Recent news, 6th June
Polyclinics may not improve patient care, says think-tank
The government proposals for polyclinic centres may not lead to an improvement in patient care, according to the think-tank the King’s fund.
Health Minister Lord Darzi announced the plan for polyclinics—which offer a rage of specialist health services under one roof—as part of his recent and wide-ranging review of the NHS. They have already been the subject of much controversy, facing much opposition most notably from the British Medical Association.
The King’s Fund was particularly concerned about the potential problems for patients living outside of cities. There is a risk that introducing polyclinics in these areas may make healthcare difficult to access for many. Niall Dickson, the chief executive of the King’s Fund, said "A major centralization of GP services into polyclinics would make it more difficult for patients to visit to their GP, especially those living in rural areas. This would be a major sacrifice given that primary care visits account for 90% of all patient contact with the NHS, and that patients are less prepared to travel further to see their family doctor than they are to use outpatient and hospital services."
This view is also shared by the Patients Association, who have serious concerns about the accessibility of polyclinics, in particular the difficulty of being able to travel easily to receive healthcare. This is of special concern to patients living in rural areas, as well as elderly and vulnerable patients.
The report also challenged the idea that collecting large numbers of GPs together into one “super-practice” would necessarily lead to health professionals working together for the benefit of patients in a cost effective way. Chief Executive Niall Dickson stated, "The evidence suggests that, in practice, these opportunities are often lost - bringing together multiple services does not always result in better working practices between professionals, and there is no evidence that larger GP practices deliver higher quality care than smaller ones."
The Patients Association is also concerned that polyclinics may erode the doctor-patient relationship. Continuity-of-care is highly valued by patients, and really benefits elderly patients and those with long-term conditions. The Patients Association is concerned that by concentrating GP services in one centre the doctor-patient relationship could be compromised. Anthony Halperin, Chair of the Patients Association’s Board of Trustees, said "The very personal GP–patient relationship is a vital component of patients' primary care services”.
More information
- The Guardian, New NHS polyclinics will damage patient care, warns thinktankhttp://www.guardian.co.uk/society/2008/jun/05/nhs.health
- The Telegraph, Super surgeries 'to force patients to travel further' http://www.telegraph.co.uk/news/newstopics/politics/health/2075519/Super-surgeries-'to-force-patients-to-travel-further'.html
Number of patients able to access dentist falls
Statistics produced by the NHS Information show that almost 900,000 fewer people have accessed dental care since the introduction of the new Dental Contract.
The New Dental Contract came into force on the 1st April, 2006. Its aim was to provide better access to high quality dental services and develop preventive dental work. This was to be achieved through a new charging system, and the handing of responsibility for contracting dental services to individual Primary Care Trusts (PCTs).
Dentists are concerned this shows that the 2006 reforms have failed in their attempt to improve access.
The statistics published also show huge variation between trusts in the availability of dentalservices across the UK. The proportion of adults who accessed dental treatment in the 24 months up to December 2007, ranged from 38.9% in the South Central Strategic Health Authority area compared with 58.3% in the North East.
The chief executive of the British Dental Association, Peter Ward, said: "These figures offer fresh evidence that the reforms have failed to achieve their stated aims. They've failed to improve access to care for patients and failed to allow dentists to provide the modern, preventive care they want to deliver. Instead, this contract encourages sporadic, episodic treatment, rather than the long-term, continuing relationships that dentists and their patients’ value."
The government has claimed that the statistics were not reflective of the state of dentistry as they did not reflect a range of new dental services that are opening.
The Patients Association are concerned that patents are not able to access the dental services they should be entitled to. We also remain anxious that many patients are confused about what services are available to them, and what the 2006 dental contract means to them. As these statistics show, patients are also subject to an unjust ‘postcode lottery’ which can unfairly penalise patients by restricting their access to appropriate care on the basis of where they live. The Patients Association continues to campaign on behalf of patients for access to affordable and convenient dental care.
In March 2008 the Patients Association published a report ‘The New Dental Contract: Full of Holes and Causing Pain?’ which looked at the implications of the Dental Contract of 2006. To download a copy, please visit the ‘research publications’ section of our website: http://www.patients-association.org.uk/Research-Publications.
More information:
- The Patients Associations’ dentistry campaign: http://www.patients-association.org.uk/Dentistry
- BBC News Online, NHS Dental access ‘falls further’ http://news.bbc.co.uk/1/hi/health/7438255.stm.
Private firms could help run failing Trusts
New measures to identify failing Primary Care Trusts (PCTs) and poorly performing managers have been announced by the government. Ministers have announced that provate firms could be drafted in to help run failing NHS Hospital Trusts and PCTs in a bid to improve services.
Executives from well-run trusts or companies could be called in to replace bosses of failing trusts. But the government has insisted that no acquisition NHS assets or staff would be seen by private companies, ad frontline staff would remain NHS employees.
This would be likely to be confirmed in the new criteria for quality, safety and financial performance that the governments are due to publish in October. It is thought about 20 trusts labelled weak by a Healthcare Commission report last autumn could be identified as candidates.
The BMA have voiced grave concerns about the announcements, saying that they amounted to a privatisation and fragmentation of the health service. The BMA also accused the government of being ignorant of how the NHS works. Addressing a BMA Conference, Dr Jonathan Fielden said "You can't just fly in management. There is no evidence that private management is any better in the NHS. How many of us have seen our Trusts bring in the management consultants, paying through the nose, only to get a half baked solution and one that the real talent in the NHS could have delivered for less?"
Ben Bradshaw MP, a government Health Minister, stated that in most cases management would be taken over by executives from within the NHS. However, he also stated that “there may be examples where no NHS hospital is interested in taking over a failing hospital, or where local NHS managers think that in order to have more competition and choice for people locally that bringing in a private manager on a franchise arrangement will be the most sensible idea.
The Patients Association will monitor these proposals very carefully over the coming months.
More information:
- Private companies to take over failing hospitals, The Daily Telegraph http://www.telegraph.co.uk/news/uknews/2071604/Private-companies-to-take-over-failing-NHS-hospitals.html
- Private firms may run NHS hospitals, Channel 4 News Online, http://www.channel4.com/news/articles/society/health/private%20firms%20may%20run%20nhs%20hospitals/2269802
- Firms 'to run failing NHS trusts', BBC News Onlinehttp://news.bbc.co.uk/1/hi/health/7434728.stm
Failure to care for bypass patients
An expert report has found that many patients undergoing bypass operations receive inadequate care.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that of the 20,000 patients a year who receive bypass operations, as many as one-in-five receive a substandard level of care. It also found that a third of the patients who did not survive the operation died partly as a result of delays.
The organization exists to find lessons to be learnt from the deaths of patients. They studied the care received by patients who died receiving bypass surgery from the moment of referral onwards, and looked at 39 NHS hospitals and 19 private hospitals in particular.
The findings show that in two-thirds of the cases looked at least one aspect of the care provided was flawed. These ranged from problems of communication, organization or teamwork. Furthermore, nearly half of the hospitals looked at were not following Department of Health Guidelines, even though these were published several years ago.
From their findings NCEPOD issued several recommendations. These included surgery teams adhering to national guidelines, and to write clear plans for the treatment of patients in cases where they had other conditions which might complicate the procedure.
The NHS Medical Director, Professor Sir Bruce Keogh, responded to the findings, stating "England already has the best results for cardiac surgery in the world and it is encouraging that NCEPOD recognises this. Cardiothoracic surgeons have led the way in publishing their outcome data and scrutinising what they do. We will continue to work closely with them to ensure that patients get the highest possible standard of care".
Welsh Assembly delays screening for bowel cancer
The Welsh Assembly government has admitted that it will not be implementing national screening for the over 50s for another 7 years. National screening for those over 50 has been a commitment of the government for many years, but the government claim more time is needed to meet this goal.
Campaigners have responded angrily to the announcement. Nick Phillips, Director of bowel Cancer Wales "The argument is that they do not have the capacity to do the work. Are they frightened by what they might find in the screening programme?"
Bowel cancer is the most common cancer killer in the UK second to Lung Cancer. However, if caught early treatment has a success rate of around 90%. In England screening is already on track, although only for those aged 60-69.
A spokesman for the Welsh Assembly said "It is vital that the introduction of a screening Programme does not disadvantage those that have symptoms suggestive of bowel disease. After detailed planning for the programme it became clear that more time would be needed for the roll-out."
The Patients Association welcomes moves to introduce screening for bowel cancer to prevent the avoidable deaths that result from this common form of cancer, and is disappointed by this news. .
