Responding to Our vision for Primary and Community Care, published today by the Department of Health as part of the Next Stage Review of the NHS, Chief Executive of The King’s Fund, Niall Dickson, said:
'We welcome this strategy – patients place enormous value on the care they receive from family doctors and community staff but a step change in these services is needed – not least because the reforms to the rest of the health system rely crucially upon them. This strategy lays down an important challenge to the professionals involved – the future lies in changing the nature of services so that they are geared more to helping keep patients as healthy as possible rather than just treating their illnesses.
Choice of GP
‘GPs are in a unique position being given in effect contracts for life, with little or no competition for patients and a guaranteed income stream. The government is right to say it must be made easier for patients who want to change their GP – indeed every patient should know that it is their right and that the system will make it easy for them to switch.
'This is unlikely to lead to large numbers of patients moving if the majority of patients trust and are happy with their GP. However, the chance to move easily and still be able to access out of hours care will be of real benefit to some people. The vast majority of excellent GPs will welcome that.
Out of hours
'Out of hours care has not been addressed in the review. This is a major omission given the poor way it has been handled in recent years. Patients should not have to wait for another 'once in a generation review; to see this tackled.
Individual health budgets
'The more we can tailor treatment the more likely it is to be responsive to individual needs. While individual budgets and direct payments are used in social care their effective use in health care poses some challenges.
'This is a reform that is worth piloting and evaluating, but it should not follow the government’s usual pattern of using pilots as a prelude to national roll out – it should be carefully assessed and all the implications understood before any decisions are made about its use in the NHS.'
Dr Nick Goodwin, Senior Fellow at The King’s Fund, said: ‘The spotlight on community services is welcome – this is an area which has been neglected for too long and which would benefit from close examination of working practices, levels of expertise and staff deployment. Extending the same kind of evaluation and regulation to the work of health visitors, district nurses and those who attend to patients in their homes that is applied to other parts of the health service, is absolutely necessary as part of the new drive to improve quality.'
'Current evidence shows an overall lack of progress with practice-based commissioning and lack of active GP involvement in the scheme. The evidence suggests GPs are more interested in providing services rather than commissioning them and some PCTs are less supportive of practice-based commissioning. Whilst the strategy will hold PCTs to account for the quality of their support, our research has found that PCTs themselves need more capacity to provide such a role effectively. In particular the quality of data on which to give GP commissioners real budgets is in some cases so poor this would not actually be possible. Better articulation of the practice-based commissioner’s dual role as commissioner and provider is essential to manage inherent conflicts of interest. Until practice-based commissioning really gets off the ground the jury is still out on whether it can achieve all its objectives.
Integrated care pilots
'The principle of better care integration between primary, community and social care implies a welcome move to better continuity of care, a more personalised service, and more efficient care co-ordination to patients.
'However, there is a tension between integrating care across community, primary and secondary care on the one hand, whilst on the other promising patients in the draft constitution the right of greater choice not only over treatment but over providers. If 'integrated care organisations' are also commissioners of care there is a potential conflict of interest which could reduce patient choice rather than increase it. The government’s plans to test the benefits of integrated care through pilots must be accompanied by robust evaluation of its risks as well as its benefits.
Payment to GPs, Quality and Outcomes Framework (QOF) changes
'Moving standards of the quality of practice management out of the QOF and into an accreditation scheme is a sensible move. It will strengthen incentives within QOF that relate to health outcomes and disease management. It may also mean that smaller practices may need to co-ordinate or merge their management functions with others in order to obtain accreditation.'
Notes to editors:
- A briefing by The King’s Fund on practice-based commissioning was published in November 2007
- For further information or interviews, please contact The King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
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