Brexit reaction on the NHS
Reactions on Britain’s vote to leave the European Union and the potential impact on the NHS are starting to emerge. Here is our roundup of some of the initial commentary in the media.
Nigel Farage labels £350m NHS promise ‘a mistake’: Nigel Farage has admitted in a live interview with Good Morning Britain that the Leave campaign had made a mistake in its promise to pour £350m a week into the NHS if Britain backed a Brexit vote. Speaking just hours after the referendum vote was announced, the UKIP leader said he could not guarantee the money would be spent on the health service. Vote Leave had pledged to spend £350m earmarked for the European Union on the UK’s struggling health service. The critical claim was emblazoned on the side of the Brexit tour bus. Quizzed on the programme, Farage was asked: “The £350m a week we send to the EU every week, which we will no longer send to the EU, can you guarantee that will go to the NHS?” Farage replied: “No I can’t, and I would never have made that claim, it was one of the mistakes the Leave campaign made.”
Strong agreement with EU ‘vital’ to offset impact on NHS, says Dalton: The UK will need a strong agreement with the EU to offset the potential impact on the NHS following the decision to leave the union, the chief executive of NHS Confederation has said, according to National Health Executive. Stephen Dalton, chief executive of the NHS Confederation, said: “The NHS has broadly benefitted from being in the EU and leaving it will undoubtedly have implications which are yet to be clearly understood. The priorities for those who lead and are on the frontline of delivering NHS funded services are the sustainability and quality of patient care. It is impossible to predict the full impact at this stage, but clearly it is vital that our government seeks a strong, nuanced agreement with the European Union that recognises how interwoven NHS and EU policies have become.”
Keogh: We must make EU NHS staff feel welcome and valued: The NHS’s most senior doctor has called on NHS leaders to send out a message to European staff working in the health service that they are valued and welcome in the wake of Friday’s vote for the UK to leave the EU, reported Health Service Journal (HSJ) (subscription required). Sir Bruce Keogh, the NHS England medical director, said it was important the 55,000 EU nurses and doctors working in the NHS were supported. “It is really important we make them feel welcome. If you are a European doctor or nurse you might not feel too welcome at the moment. The essence of delivering high quality care is dependent on a workforce that feels valued and secure.” Danny Mortimer, chief executive of NHS Employers echoed his comments: “The NHS has always needed to supplement UK trained staff with people from across the globe. Leaders across the NHS need to let the EU nationals in their teams know how valued this contribution will continue to be.”
UK’s vote to leave EU will impact on NHS: Health organisations and experts have reacted cautiously to the news that the UK has voted to leave the European Union (EU), saying the momentous decision will impact on the NHS, reported OnMedica. A BMA spokesperson said that the NHS must be protected: “In the aftermath of the UK’s vote to leave the EU, the BMA reaffirms its commitment to working with our European partners and the European Union to safeguard the future of our profession and the patients we serve. We urge politicians not to play games with the UK’s health services as the country faces a new future. We stand together as one profession with our colleagues from Europe and across the world, with whom we live, work and study and on whom the NHS depends.” Dave Prentis, general secretary of trade union UNISON, added: “The people have spoken, and they have made a clear call for change – and a different relationship with Europe. We will be working in the coming weeks and months to hold the leave campaigners to the promises they’ve made – that there will be more money for the NHS, and that our rights at work will remain intact.” House of Commons science and technology committee chair, Nicola Blackwood, said the UK’s scientists would need to be reassured of their future: “The British people have voted to leave the European Union and we must respect the outcome of the referendum. It is vital that the government moves quickly to reassure our scientists and their collaborators in Europe that the UK remains firmly open for business as a willing and reliable partner.”
Brexit: What it could mean for digital health: A report on DigitalHealth.net pointed to financial clouds gathering for the NHS, with consequences for health IT projects around the country. Quentin Cole, health industries lead partner at PwC, was quoted as saying: “The resulting insecurities of this result will be felt strongly across the health service. The NHS is facing unprecedented financial difficulty and needs a long-term sustainable funding settlement to allow it to navigate the real challenges it faces. This result makes that less likely as we face the very real prospect of economic uncertainty.” Jason Parker, KPMG’s head of healthcare, said as well as the economic uncertainty, Brexit would have implications for NHS “research and innovation” as “many collaborations and employees in this domain rely on existing links with the European Union”. He said: “NHS leaders will be hoping that the Brexit camp stay true to their word to redirect some of the capital linked to the European Union back into the NHS, however whether that is financially practical remains to be seen.” The article also pointed to potential implications for data management, that incoming rules for EU data protection will no longer apply in the UK, and NHS health data stored might have to be repatriated from the continent. The Information Commissioner’s Office issued a statement, stating that while the Data Protection Act remains in place legal reform will be needed. The UK will have to develop its own equivalent regulation if it wanted to continue trade with the Single Market, the ICO said: “With so many businesses and services operating across borders, international consistency around data protection laws and rights is crucial both to businesses and organisations and to consumers and citizens.”
Working hours protections for NHS staff in doubt after Brexit: Working hours protections for more than 1 million NHS staff could be in jeopardy in the wake of Britain’s decision to leave the EU, Health Service Journal (HSJ) (subscription required), has reported. Trade union leaders reportedly said protections for staff on the Agenda for Change pay framework would be need to be re-examined and if necessary “contractualised” to ensure they are not lost. Chair of the NHS staff council and Unison’s head of health Christine McAnea said: “The European Working Time Directive (EWTD) would have to be contractualised for Agenda for Change staff. We want an assessment of what are the terms and conditions that NHS staff have got that derives from European legislation and how do we ensure they are protected. We need an analysis of that and whether they can be lifted and shifted into Agenda for Change.” Danny Mortimer, NHS Employers chief executive, said: “There are clear contractual commitments for junior doctors which meet or exceed the details set out in the EWTD. A yes vote in the BMA referendum [on the junior doctors contract] will mean that these rules are legally binding between the NHS and trainee doctors, regardless of the post-2018 settlement for the rest of the economy.”
News in brief
Endless winter in NHS ‘puts patients at risk’: The NHS is stuck in an “endless winter” with hospitals left in chaos struggling to cope, doctors and nurses said, reported the BBC. The warnings have been made at the Royal College of Nursing (RCN) and British Medical Association (BMA) conferences. Delegates at each explained how pressures have got so bad that patients are being put at risk. But ministers in England rejected the claims, saying investment was making the NHS the safest health system in the world. The RCN produced a dossier showing how frail elderly people were being moved at night and patients were being treated in corridors and storerooms. And doctors warned the NHS had been left drastically short of beds and was “bursting at the seams”. In England, the number of hospital beds has been cut by more than a fifth over the past decade to just over 103,000, leaving hospitals dangerously full according to BMA leader Dr Mark Porter. He said the situation meant there was an “increased risk” of infections and meant it was less likely that patients would end up on the right ward. Mr Michael Hardingham, an ear, nose and throat surgeon from Cheltenham, said: “patients are being harmed because they are being sent home as there are no beds available.” RCN general secretary Janet Davies said the NHS was stuck in a state of “endless winter which was creating chaos”.
Eight out of 10 people concerned for future of NHS, survey suggests: Almost eight out of 10 people are concerned for the future of the NHS, according to a new survey commissioned by the British Medical Association (BMA), reported Health Business. Respondents showed a lack of confidence in the government’s handling of the health service, with fewer than one in five of the 1,240 people surveyed saying they trusted the government with the management of the NHS. While 53% agreed with the government’s focus on seven day services, 69% thought that the NHS couldn’t afford the policy. Additionally, 77% believed that government policies were causing discontent among NHS staff. Dr Mark Porter, BMA council chair, said: “People are increasingly concerned about the future of a health service that they know is under unsustainable pressure. There is a gulf between the government’s promises on the NHS and what the public believe to be true. Everyone agrees that the NHS needs to grow and change, yet there is no long-term plan to address the crisis in our health service. It’s little wonder that many people question the government’s commitment to the NHS and believe it is going in the wrong direction.”
Hunt brushes off concerns around GP mass resignation: Jeremy Hunt has brushed off the threat of GP mass resignations while defending the government’s austerity policies, reported Pulse. When asked whether he is worried about another dispute with doctors, the health secretary said GPs were already getting ‘billions’ in the GP Forward View settlement. It comes as Mr Hunt has yet to conclude a trade dispute with junior doctors about a new contract and after GP leaders voted last month to canvass GPs on their willingness to submit undated resignations unless outstanding General Practitioner Committee (GPC) demands are met – above and beyond what NHS England promised in the GP Forward View. But Mr Hunt simply responded that he has already pledged increases to the GP budget. He said: “The GP Forward View we announced does indeed announce and involve a multibillion-pound increase in investment in general practice, and an increase in the proportion of NHS resources going to general practice. This is something I have long campaigned for as health secretary, I fought for the money in the spending review, to deliver that change. And indeed I think it has been welcomed by the BMA and GPC chair Dr Chaand Nagpaul.” Mr Hunt also shot down GPC’s urgent call for a larger proportion of GDP to be spent on healthcare. He said: “I happen to be someone who believes that we will need to see significant increases in investment in the NHS in coming decades, and indeed in the social care system, as we grapple with the challenges of an ageing population. But, and I don’t want to be party political here, I also believe that the only way to do that is a strong economy, and that we do need therefore to control our national deficit.”
Government ‘in denial’ about state of NHS funding crisis, say doctors’ leaders: The government is in denial about the state of the funding crisis facing the NHS, the head of the doctors’ union has said, reported OnMedica. Addressing the BMA’s annual representative meeting (ARM) in Belfast, Mark Porter, chair of BMA Council, said that year-on-year funding cuts have left almost every acute trust in England in the red, with trusts facing a deficit of more than £2bn, a 20-fold increase in two years. The UK spends less of a share of its wealth on healthcare than the EU average, and cuts of £200m to public health have affected many services locally, including sexual health and smoking cessation services. A BMA public survey found that only a small minority (13%) of respondents believe the government is giving the NHS the money it needs and that three quarters were worried about public health funding. Highlighting the pressure on NHS services, Dr Porter pointed out that there are more health ministers in England than there are major emergency departments that recently met the government’s four-hour waiting time target. And elective waiting lists are now at their highest for 10 years. “The government is in denial. The chancellor says he has a ‘fully funded’ plan for the NHS. But while he announced £10bn of new money in November, our funding report showed the real increase in health spending is less than half that. As for the rest, for the largest part of the unmet need, the plan relies on what he laughably calls ‘efficiency savings,’” he said.
Digital roadmaps deadline “unrealistic” – IT directors: Some NHS IT directors have called the deadlines for digital roadmaps “unrealistic” but NHS England remains confident that “most” plans will be lodged by the end of the month, reported DigitalHealth.net. An NHS Providers survey of 25 NHS IT directors found that while most agreed with the strategy and goals of the roadmaps, less than half thought it was achievable under the current timeline. As at 9 June, the commissioning body confirmed no finalised roadmaps had been submitted. The roadmaps are meant to be a plan, developed by the NHS and care organisations within a local roadmap “footprint”, for how they will become paper-free by 2020. The NHS Providers survey, which was conducted in April, showed that while most thought the digital roadmaps were “helpful” or “somewhat helpful” in achieving the paperless 2020 target, they felt progress had been poor.
BMA demands survey to quantify GP workload and improve patient safety: Delegates at the 2016 ARM have demanded that the BMA undertakes an immediate analysis of the GP workforce to define the safe limits of working in general practice and preserve patient safety, reported GPOnline. The motion for the ‘long overdue’ survey was unanimously approved by BMA members after GPs raised patient safety concerns as GP workload remain largely unknown. The last survey of the workforce was undertaken a decade ago in 2006/07. Proposing the motion, Dr Farah Jameel said it was essential to collect robust data to recognise what is safe and sustainable for general practice. “NHS England published its GP Forward View in April this year – supposedly a roadmap to dealing with the crisis in general practice,” she said. “But where is the up-to-date evidence that explains the causes of this pressure on general practice? How many consultations are carried out each week? What about complexity of cases? Are patients more demanding? The evidence simply doesn’t exist.” Dr Jameel added: ‘Increasing activity in general practice is largely un-resourced because there’s no data to help policy makers match resource GPs desperately need to meet demand. Two out of three GPs have significant work-related stress. We legislate to prevent lorry driver and pilot fatigue, but not doctor fatigue. A similar survey ran last year in Northern Ireland had shown “dramatic changes”, said Dr Krishna Kasaraneni. He said: “Commissioning a survey will help us see that patients can’t access GP services. It’s time for us to show how our workload is changing and say this is how to fix it.”
RCN calls for nursing staff to have better technology access: All nurses should have the skills to be able to use electronic technology to help them in their work, according to a motion passed at the Royal College of Nursing’s (RCN) annual conference, reported Nursing Times (subscription required). A resolution was passed at RCN Congress in Glasgow calling on the union’s council to promote the concept that every nurse should be an “e-nurse”. The resolution was submitted by the RCN’s E Health Forum, with Ian Ireland putting the case to delegates. The forum described the concept of being an “e-nurse” as having the skills to access the information they needed to do their job. It said the use of information and digital technologies is “key” in meeting the significant challenges in delivering health and social care now and in the future. However, it warned that services have historically “absorbed” investment in technology without changing ways of working or debating “fundamental impact” it could have on professional practice. “In order that care can be transformed, nurses and nursing need to engage with developments, and seek new ways of working in order to achieve progress,” stated the forum. The forum also noted that the RCN had held two summits last year on the digital health agenda, where attendees had set a goal that all nurses should be “e-nurses” by 2020.
Community pharmacies should be put at heart of care delivery: Community pharmacies should be put at the heart of delivering care, the new NHS Alliance has said in a new report. National Health Executive revealed that the report said that NHS England should consider commissioning a community pharmacy led model of care and that GPs should support community pharmacy as the first call point for patients with acute self-limiting conditions and minor ailments. It said that allowing pharmacies to take more of the burden in providing care would help reduce problems facing the NHS, including financial shortfalls, pressure on GPs and increased patient expectations of care. Dr Mark Spencer, co-chair of the New NHS Alliance, said: “New NHS Alliance is disappointed that there is not a community pharmacy led new model of care and that the NHS has failed to fully utilise the expertise of the community pharmacist within their locations in the heart of many communities. We must recognise community pharmacy as a professional clinical retail healthcare environment and as an integral member of the primary care team. We must also recognise the pharmacy’s unique position within the community and their ability to reduce demand within general practice as part of the solution to the crisis within general practice.” The report said that the 11,700 community pharmacies in the UK serve 1.6 million people a day and provide services including physiological measurements and blood and STI tests, including in rural areas that do not have other healthcare resources. The ‘Making time in general practice’ report found that 27% of GP appointments were avoidable and 5.5% could have been dealt with in a community pharmacy.
Belfast-based medical software firm sold to Philips: The Belfast-based digital pathology firm PathXL, has been sold to the multinational health technology company, Philips, reported the BBC. PathXL specialises in software which improves the analysis of cancer tumours. Philips said PathXL’s image analysis and tissue pathology software will complement its existing products. A spokesman for Philips told the Reuters news agency that its digital pathology business was already “doubling every year”. He said its digital pathology sales would pass “several tens of millions” of euros in sales this year, including the acquisition. Philips chief executive, Frans van Houten, said: “The computer can do a much better job than the human eye, as it is much more systematic in analysing tissues. We’re acquiring a company that has deep clinical knowledge and technology to analyse cancerous cells.”
NHS England director admits ‘work to do’ to fix STP and digital plans mismatch: A senior NHS England director has said work needs to be done to align the “mismatch” between the geographical areas covered by the sustainability and transformation plans (STP) and the local digital roadmaps (LDR), reported Health Service Journal (subscription required). NHS England head of technology strategy, Paul Rice, said the lack of alignment between the 44 STPs and the 83 LDRs was a live issue under consideration by the national body. Mr Rice said: “We wanted to get the digital conversation stipulated as early as possible. The STP process came into play following the planning guidance (in December).” The roadmaps were established earlier in 2015. He continued: “We have a mismatch out there at the moment. We have 83 local digital roadmaps. We have 44 STPs. We have some work to do on that. But in principle we asked people in the LDR to organise themselves in the way they felt they could actually be successful to deliver this agenda. So (they are based on) well founded, well established relationships.” The roadmaps – the first iterations of which need to be submitted to NHS England by the end of this month – are akin to digital versions of the STPs. Beverley Bryant, now at NHS Digital but until last month NHS England director of digital technology, said in April that whether or not the digital plans would be restructured to become coterminous with the STP areas would be a “local decision”. “It is different from place to place how they are managing it. We are not going to dictate (how they do it),” she said.
NHS England recruiting for new senior digital role: NHS England are recruiting for a new “director of digital experience” as the organisation continues the restructure of its senior technology team, Health Service Journal (subscription required) has learned. The new post will report to the chief information and technology officer, another new role which a candidate is yet to be filled, and take on a number of high profile responsibilities and programmes. The new director will be senior responsible officer for the health and social care digital service, NHS Choices and “lead all citizen facing digital services development… including development of nhs.uk to become a multi-channel access point for citizen feedback and complaints”. The job advert said: “To succeed you’ll need to have demonstrable and very significant senior commercial experience and knowledge in the deployment of digital technologies and channels to yield major cost improvements and enhanced end user outcomes. You’ll also need to possess excellent experience in the design, development and deployment of digital channels and technologies, including practical experience of leading channel, website and application development.” The new director will also be expected to deputise for the national director of operations and information, Matthew Swindells, and the chief information and technology officer “as required, including attendance at the National Information Board”.
Healthwatch England to reduce staff numbers and work more closely with CQC: Healthwatch England will cut staffing numbers and work more closely with the Care Quality Commission (CQC), a paper from this week’s CQC board meeting said, reported National Health Executive. The paper, from Susan Robinson, acting national director of Healthwatch England, said that Healthwatch England will have to reduce its staffing to remain “lean and fit for purpose” after its pay budget for this year decreased from £2.8m to £1.8m. The paper said: “A new chapter’s opening for Healthwatch England as we take our existing links with the rest of CQC to the next level. Our closer relationship will enable us to benefit from the facilities that CQC has to offer us, which will also help us make even better use of public money.” It adds that one of its key priorities in the next year will be: “Reshaping the organisation, managing a reduced budget and therefore reducing staffing, so that it is lean and fit for purpose through a restructure. As the pay budget has reduced from £2.8m to £1.8m for 2016-17, the staff team size will reflect this budgetary decrease.”
St George’s deploys Cerner in Neonatal, a first for the UK: St George’s University Hospitals NHS Foundation Trust will become the first in United Kingdom and Ireland to deploy Cerner in its neonatal unit, reported DigitalHealth.net. The South West London trust has a history of firsts with the Cerner Millennium platform, but making the system work for its smallest patients has been a big leap. Dr Sijo Francis, clinical lead for newborns, said the platform had to be shaped to handle a much wider range of patient needs than was required in other units. “Paediatric intensive care unit as a group are a little more homogenous. (In the neonatal unit) we have really well babies and then we have really sick babies and then we have everything in between.” But after months for fine tuning and training, a go-live date had been set for 2 August. The system will cover charting, documentations, prescribing, ordering and results. It will also link up to some medical devices, including ventilators but not, at this stage, infusion pumps. It will replace a largely paper-based system and Francis said it would require a big shift in thinking for staff. Matthew Barlin, who was previously employed by Cerner and moved to the trust three months ago to manage the project, has built up an in-house team of clinical champions to help with the transition.
Simon Stevens launches medtech innovation fund: At the NHS Confederation conference on 15-17 June 2016, NHS England head Simon Stevens announced the launch of a programme to speed up the uptake of innovations in the NHS, reported Computer Weekly. The programme means that the NHS will provide an “explicit national reimbursement route” for “medical technology (medtech) innovations” through introducing an innovation and technology tariff category. In the spending review last autumn, chancellor George Osborne said the overall funding plan drawn up for the NHS will completely bridge the £30bn funding gap by the end of this parliament. Stevens said that the “u-shaped” funding settlement “can be regarded as good as would be obtainable under those circumstances”. Commenting on Steven’s speech, IMS MAXIMS CEO Shane Tickell said that the “resetting of finances” and the u-shaped funding settlement “will no doubt unsettle many service providers. I’m proposing something completely different – off-balance sheet investment in digital that means service providers can use technology to deliver better, safer patient care, whilst also addressing their run rates. This should make a significant difference, particularly as we are yet to enter the bottom of the U shaped funding settlement.”
NHSMail 2 rolled out to 200,000 NHS staff: More than 200,000 people have already been switched to NHSmail 2 and most will have barely noticed, the Health and Social Care Information Centre (HSCIC) said, reported DigitalHealth.net. One of the biggest email migration projects ever kicked off on May 29, with just a 50 accounts. It has been slowly ramped up, with the number ticking over 200,000 this week. Cleveland Henry, who is leading the project at the HSCIC, said if all goes to plan every one of the 850,000 NHSmail accounts would be switched by early August. “This is a massive migration. It’s potentially the biggest migration of mailboxes ever undertaken,” he said. “We are getting there and so far it’s been really positive but I’m not going to report a success yet.” NHSmail 2 replaces the ageing NHSmail 1, which was introduced in 2002. Henry described the earlier version as a “burning platform” stretched to capacity, beset by performance issues and no longer able to meet the growing demand. NHSmail 2 includes a number of new features, including doubling the mailbox storage capacity to 4GB, better mobile integration and a wider range of tools. As the new system is rolled-out it will be used more as a platform for delivery rather just an email service, Henry said.
Computer Weekly announces the 50 most influential women in UK IT 2016: Beverley Bryant, director of strategic systems and technology, NHS England, is number 45 on the Computer Weekly list of 50 most influential women in UK IT 2016. Bryant has been in the role since 2013, leading technical initiatives in the NHS such as Integrated Digital Care Records, NHS E-referrals, Patient Online and electronic prescriptions. Before joining the NHS, Bryant was managing director at Capita Health and CIO of the Department of Health for three years. Computer Weekly wrote: The 50 women featured on this list, act as role models to the wider industry in promoting diversity for the technology sector.
Opinion
The NHS needs a strong dose of tech investment
Rebecca George, vice chair and public sector health lead for Deloitte UK, tells the Guardian Healthcare Network how the health service could do with an IT injection to help it bring its 1950s-style processes into the 21st century.
“The announcement of £4.2bn in funding to move the NHS towards a digital, “paper-free” future raises challenges and rekindles memories of past attempts.
“In fairness, the NHS gets less credit than it should for its progress with technology. GP surgeries are computerised, the health service has excellent technology for transferring data around the country, digital imaging and online referrals, and the largest secure email service in the world.
“There are good examples of technology in the NHS. Mobile IT can cut 60% of paperwork for community nurses, giving them 29% more patient time. Airedale NHS trust found that Skype consultations from care homes led to 35% fewer hospital admissions, a 53% reduction in A&E use and 59% fewer hospital bed days. But the NHS has struggled to repeat such successes across different organisations.”
George says that for technology to work well, lessons should be learned and the right people must be involved: “Clinicians must own and lead the process. Digitising care is difficult because medicine is complex and full of judgment and exploration. Clinicians must know what’s on offer and what works for their environment, help develop their organisation’s vision and work with colleagues and management to agree clinical processes. Technology can, and should, enable this vision and professionals need, and often want to be at the forefront.
“Nor will one size fit all. A system right for one hospital, or to link several, won’t be right for another. It depends on the clinical vision. A large teaching hospital – with academic links, specialist treatments and looking at collaborating or merging with other organisations – will require a comprehensive transformation programme assessing and improving patient pathways and care plans, taking two or three years. But smaller organisations, offering a narrower range of services, won’t need such complicated solutions.”
What can England learn from Scotland?
At the annual NHS Scotland conference in Glasgow last week, Chris Ham, chief executive at The King’s Fund, said there were three programmes of work from NHS Scotland that he thinks holds particular interest for the NHS in England
“The first is work to improve patient safety and the quality of care. Leadership is provided by Healthcare Improvement Scotland which brings together in one organisation some of the functions that in England are dispersed between the Care Quality Commission, NHS Improvement and the National Institute for Health and Care Excellence. Healthcare Improvement Scotland also houses the Scottish Health Council and is currently placing particular emphasis on supporting person-centred care and a greater voice for citizens and communities.
“The second programme is work to improve clinical care through the national clinical strategy for Scotland and the initiative of the chief medical officer on realistic medicine. The clinical strategy encompasses all aspects of health care and outlines the need for changes in where some specialist services are provided to improve outcomes. It also makes the case for hospitals to collaborate in networks to ensure greater consistency in care and to provide more opportunities for learning. This is in recognition of variations in standards of care that need to be tackled.
“The third programme is work to achieve closer integration of care, including between the NHS and local government. This is being pursued through the creation of integration authorities under legal powers introduced this year which make it a requirement for health boards to work in partnership with local authorities. These arrangements build on a history of joint working and I was told that delayed transfers of care are much less of an issue in Scotland than in England because of the work already done to build bridges between health and social care.
“One of the paradoxes of political devolution is that it has created greater differences in how the four countries of the United Kingdom run their health services but, with limited exceptions, appears to have reduced the appetite for countries to learn from each other. At a time when innovation in how care is provided is more necessary than ever, this is a major missed opportunity. Now is the time to encourage greater curiosity and exchange of ideas in a spirit of learning and humility that has been crowded out by the competitive behaviours of governments of the four countries.
Embrace the new hub culture
Staffordshire GP Dr Mark Williams, explains why clinical hubs are vital to the future of primary and urgent care.
Writing on the NHS England website, Dr Williams writes: “When the urgent care system is under pressure then primary care feels this. A packed ED department leads to earlier discharges from the acute trusts. Increasingly sick and unstable patients are discharged into the community which results in more pressure on general practice to keep these patients safe and in their homes.
“At the time of writing this blog GPs will soon be balloted on strike action, recruitment is extremely difficult and many GPs are retiring, leaving or emigrating. We need to reduce the pressure on primary care and the urgent care system.
“The clinical hub aims to provide timely, specialist advice to both patients and clinicians via a single point of access (111), 24 hours a day, 7 days a week. It will reduce the need for clinicians to make complex decisions in isolation and reduce inappropriate dispositions from 111 to primary care or the ED. The hub will offer advice from GPs, pharmacists, dental and mental health nurses and specialists. The clinical hub will be staffed centrally, virtually or a combination of both. It will be based in 999,111 or OOH centres.
“How is this any different to the 111 service people currently have access to? In March 2016, there were 1.5 million calls to 111, a third more than in Mach 2015, with just under one million callers being given advice to attend primary care. My question is this, if the clinical hubs were active, how many of these dispositions could have been avoided with clinical advice with or without a prescription sent electronically to a pharmacy?
He adds: “To be successful, the clinical hub will need to be supported in both principle and practice by primary care and by GPs in particular. They will need to use the hub in order for it to fully develop to support primary care. They will need to promote the hub to patients and share care plans with their patients consent. GPs will need to either work physically within or virtually in these hubs.
“For all GPs, the hub may provoke a cultural transformation where primary care is an integrated part of the urgent care system and not just the end point for patients leaving the system.”
