QOF 2012/13 changes summary

QOF guidance 2012-2013 (fifth revision)

As part of the 2012-2013 GMS contract changes, the General Practitioners Committee (GPC) and NHS Employers have agreed a number of changes to the quality and outcomes framework (QOF) effective from 1 April 2012.

The key changes are:

• the retirement of seven indicators (CHD13, AF4, QP1, QP2, QP3, QP4, QP5) releasing 45 points to fund new and replacement indicators
• the replacement of seven indicators with eight NICE recommended replacement indicators, focusing on six clinical areas namely Diabetes, Mental Health, Asthma, Depression, Atrial Fibrillation and Smoking
• the introduction of nine new NICE recommended clinical indicators, including two new clinical areas (Atrial Fibrillation, Smoking, PAD and Osteoporosis)
• the introduction of three new organisational indicators for improving Quality and Productivity which focus on Accident and Emergency attendances
• amendments to indicator wording for CHD9, CHD10, CHD14, Stroke12, DM26, DM27, DM28 and DEM3
• inclusion of telephone reviews for Epilepsy 6

Quality and productivity indicators
The six quality and productivity (QP) indicators covering outpatient referrals and emergency admissions have been agreed for a further year. Three new QP indicators on Accident and Emergency (A&E) attendances have been introduced for one year and are aimed at reducing avoidable A&E attendances. These indicators continue to be aimed at securing a more effective use of NHS resources through improvements in the quality of primary care.

Miscellaneous changes
In addition to the above, a number of other changes have been agreed as follows:

Changes to the points values for the following indicators:

• BP4 – reduced by eight points to eight points
• BP5 – reduced by two points to 55 points
• DM2 – reduced by two points to one point
• DM22 – reduced by two points to one point
• CKD2 – reduced by two points to four points
• Smoking3 (now Smoking5) – reduced by five points to 25 points
• Smoking4 (now Smoking6) – reduced by five points to 25 points

A number of threshold changes as follows:

1. raising all lower thresholds for indicators currently 40-90% to 50-90%,
2. raising all lower thresholds for indicators currently with an upper threshold between 70-85%      to 45%,
3. a number of upper threshold changes for indicators CHD6, CHD10, PP1, PP2, HF4, STROKE6, STROKE8, DM17, DM31, and COPD10
4. lower and upper threshold changes for BP5, MH10 and DEM2

ASTHMA3 has been renumbered to ASTHMA10 following a change to the business rules to include a new exception cluster.

DEP4 has been renumbered to DEP6 following a change to the prevalence calculation to apply to all new diagnosis of depression from April 2006.

MH14 has been renumbered to MH19 following a change to the business rules to include an exclusion cluster for patients already diagnosed with CVD.

Records23 has moved into the clinical domain and the supporting business rules have been amended. This indicator is renumbered to Smoking7.

Education1 has been renumbered to Education11 due a change to the indicator wording.

Summary of Allocation of Clinical Domain points

CLINICAL DOMAIN  2012/13 QOF  POINTS

Secondary prevention of coronary heart disease   48

Cardiovascular disease – primary prevention  13

Heart failure 29

Stroke and Transient Ischaemic Attack  22

Hypertension 69

Diabetes mellitus  88

Chronic obstructive pulmonary disease 30

Epilepsy  14

Hypothyroidism  7

Cancer 11

Palliative care 6

Mental health 40

Asthma 45

Dementia 26

Depression 31

Chronic kidney disease 36

Atrial fibrillation 27

Obesity 8

Learning disabilities 7

Smoking 73

Peripheral arterial disease 9

Osteoporosis : secondary prevention of fragility fractures 9

If you have found this informative please visit the  2020 Selection website where you will find many other relevant Factsheets in the Candidates Section

Source: http://www.nhsemployers.org The full QOF guidance is available to download from this site

NHS Patient Safety – Medication

How can Pharmaceutical Companies contribute to improving NHS Patient Safety?

They can demonstrate ‘added value’ , for example, by either offering products which contribute directly to making the administration of medicines safer by helping to reduce:-

• Making the drug up to the wrong strength
• Using the wrong diluent
• Microbial or other forms of contamination
• Labelling errors
• Administration by the incorrect route by clearer design/packaging of the product

The products which are commonly offered as part of a compounding service include:-

• Cytotoxics
• Antibiotics
• Inotropes
• Potassium solutions
• TPN
• Unlicensed medicines

In addition, the provision of non-promotional training/educational services to healthcare professionals in the form of Continuing Professional Development events and nurse advisor teams helps to educate NHS staff on how to administer medicines more

• Confidently
• Accurately
• Competently

The Department of Health (DH) has issued the following list of ‘Never Events’ for 2012-13. The list is circulated to a wide range of NHS managers, clinicians and healthcare professional allied to medicine.

The document authors are the DH’s Patient Safety and Investigations unit. The purpose of the document is to highlight certain events which are deemed to be very serious risks to the standard of care to patients, but most importantly avoidable.

The document forms part of the wider DH’s Patient Safety Agenda policy and should be read in conjunction with the NHS Standards Contract for organisations providing services to the NHS

1. Wrong site surgery
2. Wrong implant/prosthesis
3. Retained foreign object post-operation
4. Wrongly prepared high-risk injectable medication
5. Maladministration of potassium-containing solutions
6. Wrong route administration of chemotherapy
7. Wrong route administration of oral/enteral treatment
8. Intravenous administration of epidural medication
9. Maladministration of Insulin
10. Overdose of midazolam during conscious sedation
11. Opioid overdose of an opioid-naïve patient
12. Inappropriate administration of daily oral methotrexate
13. Suicide using non-collapsible rails
14. Escape of a transferred prisoner
15. Falls from unrestricted windows
16. Entrapment in bedrails
17. Transfusion of ABO-incompatible blood components
18. Transplantation of ABO incompatible organs as a result of error
19. Misplaced naso- or oro-gastric tubes
20. Wrong gas administered
21. Failure to monitor and respond to oxygen saturation
22. Air embolism
23. Misidentification of patients
24. Severe scalding of patients
25. Maternal death due to post partum haemorrhage after elective Caesarean  section

Source: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132352.pdf

You can read the whole document if you wish, but the indicators within the specific areas where the Pharmaceutical Industry has opportunities to work in conjunction with the NHS includes:-

1. Wrongly prepared high-risk injectable medication

• Death or severe harm as a result of a wrongly prepared high-risk injectable       medication.
• High-risk injectable medicines are identified using the NPSA’s risk assessment tool1. A list of high-risk medicines has been prepared by the NHS Aseptic Pharmacy Services Group using this tool2. Organisations should have their own list of high-risk medications for the purposes of the “never event” policy, which may vary from the NHS Aseptic Pharmacy Services Group list, depending on local circumstances.
• A high risk injectable medicine is considered wrongly prepared if it was not; o prepared in accordance with the manufacturer’s Specification of Product Characteristics;

1 NPSA High Risk Medication Risk Assessment Tool, 2007, available at

http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60097&type=full&servicet ype=Attachment

2 Pharmaceutical Aseptic Services Group. Example risk assessment of injectable medicines. 2007. Available at http://www.civas.co.uk/

• This event excludes any incidents that are covered by other “never events”.
• Where death or severe harm cannot be attributed to incorrect preparation, treat as a Serious Untoward Incident.

5. Maladministration of potassium-containing solutions

• Death or severe harm as a result of maladministration of a potassium-containing solution.

Maladministration refers to;

• selection of strong potassium solution instead of intended other medication,
• wrong route administration, for example a solution intended for central venous catheter administration given peripherally,
• infusion at a rate greater than intended.

Setting: All healthcare settings.

Guidance: – Patient safety alert – Potassium chloride concentrate solutions, 2002 (updated 2003), available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59882

6. Wrong route administration of chemotherapy

Intravenous or other chemotherapy (for example, vincristine) that is correctly prescribed but administered via the wrong route (usually into the intrathecal space).

 

Setting: All healthcare premises.

Guidance: – HSC2008/001: Updated national guidance on the safe administration of intrathecal chemotherapy, available at http://www.dh.gov.uk/en/publicationsandstatistics/lettersandcirculars/healthservicecirculars/dh_ 086870 – Rapid Response Report NPSA/2008/RRR004 using vinca alkaloid minibags (adult/adolescent units), available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59890

7. Wrong route administration of oral/enteral treatment

Death or severe harm as a result of oral/enteral medication, feed or flush administered by any parenteral route.

Setting: All healthcare settings.

Guidance: – Patient Safety Alert NPSA/2007/19 – Promoting safer measurement and administration of liquid medicines via oral and other enteral routes, 2007, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59808

8. Death or severe harm as a result of intravenous administration of epidural medication.

• A broader “never event” covering intravenous administration of intrathecal medication or The “never events” list 2012/13 9 intrathecal administration of intravenous medication is intended once the deadlines for Patient Safety Alert 004A and B actions have passed.

 Setting: All healthcare premises.

Guidance: – Patient Safety Alert NPSA/2007/21, Safer practice with epidural injections and infusions, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59807 – Safer spinal (intrathecal), epidural and regional devices – Parts A and B, available at http://www.nrls.npsa.nhs.uk/resources/?EntryId45=65259

9. Maladministration of Insulin

Death or severe harm as a result of maladministration of insulin by a health professional. Maladministration in this instance refers to when a health professional

• uses any abbreviation for the words ‘unit’ or ‘units’ when prescribing insulin in writing,
• issues an unclear or misinterpreted verbal instruction to a colleague,
• fails to use a specific insulin administration device e.g. an insulin syringe or insulin pen to draw up or administer insulin, or
• fails to give insulin when correctly prescribed.

Setting: All healthcare settings.

Guidance: – Rapid response report – Safer administration of insulin, 2010, available at http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287 – NHS Diabetes – Safe use of insulin, 2010, available at http://www.diabetes.nhs.uk/safe_use_of_insulin/ – NHSIII Toolkit – Think Glucose, 2008, available at http://www.institute.nhs.uk/thinkglucose – NHS Diabetes guidance – The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus, 2010, available at http://www.diabetes.nhs.uk/document.php?o=1037

19. Misplaced naso- or oro-gastric tubes

Death or severe harm as a result of a naso- or oro-gastric tube being misplaced in the respiratory tract.

Setting: All healthcare premises.

Guidance: – Patient safety alert – Reducing harm caused by misplaced nasogastric feeding tubes, 2005, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59794 – Patient safety alert – Reducing harm caused by misplaced naso and orogastric feeding tubes in babies under the care of neonatal units, 2005, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59798&q=0%c2%acnasogastric%c2%ac

Please visit the20:20Selection website if you have found this article helpful, as we regularly update the articles in our Factsheet section

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Top 25 UK Pharma Company Recruiting For Hospital Representative To Cover Yorkshire

Springboard your career with a New Job in medical sales – Key Account Manager, Hospital Sales Representative, Yorkshire (North Yorks, York, Wakefield, Leeds, Hull, East Riding)

An opportunity to take your career forward selling to specialist customers in secondary care and also pulling this through with selected primary care customers with a relevant interest; this is a key account management role with responsibility for the sales and market share growth of a specialist product on your territory.

You would be working for an established yet evolving pharmaceutical company who are focused on developing lasting business partnerships with their customers in the NHS.

This position does require that you are ABPI qualified and have a proven track record of delivering against your targets in your career to date. If you have worked this territory and have proven your ability in key hospital accounts then this will be a distinct advantage. Importantly you will be;
– Highly motivated, enthusiastic and driven to succeed
– Have excellent business planning skills
– Be able to develop relationships and networks within your key accounts
– Want to be part of a high performing specialist team
– Be willing to go the extra mile to differentiate yourself, your product and company within the marketplace.

On offer will be an attractive basic salary, car, bonus and other benefits associated with the pharmaceutical industry. 2011 has been an exciting year in this organisation; be part of it in 2012.
The team at 20:20 Selection Ltd is here to discuss your background and suitability for this fantastic opportunity. Call us on 0845 026 2020 or you can also email administrator@2020selection.co.uk with your CV.

Which Recruitment Agency?

Despite the global recession and credit crunch, one of the UK’s leading pharmaceutical recruitment agencies , 20:20 Selection Ltd has gone from strength to strength. How have they acheived their organic growth in these difficult times?

The team have over 50 years of combined, actual experience in the pharmaceutical and healthcare sales arenas in the UK.

Managing Director Karen Forshaw formed the company in 2002, after a successful career in medical sales (both primary and secondary care) and medical sales management (at both area and national sales manager level). She is passionate about providing an unirivaled service to both clients and candidates. The 20:20 Selection maxim of “perfect vision: not hindsight” extols the company virtues down to a tee. By carefully selecting their  candidates, 20:20 Selection ensure that when one goes before a client for an interview then they have an excellent chance of actually getting hired.

Using the experience and advice from Karen’s team, 20:20 Selection will ensure that you are only ever put forward for roles which you really understand and want to do. They only send your CV to clients with your full permission. Should you get an interview, then Karen and the team will keep you fully briefed and ‘prepped’ during the entire process. They have an enviable reputation within the industry as a recruitment company that really cares about both clients and candidates. One of the prime motivating factors is that individual consultants are not bonussed on just their own performance, but on the performance of the whole company. As a result you will not find yourself being forced or coerced into going for a role just to make up the sales figures of the consultant that you are dealing with.

So if you are interested in a role in UK pharmaceutical, medical or device sales then please contact us at administrator@2020selection.co.uk or visit our website http://www.2020selection.co.uk to find out more about the company.

Please note that in order to reach our minimum standards you will need to be qualified to work in the UK, have a full UK driving licence with not more than 6 points and be educated to degree level or be of graduate calibre.

Good Luck in your career.

Top 10 UK Medicines

Primary Care Medical Sales Representative

Primary Care Representative

A Primary Care Representative is an ABPI qualified Medical Sales Representative who concentrates their efforts in the primary care setting, with customers who work in the primary care arena.

The Primary Care setting consists of local GP surgeries/ Health Centres/ Medical Centres/  Walk-in-Centres/ Community Pharmacies/ Primary Care Trusts(PCTs) and Clinical Commissioning Groups(CCGs). These locations will house the customer base for the Primary Care Representative – for instance: GPs, practice nurses, practice managers, dieticians, practice pharmacists, non-medical prescribers, community pharmacists, PCT personnel ( medicines management team, medical director, prescribing lead).

A Primary Care Representative is responsible for business planning, budgetary planning and targeting, to make sure that they sell to the ‘right people and see them the right number of times’. It is the role of the Primary Care Representative to build trusted working relationships  with their customers  and to implement the marketing plan in their area. They work closely with colleagues in their team, such as Hospital Specialists and NHS Liaison Managers, sharing relevant information so that customers receive excellent service from the company, and so that product sales grow optimally.

Typically, a Primary Care Representative will be a graduate with a science based background, although graduates in the Humanities, Commerce or Law fields are also employed.  Occasionally, non-graduates with a good academic background and relevant background in sales may also be employed as Primary Care Representatives.  Nurses, pharmacists and other health care professionals can also make excellent sales representatiives if they have good commercial acumen and selling skills also. The most important qualities that an employer will be seeking in any potential Primary Care Representative are positive attitude, resourcefulness, commercial focus, good work ethic, ability to work autonomously, excellent planning and organisational skills, good time management skills and above all exceptional communication skills.

What is the typical working day of  a Primary Care Representative ? Having already planned the day several days or more in advance, they tend to see GP’s either during or after surgery in the morning, and see retail pharmacists and practice nurses in the afternoons.Their role is to build relationships with practice staff, doctors, nurses and retail pharmacists, to ensure that they create an environment where their products are most likely to be prescribed more frequently. These meetings will take the form of one-to-one discussions during which the Primary Care Representative will seek to understand the health care professional’s needs through appropriate questioning and enagement in a two way communication to sell the benefits of their product portfolio for the customer and for the patients. Promotional materials may be used to remind a reinforce product benefits of the Primary Care Representative’s visit but the nature of it’s content and the format is tightly controlled by the ABPI.

Alternatively, the Primary Care Representative could hold a structered meeting witht a wider audience which usually involves delivering a presentation during a luch time break at a GP surgery or to a larger audience perhaps at an after hours educational meeting led by Key Opinion Leaders. A meeting or appointment may be subject to change at short notice as the healthcare professional who the Primary Care Representative is going to visit may have to attend to the clinical needs of their patients, so it is always prudent to have several back-up plans and contingencies for each days work.

The success of a Primary Care Representative is largely measured by the sales of the products that they have in their portfolio. Sales data is usually collected by the amount of product that is sold into the pharmaceutical wholesalers and by the number of prescriptions that are processed by the NHS Business Services Authority who are the government agency responsible for reimbursing pharmacies for the NHS prescriptions that they have dispensed.

The Primary Care Representative may find themselves either employed directly by a manufacturer of a pharmaceutical product i.e. in what is known as a ‘headcount’ role or possibly as a part of a team of contract sales representatives, as either a dedicated or syndicated sales team.

Contract teams are run by organisations which specialise in putting sales teams into pharmaceutical companies who maybe wish to run a sales campaign for a limited period of time or want to assess the uptake of their product before they employ a large ‘headcount’ sales team. The pharmaceutical industry is held in very high regard for the excellent level of training that it gives it’s employees and for the ethical manner in which they work.

Clinical Commissioning Groups

A Clinical Commissioning Group (CCG) is a group of GPs and other clinicians who have chosen to come together to commission (buy) health services for their local communities. From early 2013, Clinical Commissioning Groups will be responsible for commissioning NHS services for patients inEngland. All GPs will need to be part of a CCG. They will replace Primary Care Trusts (PCTs). CCGs will be responsible for commissioning hospital services (elective, acute and emergency) and most community health services (for example district nurses), and mental health services. The 151 PCTs have already been organised into 51 clusters in preparation for the change. There will be a period of dual functioning as CCGs mature and PCTs delegate more responsibility to CCGs.

 

The governing bodies (Boards) of the CCGs will have, in addition to GPs, a least one registered nurse and a doctor who is a secondary care specialist. Groups will have boundaries that will not normally cross those of local authorities.

Some CCGs have been given authority by central government to test new models of clinical commissioning and to lead in their development – the term ‘pathfinder’ is used to describe such groups.

 

Commissioning is the term used in the public sector for buying services. It is a structured way of deciding how public money should be spent. In the case of the NHS, commissioning relates to the provision of health services. Commissioning healthcare and health services is the process of examining:

• the healthcare needs of the area
• the way in which healthcare services are delivered
• ways in which healthcare resources will offer the best overall value for money

 

Health services, such as GPs and community and hospital services have historically been commissioned by PCTs. This way of buying in services has meant that GPs and other clinicians, who are the best placed to advise on their patients needs, have been too far removed from the process.

 

The health White Paper: Equity & Excellence: Liberating the NHS was published in July 2010. The White Paper reinforces this view, and in time, much of the responsibility for commissioning health services will be given over to clinicians including GPs.

 

The CCGs will be overseen by the newly formed independent NHS Commissioning Board which will make sure that CCGs have the capacity and capability to commission services successfully and to meet their financial responsibilities. The NHS Commissioning Board will become fully operational from April 2012. Its senior structures should contain a range of healthcare professionals, and it will have a Medical Director and a Chief Nursing Officer on its board.

The NHS Commissioning Board will also be responsible for directly commissioning:

• Pharmacy services
• General Practice
• Dentistry services
• Specialist services (specialised services that are required by a limited number of people)

At a local level, new Health and Wellbeing Boards will be set up in local authorities to ensure that CCGs are meeting the needs of local people. The membership of these boards will include representatives from:

• Clinical Commissioning Groups
• Directors of public health
• Children’s services
• Adult Social Services
• Elected councillors
• Health watch (representing the views of patients, carers and local communities)

 

These boards will be in place in shadow form April 2012.    

 

 

For further information

More information on the health White Paper: Equity & Excellence:

Liberating the NHS see the Department of Health website:

http://www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm

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VALUE BASED PRICING (VBP) – How the NHS will purchase drugs

 The government intends to reform the way in which drugs purchased by the NHS are priced by the end of 2013. It aims to ensure that drug costs more fully reflect clinical benefit and to improve patient access to new treatments. At present the prices are determined by the Pharmaceutical Price Regulatory Scheme (PPRS). These prices are usually reviewed at 5 yearly intervals. Pharmaceutical companies are relatively free to set the price of a newly launched product (assuming it is accepted for use by NICE, the Scottich Medicines Consortium or the All Wales Medicines Strategy Group in the first instance). The PPRS then reviews these prices so that the profits that are made from the sale of drugs to the NHS are not considered to be excessive.

The Office of Fair Trading argues that drug prices should reflect their clinical benefits and current policy wastes NHS resources. The pharmaceutical industry welcomes the concept of value-based pricing, but is concerned about the impact on profits which are needed to make research viable. The Office of Fair Trading (OFT) estimates that up to 25% of world pharmaceuticals sales reference UK prices to some extent. Companies are thus particularly sensitive about any agreement that reduces the UK list price of a drug as this can have a knock-on effect on the profits made on sales elsewhere in the world.

Successive price cuts and exchange rate movements mean that UK prices are currently amongst the lowest in Europe. This has led to parallel-exporting (the opposite of the practice of parallel-importing cheaper non-English language versions of the same branded product from the EEU to the UK) of UK branded medicines to the EEU, by wholesalers, pharmacies and NHS trusts for commercial gain which has led to severe shortages of many popularly prescribed medicines in the UK.

Under the new system of value-based pricing, the Government would apply weightings to the benefits provided by new branded medicines, which would imply a range of price thresholds reflecting the maximum they are prepared to pay for medicines. These thresholds or maximum prices would be adjusted to reflect a broader range of relevant factors that are not fully taken into account by the current sytem of using Quality Adjusted Life Years (QALYs) by NICE so they could be used to calculate the full value of a new product.

The Government proposes that the price threshold structure is determined as follows:

• there would be a basic threshold, reflecting the benefits displaced elsewhere in the NHS when funds are allocated to new medicines
• there would be higher thresholds for medicines that tackle diseases where there is greater “burden of illness”: the more the medicine is focused on diseases with unmet need or which are particularly severe, the higher the threshold
• there would be higher thresholds for medicines that can demonstrate greater therapeutic innovation and improvements compared with other products
•  there would be higher thresholds for medicines that can demonstrate wider societal benefits.

 

Designing the new system to be both stable and transparent would allow companies to predict well in advance how prospective products may fare, and to focus their research efforts on the treatments that society values most. Companies would be informed of these weightings – allowing them to orient their research and development investments appropriately. This may well draw to a close the ‘me too’ concept of launching ‘newer versions’ of drugs which treat similar conditions with little demonstrable benefit over the original.

Thus, a new product would be launched, then reviewed by the Government to access its impact on patient health and the others factors discussed above, and the price to the NHS adjusted accordingly over a period of time.

The work of NICE as a provider authoritative advice and information would continue, but the decision as to whether a new medicine will be used in clinical practice will ultimately be made by the clinicians themselves.

VBP models are already implemented in many European countries including Germany, Sweden, France, Spain and Italy.

QIPP

FACTSHEET

WHAT IS QIPP?

The QIPP agenda is undoubtedly one of the most significant NHS policies that all organisations who conduct business with the NHS will have to take onboard.

Quality

Innovation

Productivity

Prevention

The agenda will have to run through the every thought and every process that takes place throughout the NHS from Primary Care Trusts to Secondary Care to General Practice.

QIPP will affect every department and individual who works for the NHS – for example front line clinicians, PCT commissioners, estate managers, laundry services, ward staff, ambulance trusts, etc.

Why?

The year 2010/11 is the last year in which the £102 billion that is spent on the NHS is set to get an increase in funding of around 5.5%. For the foreseeable future the growth will be limited to inflation. The NHS needs to identify £15-£20 billion of efficiency savings by the end of 2013/14 that can be reinvested within the service so that it can continue to deliver year on year quality improvements.

HOW WILL QIPP AFFECT PHARMA?

 

In order to do business with the NHS in future, organisations will need to focus on how the products/services that they offer fit in with the local QIPP agenda. Clearly organisations will have to attain immediate overviews as to how the QIPP agenda is going to be adopted at local levels, as it is anticipated that new, complex information resources will be required to deliver tailored solutions for each NHS customer.

PCTs will be looking to move services into primary care to reduce cost and improve Quality and Productivity. Pharmaceutical companies are already working on how to utilise their existing knowledge of World Class Commissioning to drive their targeting and market access strategies – so the platform may already be there, but the message will need refining for the QIPP.

Specifically, some of the areas which the pharmaceutical industry might be concentrating on refining their messages and strategies could include:

• to reduce preventable hospital admissions resulting from sub-optimal medicines use in chronic medical conditions (e.g. COPD)
• to identify patients who are currently undiagnosed or misdiagnosed as having a treatable chronic medical condition (e.g. COPD, diabetes, cardiovascular disease)
• to improve medical adherence and thereby improve health outcomes and reduce waste by reducing levels of non-adherence to medicines (e.g. community pharmacy monitoring schemes, GP staff training)
• to improve adherence to NICE guidance (e.g. hypertension, DVT prevention)

 

RECOMMENDED EXAMPLES

There have already been some significant improvements made to Quality and Productivity and Department of Health has provided some recommended examples.

• Atrial fibrillation – detection and optimal therapy in primary care.

Opportunistic screening by pulse palpation of patients over 65 has been used in 18 regions to improve detection of atrial fibrillation. Quality is improved by the optimal treatment of patients with atrial fibrillation reducing risk of stroke. Productivity is increased by the reduction in costs associated with stroke and its complications.

• Fractured neck of femur: rapid improvement programme.

Ten pilot trusts have succesfully implemented service re-design for the Fractured Neck Femur patient pathway. This improved quality by: improving multi discplinary and cross agency teamworking, reducing mortality, and time to theatre, and earlier mobilisation. Productivity was improved by reduced length of stay, readmissions, and delays to the theatre.

• Stroke pathway: delivering through improvement.

The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT scanning. Productivity was increased through reduction in length of stay and readmission.

• The productive ward.

The NHS Institute has supported ward leaders and nursing teams with innovative methods to improve the ward environment and process. Over 60% of NHS Acute Trusts are implementing the Productive Ward programme. Key improvements from the programme include improved quality through increasing direct patient care time and staff satisfaction and improved productivity through reduced staff absence and reduced length of hospital stay.

• Electronic blood transfusion systems.

Oxford Radcliffe Hospitals have successfully implemented an electronic blood transfusion system. This has improved quality by reducing transfusion errors and the time taken to deliver blood. Productivity has improved by reduced blood usage, wastage, and staff time.

• Enhanced recovery for elective surgery.

Enhanced recovery programmes use evidence based interventions to improve pre-, intra-, and postoperative care. They have enabled early recovery, discharge from hospital, and more rapid return to normal activities. Quality is increased by reducing complications and enabling a more rapid return to function. Productivity is improved by reducing hospital stay.

To improve the uptake of QIPP by clinicians the Department of Health has published a guide entitled:  The NHS Quality, Innovation, Productivity and Prevention Challenge: an introduction for clinicians www.somaxa.com/docs/file/QIPP_2010.pdf

Further information on QIPP can be found at:

www.link-gov.org/content/view/463/188/

www.library.nhs.uk/qipp/

 

Health White Paper

LANSLEY’S HEALTH REFORMS

Tuesday 13^th July 2010

The new Health Minister announced the White Paper that lays out the future of the NHS over the course of this parliament (which is now a guaranteed 5 years).  He described this as a ‘blueprint’ for Health Policy up to the next General Election.  The main aim is to cut £20bn from the Health Budget over the next 4 years.  One of the main issues is the end of the current PCTs, which means that GPs will have direct control of the commissioning of services.  NHS Management costs are set to reduce by 45% as a part of this reduction.

This is considered by many to be the most radical NHS White Paper to date, and is expected to be well received by the Conservative back benches.  As for the Lib Dems, they had the abolition of StHAs as part of their 2010 manifesto, so this should sit well with them also.

Lansley said ‘the provision of healthcare service will be led by patients and professionals and not by politicians’.

The basics of the White Paper are set out below:

 More power to GPs

The most contentious issues will be the compulsory devolvement of huge commissioning powers to GP and GP Consortia and the abolition of Primary Care Trusts (PCTs). None of this was proposed by the Conservatives when they were in opposition.  These decisions emerged after the General Election. There is concern that a large number of GPs do not want to take on commissioning functions, and in fact are ill-equipped to do so.

It is interesting therefore to note that the British Medical Association has welcomed today’s announcement.

More power to patients

The Government is going to launch HealthWatch England, a new ‘consumer champion’, which will sit within the Care Quality Commission (CQC). The White Paper provides an ethos for structural change; the NHS must be patient led and choices must be led by those at the frontline of delivering those services to patients, i.e. clinicians. On a national level, it will be able to propose CQC investigations of poor service. This organisation will help to strengthen the patient voice and ensure that patient feedback is heard at a local level. Patients will not only have power over the choice of GP they would like to attend (regardless of where they live), but will also have power over who has sight of their patient record.

Abolition of Primary Care Trusts (PCTs)

The complete removal of PCTs, instead of simply reducing their numbers, came as a big surprise when compared to the proposals contained in the Conservative manifesto from January 2010. However, it is in keeping with current measures when you look at the plan to reduce admin costs by 45%.  Some form of supervisory role is of course required, particularly in respect of GPs and other primary care services, and it is a role which Monitor (the body currently responsible for the regulation of Foundation Trusts) may find challenging.   

Abolition of Strategic Health Authorities (SHAs)

SHAs will be abolished as early as  2012. Their functions will be taken over by Monitor. Monitors’ remit will extend to establish it as the key economic regulator in healthcare.

Foundation Trusts

All NHS Trusts will become or be part of a Foundation Trust and this will be the preferred governance model for the health service. Trusts will be given more freedom to innovate to improve patient care. NHS staff will have the opportunity – where appropriate – to manage these organisations as ‘the largest social enterprise sector in the world’.

NHS Commissioning Board

A review of existing quangos is due to report in the autumn but the White Paper makes provision for a number of new bodies which will help implement this new, patient led vision of the NHS. The most vital is the NHS Commissioning Board which will act to ensure quality in commissioning and be responsible for commissioning certain services, such as community pharmacy, which GPs cannot commission. It will also be responsible for increasing patient choice through helping patients manage their personal health budgets. The intention is for this body to be fully operational in April 2012. The underpinning concept is to reduce the number of quangos but those that do exist will be interlinked and more accessible to patients.

Value based pricing

The White Paper confirms that the Government intends to move to value based pricing when the current Pharmaceutical Price Regulation Scheme (PPRS) runs out at the end of 2013. A reference is made to the Cancer Drugs Fund, which will operate from April 2011, but no further details are provided.

NICE

In a further strengthening of its powers, NICE will be in charge of developing new quality standards for all the main pathways of care. The paper estimates that NICE will develop up to 150 new quality standards over the next five years. This will position NICE as the key quality regulator building on Lord Darzi’s work on quality improvements, under the previous Government.

 Scrapping targets

As mentioned in the NHS Operating Framework, targets with ‘no clinical justification’ will be scrapped (although not as many as were discussed in Opposition). There is a concession that some targets do work but the paper is not clear on which ones and a consultation is promised on new measureables.

Long Term Care

A Commission will be set up to look into long-term care from the Department of Health. This is in keeping with the move to strip away the Department’s NHS functions and replace them with longer term social care objectives.

Consultation

A number of consultation papers will be published in the near future, getting stakeholder views on policies including; commissioning for patients, freeing providers and economic regulation, the NHS outcomes framework, the framework for transition. This process will be an important part of the transition to the new system as will the proper management of the financial risk.

Legislation

Primary legislation will be required to make many of the proposed changes in the White Paper. The Health Bill announced in the Queen’s Speech provides for many of these reforms and is due to be introduced in late 2010. The main legislative reforms in the Bill will include: Making improvement in outcomes central to the NHS; Reforming NICE;  creating the independent NHS Commissioning Board; creating a framework for a comprehensive system of GP consortia; establishing HealthWatch; reforming the Foundation Trust model; developing Monitor’s role and reducing the number of arms length bodies in health. The Department of Health is taking comments on implementing all the changes in the Health Bill, which must be submitted by 5 October 2010. We can therefore deduce that the Health Bill will not be laid before Parliament before this date.  

The Health Bill will also support the creation of a new Public Health Service, which will streamline existing health improvement and protection bodies. Another White Paper, this time on public health will be published later this year. In addition, the public health budget will be ring-fenced and local Directors of Public Health will be responsible for health improvement funds allocated according to local need.

Sources: white paper and Mr Lansleys press release.