Thursday, 23 October 2014
Saturday, 11 October 2014
|Could the RBH be the hub to a network of GP surgeries?|
Following on from my own recent post "The time has come to complete Nye Bevan's vision of the NHS" I am interested to see this report of a speech made by the boss of the NHS in England, Simon Stevens. While I do not agree with every detail of his approach, I think the general direction of travel has much to offer Reading.
Perhaps now is the time for the Royal Berks Hospital to take the lead and bid to run the threatened GP surgery in Southcote.
From the Local Government Chronicle
10 October, 2014 | By Judith Welikala
NHS England chief executive Simon Stevens has proposed that some hospitals should be allowed to open their own GP surgeries.
Speaking at the Royal College of GPs’ annual conference in Liverpool, he described the “need to tear up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists”.
Mr Stevens suggested also that GPs could form expanded group practices with other health professionals, including hospital consultants. Such groups could control delegated budgets for a whole population.
He said that in some locations – such as deprived, urban communities where practices are struggling to recruit GPs – hospitals might be allowed to open their own GP surgeries with registered lists.
Such a model would allow primary care practices in these areas to benefit from investment from their local foundation trusts.
Mr Stevens also proposed that GPs could form expanded group practices that directly employ hospital consultants or take them on as practice partners. They could also take on a delegated annual budget to look after the whole healthcare needs of their group of patients.
Such groups could include a broad spectrum of health professionals, such as GPs, consultant physicians, geriatricians, psychiatrists, community nurses, therapists, pharmacists, and potentially some social workers, he suggested.
They could take on ownership of their local community hospital, to which they could add more local services, such as hi-tech scans, outpatient chemotherapy and dialysis.
Mr Stevens’ proposal is similar to the “accountable care organisation” model, a term created in the US which refers to groups of providers contracted to jointly provide all care for a given population for a defined period. Their funding is based to some extent on quality and efficiency performance.
“The national debate on the NHS is now picking up steam, and GP services are rightly at the centre of it,” Mr Stevens said.
“But, alongside more doctors and more funding, we also need new and better ways of caring for patients, especially older people at home.
“GPs themselves say that in many parts of the country the corner shop model of primary care is past its use by date.
“So we need to tear up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of the health and social services.”
He said 30% of emergency patients admitted to hospital were there for less than a day, which suggests their admission could have been prevented by better primary and social care.
NHS England is due to publish a “NHS five year forward view” this month, which will include details on new provider models for out of hospital services
Thursday, 9 October 2014
Wednesday, 8 October 2014
|All Purpose Clinics With Directly Employed NHS Staff|
In announcing a series of pledges to create a more integrated National Health Service, Burnham forecasts that the coming general election would be a "battle for the soul of the NHS".
Integrated care with GPs, mental health nurses, occupational therapists and physios, home care workers, midwives would all form part new local NHS teams for the “whole person – physical, mental and social”.
But here’s a thing: the first reaction to Burnham’s speech came from the Royal College of General Practitioners who are said to have “grave concerns” about Burnham’s plans to create hospital-led integrated care organisations.
Yet in Reading, as elsewhere, we see increasing struggles to maintain GP surgeries as they are – one threatened, then saved in Caversham, another giving notice of closure in Southcote – with repeated failures to recruit new GPs.
At the same time we see our great Royal Berkshire Hospital under particular financial strain for, amongst a number of reasons, loss of income from a fall in referrals by the GP-led commissioning groups and increased costs of people turning up at Accident & Emergency because they have no GP or else can’t wait two weeks for an appointment.
Would it not be better to have a network of “polyclinics” or “super surgeries” around the town where the new integrated teams could work, which could act as both a shield and referral point for the RBH, perhaps even sharing or swapping staff? Perhaps that’s what we should have had down the Oxford Road after the closure of Battle Hospital.
The trouble is, for all the talk of new waves of privatisation in the NHS, GP surgeries are for the most account, small, private business partnerships, which already control around two-thirds of all NHS spending. New GPs may not want or be able to afford to “buy in” to these established near local monopoly enterprises.
Remember when Nye Bevan established the NHS in 1948 he took the pragmatic decision in order to get the private medical professions on board, to “stuff their mouths with gold”. So, Andy, if you really want to complete Nye Bevan’s vision of the NHS, let’s not pander any more to the vested interests of the Royal College of GPs and their like, but directly employ salaried GPs in NHS hospitals and polyclinics in a real cradle to grave, whole person, integrated NHS.