Managing conflicts of interest

NHS England has published Managing conflicts of interest: revised statutory guidance for CCGs.  This guidance aims to support CCGs to identify and manage conflicts of interest. It is intended to be a practical resource and toolkit, which includes templates and case studies to support conflicts of interest management. This document supersedes Managing conflicts of interest: statutory guidance for CCGs (December 2014)

Further details including Conflicts of interest templates and Conflicts of interest summary guides can be found here

Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices

Gross, R. et al. The Journal of Pediatrics. Volume 174, July 2016, Pages 171–177.e2

https://creativecommons.org/licenses/by-nc/2.0/

Image source: Cascadian Farm // CC BY-NC 2.0

Objective: To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families.

Study design: The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall.

Results: A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004).

Conclusions: Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention.

Read the abstract here

UK stands by nasal flu vaccine for children as US doctors are told to stop using it

Hawkes, N. BMJ. 2016. 353:i3546

Image shows an influenza virus (orthomyxovirus) seen through an electronic microscope.

The £100m (€130m; $150m) a year childhood flu vaccination campaign in the United Kingdom will continue despite evidence from the United States that the inhaled vaccine is ineffective.

Public Health England (PHE) said that its data contradict those of the US Advisory Committee on Immunization Practices, which recently advised the Centers for Disease Control and Prevention (CDC) to stop vaccinating children because, for the past three flu seasons, the vaccine seemed to have little effect.

All children in the UK aged 2 have been offered vaccination against flu since September 2013, and the programme was extended last year to include infant school children. It is gradually being rolled out to include all children aged 2 to 17.

PHE published provisional figures for the UK that showed that the inhaled vaccine taken by 2 to 17 year olds achieved similar protection against laboratory confirmed flu as did adult vaccines in older age groups. The vaccine prevented flu in more than half of the children given it, with an effectiveness of 57.6% (95% confidence interval 25.1% to 76%). Similar results had been reported by the Finnish National Institute for Health and Welfare, which found an effectiveness of 46%.

Richard Pebody, head of flu surveillance for PHE, said, “These findings are encouraging and in line with what we also typically see for the adult flu vaccine. There is no reason to change current recommendations regarding use of the children’s nasal spray vaccine in the UK.

Read the full article here

View the PHE figures here

Transforming community neurology

Transforming community neurology: what commissioners need to know

Thames Valley SCN has launched a commissioning brief for local commissioners to help them to improve the services provided in community settings to people diagnosed with a long-term neurological condition. This is a three part resource consisting of a transformation guide, reference reports and examples which include case studies from around the country.

Describing team development within a novel GP-led urgent care centre model: a qualitative study

Morton, S. et al. BMJ Open. 2016. 6:e010224

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Objective: Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members’ perspectives of team development within the GP-led UCC model.

Design Open-ended semistructured interviews, analysed using thematic content analysis.

Setting: GP-led urgent care centres in two academic teaching hospitals in London.

Participants: 15 UCC staff members including six GPs, four ENPs, two receptionists and three managers.

Results: Overall participants were positive about the interprofessional team that had developed and recognised that this process had taken time. Hierarchy within the UCC setting has diminished with time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinary collaboration was likely to improve patient care. Eight key facilitating factors for the team were identified: appointment of leaders, perception of fair workload, education on roles/skill sets and development of these, shared professional understanding, interdisciplinary working, ED collaboration, clinical guidelines and social interactions.

Conclusions: A strong interprofessional team has evolved within the GP-led UCCs over time, breaking down traditional professional divides. Future implementation of UCC models should pro-actively incorporate the eight facilitating factors identified from the outset, to enable effective teams to develop more quickly.

Read the full article here

Commissioning through Competition and Cooperation

PRUComm. Published online: 17 June

prucomm

Image source: LSHTM

Following several versions of the NHS quasi market since 1990, a wide ranging set of reforms was introduced into the NHS under the recent Coalition government by the Health and Social Care Act 2012 (HSCA 2012). The idea behind these is the same as that behind previous versions of the NHS quasi market: that competition between a wider range of providers will produce the desired results of improved quality and greater efficiency. The HSCA 2012 made a direct correlation between competitive behaviour in the NHS and competition law. The Procurement, Choice and Competition Regulations No.2 2013 relate to sections 75-77 and 304 (9) and (10) of the HSCA 2012, and indicate that competitive procurement by commissioners is to be preferred, although not in all circumstances. Monitor (the former NHS Foundation Trust regulator) took on the role of economic regulator for the whole of the NHS. Along with the national competition authorities (being, since April 2014 the Competition and Markets Authority, and prior to that, The Office of Fair Trading and the Competition Commission), has powers to enforce competition law to prevent anti-competitive behaviour.

At the same time, it is still necessary for providers of care to cooperate with each other in order to deliver high quality care. There are many aspects of care quality where cooperation is needed, such as continuity of care as patients move between organisations, and sharing of knowledge between clinicians. Monitor is also responsible for promoting co-operation. It is the role of NHS commissioners (including Clinical Commissioning Groups ‘CCGs’), however, to ensure that the appropriate levels of competition and cooperation exist in their local health economies.

Read the full report here

Unmanageable GP workload threatens safety of patient care, warns GP leader

White, C. OnMedica. Published online: 22 June 2016

Unmanageable workload, too few doctors, and too little resource are threatening the delivery of safe, quality care to patients, the leader of the UK’s GPs will warn today.

Dr Chaand Nagpaul, BMA GP committee chair, will make his comments in his address to delegates at the BMA’s annual representative meeting in Belfast this afternoon.

He will outline how pressures have just increased over the past year.

“Since last year, sadly the pressures on general practice have sunk to new depths. Demand escalates relentlessly, with a growing, ageing population with expanding, multiple complex needs,” he will say.

“Meanwhile, the explicit wholesale transfer of care out of hospital continues unabated. It’s GPs who’re absorbing this burgeoning workload, with 70 million more patients seeing us annually compared to seven years ago and with fewer GPs per head which is drowning our capacity to cope.

Referring to the record number of surgery closures last year—201—he will emphasise that unfilled GP vacancies are at their highest with half of practices struggling to recruit locums to provide essential services.

“This has led to a toxic mix from which existing GPs can’t wait to escape, and which many young doctors will not join,” he will say.

Describing the typical case of a 75-year-old with heart failure, diabetes and severe knee arthritis whose ongoing care is in the hands of her GP, he will say how much care she needs.

“She’s on 10 different drugs, and today asks her GP to change the large blue tablet she can’t swallow to a smaller one, how to obtain a disabled car badge, complains her hearing aid needs repair, but the clinic insists on a new GP referral, and that she hasn’t received a date for her knee replacement, and on calling hospital was told to see her GP to write a letter. And that’s before the whole point of her appointment which was to review her uncontrolled diabetes and heart failure.

“Her four conditions would previously have taken four hospital appointments totalling an hour and a half, yet GPs are forced to juggle this multiple complexity in 10 minutes. It’s not possible. Not sustainable. Unsafe.

Read the full article here