and disinvestments and it wants selection criteria to generate such topics, particularly the latter. NICE is not too happy about deferrals of Technology Appraisal as it thinks that newly emerging topics should be referred to the Institute in time for guidance to be issued at, or near to, the point of launch of this technology into the NHS. NICE wants referrals to be presented roughly two years prior to anticipated launch, so that they can be scheduled into the Institute's work programme, and to allow completion within 2-3 months after the granting of marketing authorisation. Well worth a read. Please see the website - www.nice.org.uk

NHS Confederation Annual Conference - This annual function was held in Harrogate at the end of last month. Amongst the 1500 delegates this year were a significant number of PCT heads. In fact, everyone I talked to seemed to be a PCT Chief Executive or Chair. There was a particularly interesting session on why doctors are unhappy (reported on last month) and it strikes me that there are opportunities here for industry 'offerings'. Another interesting session was on the new StHAs. Ken Jarrold, Chief Executive of County Durham & Tees Valley, said that StHAs will stand back, and he outlined a grid that he will use to decide where the new accountabilities for delivery lie. He also said that PCTs have some surprises coming. It would be worth getting a hold of their Franchise Plan. There were also sessions on reconfiguring hospitals, PCT development, the GP gatekeeping role, changing the relationship with Government, funding systems and of course the new GMS contract for GPs. So much to choose from.

The exhibition seemed much larger this year with the 'usual' pharma companies there along with some new ones. At this conference there seemed to be a new attitude to 'sponsors'. MSD, BT, Pfizer and Priory Healthcare - the main sponsors, were constantly referred to. This is one of my favourite meetings of the year - superb for networking.

StHAs - More on Trent StHA's advertised posts in Health Policy in the NSF areas reported on last month - I applied for the post. Here are some abstracts from the information that I received:- Policy Managers - to manage the link between national task forces and local health communities by ensuring that effective local structures are in place for implementing national policy. A performance indicator will be that health communities know and understand their NSF and are making good progress towards targets, to ensure systems that report on progress in implementing NHS policy, ensuring key milestones are delivered. Sounds like key industry customers to me, along with a multitude of opportunities!

The Alliance has also put out a press release on StHAs, saying that they are a new type of body, not clones of the old HAs or regional offices. "They need to be thin conductors, not fat controllers. Just like an orchestral conductor doesn't try to play first violin, StHAs must not do PCTs job for them. They are co-ordinators, not doers", said Mike Sobanja, NHS Alliance Chief Executive. "There is at least one PCT who is waiting for their StHA to approve their management structure. That's exactly what SHAs should not be doing," says Mike. "Strategically, StHAs must be the local headquarters of the NHS rather than an area office of the DoH. The real power must be devolved to the front line - as Government ministers have made clear they expect. We must make sure that Shifting the Balance does not turn into Shifting the Blame."

Medicines Management - PCTs now appear to be picking up the 'medicines management' baton in a number of areas. Some of this is a bit deja'vu - with PCTs starting up 'traffic light' systems to make sure hospital consultants are not shifting costs and responsibilities of complex medical areas onto GPs. Certainly PCTs are increasingly encouraging consultants to consider the cost of the drugs they prescribe and to remind them that unified budgets are now in place! Joint prescribing committees, medicines management committees, therapeutic committees and area prescribing committees are being dusted down. For pharma companies, this will be particularly important for new drugs.

Interested in prescribing incentive schemes? The BMJ carried out some research last month, which suggested that such schemes may not be working. Potentially large rewards seem neither clearly connected with cost nor quality prescribing achievements. "Research evidence offers little information about the size of financial inducements needed to influence prescribing or whether this method is appropriate for changing prescribing." See www.bmj.com/cgi/content/full/324/7347/1187.

More Baggage - The BMJ also seems to be having a run of articles at the moment about all the 'naughtiness', that the Industry is involved in, across the Atlantic. So although it's not happening here, by inference BMJ readers (your customers) may assume it is going on here and perhaps folk need to be ready with reactive statements. In JAMA a report 'Doctors warned to be wary of new drugs' suggests that doctors should be wary of starting their patients on newly approved drugs because of the high rate of adverse side effects that go undetected until late in the post-marketing surveillance period (JAMA 2002;287:2215-20). See www.bmj.com/cgi/content/full/324/7346/1113. In 'Doctor sues company over unethical marketing' an allegation is made against Warner Lambert - saying that sales representatives have been encouraging doctors to prescribe gabapentin (for epilepsy) for unapproved use in children. Also, that some doctors, in exchange for money, allowed reps into their examining rooms to meet patients, review medical charts and recommend what drugs to prescribe. See www.bmj.com/cgi/content/full/324/7348/1234/b.

NHS Wales - Wales is pressing ahead with its reorganisation and an advert for the three new Regional Directors recently appeared in HSJ. These Regional Officess for North Wales, Mid/West Wales and South/East Wales will take over some of the functions of the five HAs when they are abolished. The rest of HA functions will go to the Local Health Boards, which are to be established by 01/04/03. The ROs will report in through the NHS Wales Department (NHSWD) which is also be strengthened. See www.wales.gov.uk/healthplanonline. 05/02.

NSFs - The DoH has published a One Year On report from the Ministerial Industry Strategy Group (MISG) which is now overseeing the follow up to the Pharmaceutical Industry Competitiveness Task Force (PICTF) work. See www.doh.gov.uk/pictf/pictfoneyearon.htm. It repeats the commitment to positive industry involvement in the NSF programme but as apparent from the NHS Confederation Forum meeting reported on last month, this is not necessarily reflected at PCT level.

About the author

Therapy specific, corporate newsletters, written by Alan Jones of AJC Healthcare, are employed within many 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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