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Posted by Gillian Kenyon, Sep 15 2010 1:41PM

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GP's to control all referrals ?

Health white paper summary

The health white paper from a commissioning perspective
By now you’ve probably all heard about the health white paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010. If you’re not a health and social care specialist; you might not know about it.

The paper includes the Government’s plans for the fundamental reworking of the NHS and commissioning is a predominant theme throughout the paper. Many of the changes outlined below will require primary legislation and the Government is planning to introduce a major Health Bill to Parliament in the Autumn.

The stated aims of the white paper are:
• putting patients and the public first;
• focussing on improvement in quality and outcomes;
• increasing accountability and democratic legitimacy; and
• cutting bureaucracy.

But how will the proposed structural reforms affect voluntary and community sector involvement in commissioning and public service delivery?

The Department of Health (DH) will be much reduced and become more strategic
It will focus on improving public health, tackling health inequalities and reforming adult social care. The department will also revise and extend quality accounts and work closely with Department for Education on services for children.

Abolition of SHAs and creation of NHS Commissioning Board
The White Paper rapidly accelerates the purchaser/provider separation that been introduced incrementally in recent years throughout the NHS. The complete separation of Strategic Health Authorities (SHAs) commissioning and provider oversight functions is planned for the end of 2010, with SHAs being abolished by 2012/13.

An independent NHS Commissioning Board will be established in shadow form by April 2011 and will be fully established by April 2012. It will provide national leadership and guidance on commissioning, manage some national and regional commissioning, allocate and account for NHS resources. It will be responsible for assessing NHS commissioners, holding GP consortia commissioning to account for performance and quality, promoting equality, patient and carer involvement and choice and it will lead on tackling inequalities in health outcomes and accountable for the national outcome goals identified within the Outcomes Framework. It will also be responsible for commissioning services that cannot be commissioned solely by GP consortia such as GP, dentistry, community pharmacy and primary ophthalmic services.

Abolition of PCTs and creation of GP consortia
Community health services will no longer be provided within PCTs by April 2011, moving to an ‘any willing provider’ model. Responsibility for commissioning the majority of health services will transfer to GP consortia. Every GP practice will be required to be a member of a consortium. These GP consortia will be established in shadow form during 2011/12, paving the way for the disbanding of PCTs from April 2013. The NHS Commissioning Board will allocate budgets directly to GP consortia.

The consortia will have a duty to promote equalities, work in partnership with health and adult social care, early years, public health and safeguarding, promote the wellbeing of local population and involve the public and patients in the commissioning process.

NHS Outcomes Framework, quality standards and payment by results
A new NHS Outcomes Framework will be established, covering effectiveness of treatment, safety of treatment and the broader patient experience. This framework will be developed into a more comprehensive set of indicators, reflecting NICE quality standards. Payment by results will be extended to community services, mental health and end of life care by April 2012.

Local authorities to lead on joint commissioning
Local authorities will be responsible for promoting integration and partnership working between the NHS, social care and public health by setting up (or strengthening existing) “health and wellbeing boards”. They will lead on joint strategic needs assessments.

Responsibility for local health improvement transferring to local authorities
Current PCT responsibilities for local health improvement will transfer to local authorities and national objectives will be set for this activity by a newly created Public Health Service. Local authorities will also appoint a local Director of Public Health jointly with the Public Health Service.

All NHS trusts to become foundation trusts
Within three years, all NHS trusts will be required to become foundation trusts, with the stated aim of, creating “the largest and most vibrant social enterprise sector in the world”. There will be consultation on options for governance models and the white paper states that “foundation trusts will not be privatised”.

Expanded role for Monitor
The role of Monitor (currently the monitoring body for foundation trusts) will be expanded to become the economic regulator for the health and social care sectors, with key functions in promoting competition and regulating price. Monitor will also be able to investigate complaints of “anti-competitive purchasing” by commissioners.

The Care Quality Commission (CQC) will continue to act as the quality inspectorate across all publicly and privately provided health and social care. Providers will be jointly licensed and regulated by Monitor and the CQC. They will respond to patient feedback and complaints, HealthWatch, GP consortia or the NHS Commissioning Board.

HealthWatch England
HealthWatch England will be established as a “new independent consumer champion” within the CQC. It will provide leadership, advice and support to local HealthWatch (see below). It will also provide advice to the Health and Social Care Information Centre, the NHS Commissioning Board, Monitor and the Secretary of State and will have powers to propose CQC investigations of poor services, based on information received from local HealthWatch and other sources.

Local HealthWatch
Local Involvement Networks (LINks) will become the local HealthWatch. Subject to further consultation mentioned elsewhere in this briefing, their primary role will be to ensure that views and feedback from patients and carers are an integral part of local commissioning across health and social care. In addition, HealthWatch could also provide a range of support services to individuals to help people access and choose services. In particular, they could support people who lack the means or capacity to make choices. Local authorities could also commission local HealthWatch, or HealthWatch England, to provide advocacy to support people in making complaints. Local HealthWatch will be involved in local authorities’ new partnership functions and will provide information for national HealthWatch.

How might you have your say ???

The Government will shortly publish more detailed consultation documents seeking views on different aspects of these proposals. Jon Burke (Development Adviser Social Care and Health) and LCPU will be co-ordinating responses to these. These consultations need input not only from health and social care specialists, but also those who advise on commissioning. Discussion areas have been posted on both the Commissioning and Procurement group and the Social Care and Health group of navcaboodle. Please join them and let us know your views.

Timeline (subject to change)
• Towards the end of 2010 we will see the separation of Strategic Health Authorities commissioning and provider oversight functions
• A Health Bill will be introduced into Parliament in Autumn 2010
• A white paper on public health will be published by the end of 2010
• A white paper on social care reform will be published in 2011
• April 2011 will see the establishment of the NHS Commissioning Board in shadow form.
• April 2011 will see the start of the transformation of Local Involvement Networks (LINks) into local Healthwatch
• Patient choice will be implemented in stages from 2011
• At some point during 2011 to 2012 we will see the formation of GP consortia. These will run in parallel with PCTs through the transition period.
• The majority of reforms come into effect in 2012.
o The NHS Commissioning Board will be fully established and will run in parallel with SHAs until the complete abolition SHAs by April 2013
o Local Authority Health and Wellbeing Boards will be set up
o HealthWatch will be established nationally
o Monitor will become the economic regulator for all foundation trusts.
o Payment by Results will begin to come in for community services, mental health and end of life care services.
• In autumn 2012 the NHS Commissioning Board will make its budget allocations for 2013/14 direct to GP consortia.
• April 2013 will see GP consortia take full responsibility for commissioning and for contracting with providers and PCTs will be abolished.
• 2013/14 – all NHS trusts become foundation trusts

AND therapists who aren't also medically trained - where will they be by then ?.

Personally, I doubt that GP's who will be doing all the referring and who will hold the purse strings to NHS services will be any keener to refer to therapists who do not also hold medical training than they are now.

Does anyone else read this and fear the demise of our industry ?.
Christine Beadle
Sep 18 2010 2:33PM
I read what "Natural Therapy Pages" (follow on Facebook) has to say. They announced recently that One Health Organisation contributed to the 63rd Annual UNDPI/NGO Conference -United Nations Conference in Australia Presenting the holistic perspective...for the first time ever. We should be pushing for integration into traditional health care. Targeting conferences of this ilk in UK is a start. How could it be achieved?
Christine Beadle
Sep 18 2010 2:44PM
Are you a member of BHMA ? What do you think ?
Rodney Stuart Robinson
Feb 25 2011 1:45PM
I certainly do, not least because few GP's are anything other than aggressively opposed to complementary medicine. At the very best they tolerate it. History teaches us a lot about the present. As a nurse I have studied the introduction of professional nursing by Florence Nightingale who's attempt were fought 'tooth and nail' by the medical profession. They felt threatened by another profession that may encroach on "their territory" Despite being best mates with Queen Victoria and half the cabinet of her day, the only way she was able to succeed in what she wanted to do was to order the newly trained nurses to stand back and watch the medics become overwhelmed with the number of casualties. She made the doctors ask for her help before she let her nurses 'stand to' and work on the wounded. Unfortunatley I don't think much has changed.

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