Improving Access to General Practice

This slidepack has been produced to support the roll-out of improved access to general practice and is aimed at general practice staff and commissioners.

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Public services commissioning

This report makes 10 recommendations for improving public services commissioning.  It argues that commissioning of over £100 billion of public services spend, including 95 per cent of the NHS budget, could be devolved to around 38 regions and could deliver better outcomes at a lower cost:

Recommendation 1: The Government should devolve 95 per cent of NHS England’s budget, totalling £101.9 billion in 2016-17. The Government should scrap NHS England.

Recommendation 2: The Government should devolve responsibility for the commissioning of five employment-services programmes, including Jobcentre Plus, totalling £1.5 billion in 2016-17.

Recommendation 3: Government should devolve the commissioning of 12 skills and apprenticeships programmes, totalling £3.2 billion in 2016-17.

Recommendation 4: Government should devolve the commissioning of probation and youth-justice services, totalling £1 billion in 2015-16.

Recommendation 5: Government and local areas should ensure the coterminosity of services boundaries when entering devolution negotiations. They should take into consideration population health outcomes, their wider determinants, LEP boundaries, STP boundaries and council boundaries. Taking these elements into account would approximately result in 38 devolved commissioning areas.

Recommendation 6: A combined authority or a unitary authority should cover a commissioning area and take on all devolved commissioning functions for healthcare, employment services, skills and apprenticeships, and offender management.

Recommendation 7: Local commissioning boards should be headed by a single leader accountable for these decisions. Mayors should not be mandated by central government, however, and local areas should be able to shape their own leadership structure if one elected official holds a time-limited position accountable for public services across the local commissioning region.

Recommendation 8: Local commissioning bodies should form around the outcomes set by the cabinet and leader. Agile procurement teams should tender contracts, and disband after.

Recommendation 9: The Government should expand the role of the Cities and Local Growth Unit to include oversight of the devolution of public-services commissioning. The new unit should be called the Devolution Unit with wider membership from all departments from which powers are devolved.

Recommendation 10: Local commissioning bodies should receive block-grant funding. Local commissioning bodies should only be required to meet high-level outcomes agreed with the centre to receive the funds, and the grants should cover five-year periods. Block grants should be inflation linked and the inflation index and funding formula set by a UK Funding Commission.

Full report: Vive la devolution: devolved public-services commissioning | Reform

The Role of Nurses in Alcohol and Drug Treatment Services

Guidance for commissioners, providers and clinicians on the roles of nurses in alcohol and drug treatment in England. | Public Health England

This resource describes the many potential roles of nurses in alcohol and drug treatment in England to help commissioners and providers of specialist adult alcohol and drug treatment services to recruit the right workforce to meet local needs.

The document outlines:

  • The roles of nurses working in alcohol and drug treatment including the contribution they can make to health and social care outcomes
  • The added value nurses can bring to alcohol and drug treatment
  • The competences and skills that should be expected of nurses working in alcohol and drug treatment
  • What is required to develop and maintain these competences

Full document: The Role of Nurses in Alcohol and Drug Treatment Services:  A resource for commissioners, providers and clinicians

Cancer screening: informed consent

Public Health England has updated the Cancer Screening: Informed consent guidelines.

These guidelines give commissioners, providers and healthcare professionals in cancer screening information on consent to screening and procedures.

The document covers information and advice on:

  • breast screening
  • cervical screening
  • bowel cancer screening
  • mental capacity and consent

It also provides several template letters for patients withdrawing from programmes.

Commissioning mental health services in primary care

Of primary importance: commissioning mental health services in primary care  | NHS Clinical Commissioners

This report highlights projects where CCGs and their partners are delivering better care for patients, working across the boundaries between physical and mental health, as well as health and social care, while at the same time reducing pressure on GPs and hospitals.

Developed by NHS Clinical Commissioner’s Mental Health Commissioners Network, the report aims to share learning and good practice from these projects to help support others looking to implement projects across primary care.

Case studies in the report include:

  • Community Living Well in West London which helps those with long-term mental health conditions and covers a full range of psychological therapies from guided self-help, through to sessions of short-term psychodynamic or CBT, carers therapy and a wellbeing service.
  • Work in Sheffield where IAPT workers are attached to each of the CCG’s individual 85 practices, and are incorporated as part of the practice multidisciplinary team.
  • The Well Centre, a primary care health centre in Lambeth for young people aged 13 to 20 offering support with all areas of health including mental wellbeing.

Full report available here

Collaboration in general practice

Collaboration in general practice: Surveys of GP practices and clinical commissioning groups | Nuffield Trust |  Royal College of General Practitioners

This report summarises the results of two surveys, sent to general practice staff and to CCG staff, aimed at finding out what had changed in the landscape of general practice since the previous surveys two years ago and to explore what GPs feel the future holds for them.

Key findings include:

  • The scaling up of general practice continues apace with 81% of general practice-based respondents reporting that they were part of a formal or informal collaboration, up from 73% in 2015.
  • However, the landscape is complex. Practices often belong to multiple collaborations that operate at different levels in the system, having been set up to fulfil different purposes.
  • The main priorities of all collaborations over the last year were: increasing access for patients, improving sustainability, and shifting services into the community. The priorities differed by size of collaboration. Both providers and commissioners reported that time and work pressures were the biggest challenge to collaborations achieving their aims.
  • When asked about developments in their local area, over half of GP staff and one-third of CCG staff surveyed felt practices and collaborations had not been at all influential in shaping the local sustainability and transformation partnership (STP). Only one-fifth of GPs thought STPs would deliver meaningful change in primary care. CCGs were more optimistic, with 61% reporting that meaningful change was probable.
  • When questioned about future models of care, around half of practice partners (53%) said they would be ‘unwilling’ or ‘very unwilling’ to give up their current GMS/PMS/APMS contract1 to join a new models contract (e.g. MCP or PACS contract2). The most common reason they gave was that they did not want to lose control of decision-making and leadership in their practice.

The report can be downloaded here

Musculoskeletal conditions: return on investment tool

Return on Investment of Interventions for the Prevention and Treatment of Musculoskeletal Conditions | Public Health England

This tool has been designed to aid healthcare commissioners and providers in England who wish to assess the cost-effectiveness of interventions for the prevention musculoskeletal (MSK) conditions.

It is hoped that the tool will aid decision-making and increase the uptake of cost-effective interventions aimed at the prevention of MSK conditions. Conditions within the scope of this tool are: Lower back pain; chronic knee pain and osteoarthritis (hip and knee).

Full detail at Public Health England