The PCT Procurement Guide supports NHS commissioners in deciding whether and how to procure health services through formal tendering and market-testing exercises. The Guide sets out the policy and regulatory context for procurement, and issues to consider when developing a procurement strategy. The Guide should be read in conjunction with the Principles and rules for Cooperation and Competition, published as Annex D of the 2008/9 Operating Framework, and the Framework for Managing Choice Cooperation and Competition

Project: London is a clinic of Medecins Du Monde (UK) which aims to support migrants that need help accessing healthcare.  It has just  published its second annual report the Project: London report and recommendations 2007: Improving access to healthcare for the community’s most vulnerable.

The report finds no evidence of health tourism, with patients had been in the UK for an average of 3 years before accessing care from Project: London. Migrants are no more likely to have expensive, complicated medical needs than anyone else. It also identifies difficulties for pregnant women in accessing proper care. Although they were entitled, nearly 70% of the women had no access to care, a situation which puts both mother and child in jeopardy, and must be addressed as a matter of urgency.

Proposed changes to NHS access for migrants are unlikely to be cost effective because:

• Lack of GP access means no chance of preventing diseases
• Lack of GP access means no chance of early and affordable treatment of diseases – including those which are contagious
• Lack of GP access is likely to lead to increased pressure on already burdened A&E department.

• Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit
• CSIP Better Commissioning programme
• New NICE Commissioning guides: Cognitive behavioural therapy and Faecal continence service
• West Kent PCT: World Class Commissioning strategy and delivering a commissioning model
• National Cancer Intelligence Network
• Commissioning Specialist Library: Have you say
• A resource to help primary care pharmacists in England involved in PBC
• Revised guidance: primary care dental contracts Advice on managing end of year issues
• Other documents, websites and conferences

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The NHS Next Stage Review has been led locally by clinicians in each NHS region. Seventy-four local clinical working groups, made up of some 2000 clinicians, have been looking at the clinical evidence and engaging with their local communities. They have developed improved models of care for their regions to ensure that the NHS is up to date with the latest clinical developments and is able to meet changing needs and expectations.

NHS Next Stage Review Leading Local Change sets the context for these local visions and the principles which will guide their implementation.

The Evaluation of Early Medical Abortion (EMA) Pilot Sites - final report has been heavily reported in the mass media today.  It was commissioned by the Department of Health to assess the safety, effectiveness and acceptability of early medical abortions (EMAs) in non-traditional settings, and to help establish a protocol to cover the elements and processes required for the delivery of a safe EMA service in non-traditional settings.

Conclusions

• Subject to the fairly considerable limitations of the current study, and from a range of
  sources, including medical records, and staff and client views, there are no discernible
  differences between the pilot sites and their matched comparator sites in terms of the safety,
  effectiveness or acceptability of non-traditional sites for the administration of early medical
  abortions.

• Detailed protocols and guidelines should be developed to cover staffing requirements as well
  as clinical aspects of care.

• Given the importance of reassurance and support throughout the process, the centrality of
  suitably motivated and skilled nursing staff to any expansion of EMA provision cannot be
  overestimated.

Patient Experience Scores for the PSA target – April 2008 updates the patient experience scores published on 29 January 2007. They include scores derived from survey results published by the Healthcare Commission for 2006/07. There are new data points for ‘adult inpatients’ and ‘community mental health’ in 2006/07. These figures report on progress against the PSA target for sustained improvement in patient experience.

• The overall patient experience score for adult inpatients in 2006/07 has increased slightly to 76.4 from the score of 76.2 in 2005/06. The score is 0.7 points higher than in the earliest fully comparable year of 2003/04 (75.7).
• The overall patient experience score for community mental health services in 2006/07 has increased to 75.2, up 0.7 points from the score of 74.5 in 2005/06. 
• Scores for ‘involvement in decisions about healthcare’ cannot be compared across sectors.  The baseline scores for emergency services (2004/05) is 77.1.  The baseline score for outpatients (2004/05) is 81.7.  For adult inpatients, the latest score of 70.9 is unchanged from 2003/04.  Results for community mental health services show a slight increase to 63.7 in 2006/07 (from 63.3 in 2003/04) whilst primary care results are slightly lower at 81.9 in 2005/06, compared to 82.1 in 2003/04
• The baseline score for ‘choice of provider’ is 27.3 from the 2005/06 DH survey of PCTs.  This score represents the baseline position in the last year before the choice of provider policy was introduced. 

Interim Guidance on Directed Enhanced Service - Extended Opening Hours is intended to help PCTs implement arrangements for GP practices to extend their opening hours, and arrangements for monitoring progress.  This in line with The Operating Framework for the NHS 2008/09 and is issued with the Dear Colleague Letter from Ben Dyson - Extended Opening Hours.

The Ideas from Darzi: Polyclinics report (again from the NHS Confederation) examining polyclinics, the key design rules for them and three possible models, as well as key lessons learned, and the misconceptions and concerns associated with them.

The debate about organisational models for community provider services has been ongoing since 2005. One model being examined is that of a community foundation trust (CFT), allowing community service providers to acquire the same freedoms as acute and mental health foundation trusts.

Towards autonomy from the NHS Confederation draws on the experiences of eight CFT pilots and looks at what other organisations can learn from them. The pilot CFTs have had different experiences but some common themes emerge, most importantly the potential to bring benefits for patients.

The researchers for this paper interviewed 28 GPs working in different settings and environments. They identified four factors that might affect the way GPs work and influence the decisions they might make.

• Updated Child Health Promotion Programme
• Towards World Class Commissioning Competency
• Education Commissioning Briefing
• National Dementia Strategy
• More strategic, timely information needed in primary healthcare
• Putting you in the picture
• Choice at referral
• Refocusing the care programme approach: Policy and positive practice guidance
• National Primary Care Research & Development Centre: Practice Based Commissioning
• Other documents and conferences

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This is the third quarterly practice survey (National summary of results), covering a sample of practices from each primary care trust (PCT). The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC.  The survey is part of a group of indicators that will be assessed together to give a picture of PBC implementation.

Key findings:

• There has been a rise in the number of practices commissioning new services through PBC (+8 percentage points since Wave 1 and +5 percentage points since Wave 2). 41 percent have commissioned new services through PBC.
• The percentage of practices who have agreed a commissioning plan with their PCT has continued to increase (+11 points since Wave 1 and +3 points since Wave 2). 57 per cent of practices have now agreed a commissioning plan.
• 62 percent of practices support the policy of PBC (a rise of 5 percentage points since Wave 1, and 3 percentage points since Wave 2).
• The percentage of practices agreeing that PBC has improved patient care has marginally increased from 12 percent in Wave 2 to 16 percent in Wave 3. The proportion who disagree that PBC has improved patient care is in line with that of the previous two waves (31% in Wave 3, 30% in Wave 2, and 31% in Wave 1).
• 71 percent of practices claim to have a good relationship with their PCT, a decline of 3 percentage points on Wave 2.
• The proportion of practices who have received a financial incentive scheme has marginally declined since Wave 2 to the levels recorded in Wave 1 (down 4 percentage points since Wave 2 - now 62 percent).
• There has been a rise in the proportion of practices who engage with their local population from 61 per cent in wave 2 to 70 per cent in Wave 3 (an increase of nine percentage points).
• Around 4 in ten practices continue to rate their PCT’s managerial support for PBC as good (40 per cent in Wave 3, 42 per cent in Wave 2 and 37 per cent in Wave 1), however, half continue to rate managerial support for PBC as poor (49 per cent in Wave 3).
• As in previous waves, around a third of practices continue to rate the quality, format and frequency of information provided by their PCT as being good

The devolution of increased power to local NHS bodies and front-line professionals,has resulted in calls to ensure that those who take on increased responsibility are held to account. There is no clarity on how this may be achieved or the extent people want more control over how their primary care trust (PCT) spends its money.

The main political parties im to end the ‘democratic deficit’ and ensure local people have increased input on the delivery of local health care, and this will be a central theme of Professor Lord Darzi’s review of the NHS. The King’s Fund report, Should Primary Care Trusts Be Made More Locally Accountable?, makes a thorough assessment of the various options for making PCTs more accountable to their local communities.

It states that if the aim of involving the public is to give more democratic validity to the health service, systematic changes – such as giving local councillors control over PCT budgets, or electing PCT board members – would be appropriate.

However, improving the quality of services is the target, then an incremental approach would be better.  Targeted initiatives – such as citizens’ juries or enhanced Public Patient Involvement Forums – focusing on specific PCT functions may prove to be a more successful route to accountability.

Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit aims to support the corresponding programme and has one principal aim - to help PCTs implement NICE Guidelines for people suffering from depression and anxiety disorders. The Government is committed to improving access to psychological therapies and announced additional funding to increase services over the next three years. This Commissioning Toolkit is designed to help PCTs improve or establish stepped care psychological therapies following NICE guidelines. The toolkit is structured around the commissioning cycle and is specifically linked to the World Class Commissioning competencies.

The Report on the National Patient Choice Survey, England - November 2007 and provisional headline results for January 2008 gives the final results of around 78,000 responses to the tenth national patient choice survey commissioned to assess the implementation of choice at PCT level.  The series of surveys, conducted by Ipsos MORI on behalf of the Department, monitor patient awareness of choice and recall of having been offered a choice of hospital for their first outpatient appointment.  They were designed to provide a national overview of choice and summary results at PCT level, with a revised format from November 2007 incorporating new questions.

The main findings of the November survey are:

• The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 44% in November, compared with 45% in September and 48% in the March 2007 survey.
• 41% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 39% in September and 29% in the May/June 2006 survey.
• 61% of patients who were aware of choice recalled being offered choice, whereas 32% of those not aware of choice recalled being offered it, compared with 64% and 32% respectively in the September survey.

Results of new questions introduced for the November survey are:

• 65% of patients were able to go to the hospital they wanted, with a further 25% having no preference and 7% unable to go where they wanted.
• 40% of patients discussed which hospital they might go to with their GP.
• Half the patients (50%) who were offered choice said they used the GP as a source of information to choose their hospital, with a third (33%) saying they used their own experience or that of friends and family.
• 39% of patients booked their first hospital appointment when the hospital contacted them following a letter from the GP.  30% telephoned an appointments line, 19% were booked on screen by the GP or other practice staff and 3% used the internet.
• 78% of patients were satisfied with how long they had to wait from the time their GP referred them to when they saw the hospital.
• For the first time, hospital cleanliness and low infection rates were selected more often (by 76% of patients) than location or transport considerations as an important factor when choosing a hospital.

Provisional headline findings of the January 2008 survey are:

• 46% of patients recalled being offered a choice of hospital for their first outpatient appointment, compared with 44% in the November survey.
• 42% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 41% in November.
• 68% of patients were able to go to the hospital they wanted, with a further 22% having no preference and 7% unable to go where they wanted.

Implementing the Health Act 2006: NHS (Pharmaceutical Services) (Amendment) Regulations 2008 Information for Primary Care Trusts on these directions that come into force on 21 April 2008.

Putting prevention first - vascular checks: risk assessment and management sets out the plans for the NHS to introduce a systematic and integrated programme of vascular risk assessment and management for those aged between 40 and 74. It explains in more depth what vascular disease is, why undertaking risk assessment and management is important, and how these checks might be performed throughout England.

A consultation on the framework for the registration of health and adult social care providers follows on from the previous consultation on the future regulation of health and adult social care (November 2006), and the response to that consultation, which was published in October 2007. It seeks views on: which health and adult social care services should require registration with the Care Quality Commission; and what the requirements for registration should be. It also seeks views on when providers of regulated services should be required to have a registered manager, and how primary care services should be included in the new registration system.

A partial Impact Assessment of the Scope of Registration of Primary Medical and Dental Care has been completed as part of this consultation.

Public and patient involvement in the NHS from the BMA looks at the concept of public and patient involvement. It has a focus on the new mechanisms that are designed to ensure local communities more say in commissioning services.

It concludes there is a real risk of the having the opposite effect. To increase the involvement of ordinary people in their health service, more effective fora for expressing their views are required. Suggestions on how this may be achieved are developed in this report.

Local Pharmaceutical Services (LPS) - guidance notes provides information on aspects of LPS permanence which allows PCTs to enter into LPS contracts without requiring prior approval of the Secretary of State for Health and provides PCTs with flexibility to make LPS arrangements in response to local needs within timetables of their own choosing. The guidance also details the commissioning process and may be of use to those PCTs that wish to use LPS