King’s Fund Report Warns NHS Primary Care Reforms Face Uncertain Future

The King’s Find and Nuffield Trust have published the results of their annual survey into the success of Clinical Commissioning Groups (CCGs) in general practice.

This year’s report, Clinical commissioning: GPs in charge?, suggests that GPs have felt more engaged with the commissioning process through CCGs.  Over 70per cent of CCG members felt at least ‘somewhat’ engaged with the work of their CCG, a higher engagement rate that all other models of joint commissioning since 2005.  But despite the progress made, the report warns that CCGs’ clinically led model of commissioning is at risk if barriers to effective clinical involvement are not addressed.  The research found that CCGs feel they need more autonomy to involve GPs in decisions about service design. There are also concerns that inadequate resourcing of CCGs is undermining efforts to develop high-quality, clinically led commissioning and that there is a lack political support when making tough decisions about priorities.

In 2016 only 20 per cent of GPs without a formal role in their CCG reported that they could influence the work of their CCG if they chose to – down from 35 per cent in 2014. GPs felt that CCG managers still had more influence over commissioning decisions than GPs and that there had been little or no change in the quality of care in general practice as a result of their CCG.

Ruth Robertson, Fellow in Health Policy at The King’s Fund, said: ‘Our research shows that while CCGs have made good progress in engaging GPs in local commissioning decisions, there remain significant barriers to effective clinical engagement and to translating this into improvements in quality of care.

‘The NHS must now build on CCGs’ achievements and do more to embed clinical involvement in planning decisions across the health care system. As well as properly supporting GP commissioners within CCGs, this means ensuring that GPs and other clinicians have a strong voice in the sustainability and transformation planning process and in the vanguards.

‘Engagement with GPs and other clinicians is crucial to efforts to transform out-of-hospital health and care provision and to move the NHS to a more financially sustainable position. In these challenging times for the health service, it is more important than ever that clinical engagement in commissioning decisions is properly supported.’

Holly Holder, Fellow in Policy at The Nuffield Trust, said: ‘Involving doctors and their colleagues in decisions about how NHS money is spent is very important. It won’t be possible to make the kind of changes at the front line we need to see without buy-in from people who actually deliver care.

‘We are now moving into a complicated world of multiple and overlapping organisations taking on some of the responsibilities that GP-led clinical commissioning groups were given in the 2012 reforms. This must not mean diluting the voice of GPs and alienating those who have contributed to CCGs over the past few years. We want to see national leaders say clearly that clinical commissioners will still have an important place in the future NHS. They must support CCGs to make taking part an attractive, rewarding career path for GPs – which we know it sometimes is not.’

Winnie the Pooh Knocks Harry Potter Off The Top Spot In Summer Reading Poll

Winnie the Pooh has topped the list of favourite childhood book characters in the Reading Agency’s annual Summer Reading poll, knocking the popular wizard Harry Potter off the top spot.

Image reproduced under license: Antonia Hayes, Flickr

Top 10 Childhood Book Characters

• Winnie the Pooh
• Harry Potter
• George from the Famous Five
• Bilbo Baggins, The Hobbit 
• Matilda 
• Lucy, The Lion the Witch and the Wardrobe 
• The Cat in the Hat
• Spot the Dog 
• Charlotte, Charlotte's Web
• Tracy Beaker

The Summer Reading Poll revealed differences between the generations, whilst Pooh was a favourite across the ages, Harry Potter is a firm favourite with nearly half (48%) of 16-24 year olds, and those over 55 favoured George from The Famous Five and Bilbo Baggins from The Hobbit.

When asked what they liked about our favourite characters almost half of people (45%) ranked an adventurous nature top, with a third choosing their favourite character because they felt like a good friend. A British sense of humour could have contributed to a third of people also saying cheekiness and sense of humour are key factors.

These books were also loved for their life lessons, with over a third saying their favourite character taught them 'It is okay to be different'. A third said they learned 'How to be kind to people' and a quarter learned 'How to get through difficult times'.

Sue Wilkinson, Chief Executive of The Reading Agency said "We know the power of picking up a book you love and discovering a favourite character amongst the pages. The Summer Reading Challenge gives children the chance to be transported and inspired by the adventures of their favourite characters, and read books that can go on to play a fundamental role in their lives.

"For this reason, we were curious about which characters would stand the test of time and stay with us into adulthood, and the ones that would remain firm favourites across the generations.”

CQC Inspectors Find Liverpool Community Health NHS Trust Still Requires Improvement

England's Chief Inspector of Hospitals has told Liverpool Community Health NHS Trust that it must make further improvements to services following its latest inspection by the Care Quality Commission.

When the CQC inspected in May 2014 the trust was rated as Requires Improvement overall. The trust was told it must make improvements in respect of a number of areas, including, staffing levels, waiting times and a culture in some services which was negative and on occasion intimidating. Following the latest inspection in February 2016, the trust is still rated Requires Improvement.

Inspectors were satisfied that the trust had sought to address the findings of the last inspection, and that improvements had been made. However, progress to make the necessary changes was often slow and some services still required further improvement.

Inspectors found there was well established multidisciplinary team working which focused on the best outcomes for patients and their families. Community services for children, young people and families and the health visiting and school nursing teams worked closely together to support children as they developed through their early years and into primary and secondary education. Health visitors supported local GP practices to help provide a more integrated service

Staffing had improved in community services since the last inspection but there were still concerns in some areas of community adult services. Team leaders in the community services for children, young people and families’ had responsibility for a large number of staff. Inspectors also noted high levels of sickness in some teams.

Although waiting times in the services for adults and children, young people and families’ had improved but in other areas, performance was worse than at the last inspection. Demand was so high for the paediatric speech therapy service that the trust had suspended the waiting list last year.

Inspectors were pleased to report an improvement in culture in the community inpatient service, which, at the last two inspections, was found to be very negative. All staff were clear that huge efforts had been made to change and support the delivery of intermediate care services.

Previously inspectors had found that the staff culture in some services was negative and on occasion some people found it intimidating. At this inspection inspectors found there had been significant improvements in culture across the organisation, although the percentage of staff that had experienced harassment or bullying was worse than the national average.

The CQC has told the trust it must draw up a plan to address the issues found during the inspection. Inspectors will return to check that the required improvements have been made.

Businesses Rates Appeals Reform Aims to Streamline the System

Secretary of State Greg Clark has announced plans to simplify business rate appeals systems, promising that businesses will benefit from a quicker and more efficient service when checking and challenging their business rates bills.

The new “check, challenge, appeal” process will help prevent speculative appeals, and make sure genuine disputes are settled more quickly for all involved.

Businesses will now go through a 3-stage process:

Check – ensuring the relevant facts are up to date and accurate, with any agreed errors quickly corrected. For the vast majority of rate payers it is expected that this check stage will be complete in a matter of days.

Challenge – allowing the business to challenge the rateable value on which their business rates bill is based, giving them the opportunity to set out their grounds for challenging, an alternative valuation and to put forward supporting evidence - it is expected that the great majority of cases to be resolved by this point.

Appeal – offering the opportunity to appeal to an independent valuation tribunal.

To help improve the flow of information between ratepayers and the Valuation Office Agency a new simple online service will allow customers to provide information about their property as often as they like and to track the progress of their check or challenge.

With this streamlined process, and improved information exchange between ratepayers and customers, it is expected that the vast majority of cases will be settled in the check and challenge phases.

A new £300 fee will be charged for anyone looking to lodge an appeal, to try to deter speculative cases and therefore reduce the queue and so reduce the length of time taken to hear an appeal.  The fee will be refunded if an appeal is successful.

To meet small businesses needs a tailored package will be offered providing:

·         a fast track through the system

·        clear guidance which will help them navigate the system without professional support

·         lower levels of fees for making an appeal, which will be refunded if successful

Secretary of State for Communities and Local Government Greg Clark said “For too long we’ve had an appeals system where backlogged cases – often caused by unscrupulous agents eyeing up a fast buck – meant unnecessary costs and uncertainty for all involved.

That’s why we are going ahead with our plans to streamline the process and help resolve cases as quickly and fairly as possible.

The vast majority of disputes will now be settled long before lengthy litigation and will mean businesses and councils can get on with planning budgets, confident they are getting a fair deal.”

New NHS Approved Mental and Sexual Health App for Students

The new 'ESC Student' app was launched at the Student Health Association Conference in Leeds on 27 June, as part of a wider campaign to help improve student health and increase health literacy among young people.

The app was developed by experienced GP Dr Knut Schroeder from Bristol together with a team of experts from the University of Bristol Students' Health Service, students and health professionals from the wider NHS. It has been certified by the NHS England Information Standard as a source of reliable health information.

Students worked with the developers to identify key areas of concern – from first aid and how to deal with emergencies, to common ailments, mental health problems, physical (body) symptoms, love and sex, healthy living, travel health, alcohol and drugs, long-term health problems, staying safe at school or uni, and how to access health services.

By answering common questions about their health students can find reliable health information on over 120 important student health topics in plain language – anytime (24/7) and in total privacy.

The app offers:

• Access appropriate advice and services for specific health problems – with general advice and information and signposting to appropriate services.
• Advice for dealing with emergencies and general ill health – users can discover the truth about life-threatening illnesses as well as sleep problems, stress, and tiredness etc...
• Treatments for common ailments – getting to the bottom of headaches, providing advice on treating spots, and managing common aches and pains.
• Mental health advice – with advice on what to do when they (or their friends) feel low or anxious, self-harm or are worried about drinking too much alcohol.
• Useful links – to hundreds of trusted sites with useful further information.

Dr Dominique Thompson, Director of the Students' Health Service at the University of Bristol, says: "This app provides reliable, relevant health advice for young adults who want to look after themselves and use medical services wisely."  

The app is available from the Apple App Store – click here. 

Contribute to the CQC PIR Form Review for Adult Social Care

The CQC has been using Provider Information Returns (PIRs) to gather information about adult care service providers, ahead of inspections, since 2015.

The returns are used to collect information relating to care provider’s performance, standards, ethos and values. The information provided is used by Inspectors to help plan and prioritise inspections and informs the agenda during each site visit making them critical to the service review cycle.

When reviewing completed PIRs inspectors are looking for evidence that services are:

• Safe
• Effective
• Caring
• Responsive
• Well-led.

With a maximum word could for each submission, and a ban on attaching additional information, the challenge for service providers is to be clear and concise whilst providing examples to back up statements, all within the word count. For the system to work for all involved it is important that the forms are clear and questions are unambiguous, ensuring that the right evidence is gathered and avoiding miscommunication.

The CQC is currently reviewing the content of their adult social care PIRs and they are seeking feedback from service providers to ensure the PIR form is asking the right questions, in a way that can maximise support for providers as well as inspection scheduling and planning.

They have specifically asked for feedback on (but not limited to):

• Positive outcomes from completing the PIR
• Examples of improvement as a result of the form – for example, in quality assurance or record management
• Issues identified with current PIR content
• Specific examples of unclear PIR content or a duplicate request for information from other professional bodies
• PIR questions which do not reflect the needs of your specific service type, e.g. Shared lives
• Any comments on the available PIR guidance
• Feedback on the support received for any PIR-related queries

You can email your ideas and feedback toASCPIRContentReview@cqc.org.uk. The deadline for all responses is Wednesday 31 August 2016.