Health & Care Review

Health & Care Review

April 4, 2018

Keeping up with all the latest developments in health and care policy could almost be a full time job and PSNC regularly receives questions from LPCs and pharmacy contractors about what is going on in the wider health and care landscape beyond community pharmacy. To help answer some of these questions and to help contractors and LPCs stay up to date, PSNC provides this update service outlining the latest information in an easily digestible format. Weekly updates are published on our website and contractors can ensure they do not miss them by signing up to PSNC’s email newsletter service here.

The reviews extend the work we have been doing for some time to help LPCs stay informed about the NHS changes, and they inform the more detailed PSNC briefings which we continue to publish on this topic; these can be accessed in the Healthcare Landscape section of the website.

NHS mandate 2018 to 2019

The Department of Health and Social Care (DHSC) has published its mandate for NHS England. The Mandate sets out the Government’s overall objectives and budget for NHS England until 2020. The mandate also provides information on how NHS England’s performance will be assessed.

NHS England’s seven objectives are:

  1. Through better commissioning, improve local and national health outcomes, and reduce health inequalities;
  2. To help create the safest, highest quality health and care service;
  3. To balance the NHS budget and improve efficiency and productivity;
  4. To lead a step change in the NHS in preventing ill health and supporting people to live healthier lives;
  5. To maintain and improve performance against core standards;
  6. To improve out-of-hospital care; and
  7. To support research, innovation and growth and to support the Government’s implementation of EU Exit in regards to health and care.

NHS England’s total revenue budget for 2018/19 is £114,269 million.

PHE remit letter: 2018 to 2019

The Parliamentary Under Secretary of State for Public Health and Primary Care, Steve Brine, has written a letter to Public Health England (PHE) to set out the Government’s expectation of PHE and PHE’s priorities for 2018/19.

PHE’s role will continue to evolve as the Government takes forward changes to future local government public health funding arrangements, as greater integration between the NHS, social care and public health is achieved, and as devolution deals develop.

Public health commissioning in the NHS 2018 to 2019

DHSC has published a briefing to set out the NHS public health functions agreement, under which the NHS is delegated responsibility for certain public health services. Services currently commissioned in this way are national immunisation programmes and national cancer and non-cancer screening programmes.

New GP contract agreed for 2018 to 2019

DHSC has published the details of the new GP contract for 2018/19. The contract was agreed by DHSC, NHS Employers on behalf of NHS England and the British Medical Association’s General Practitioners Committee and came into effect on 1st April 2018.

The new contract will see a £256 million investment in general practice. It also includes:

  • an agreement that will pave the way to GPs using the NHS electronic prescription service instead of issuing paper prescriptions;
  • a renewed focus on the analysis of appointment data to improve GP workflows;
  • supporting the further roll out of the NHS e-referral service into general practice;
  • a commitment to end advertising of private services by GP practices which should be provided free of charge by the NHS.

National bodies agree on shared view of quality for general practice

The Regulation of General Practice Programme Board has published a joint view of the principles that define quality in general practice. The key themes of the shared view of quality for general practice are: positive experience; effective; well-led; safe; and sustainable use of resources.

By bringing together multiple definitions of quality, the Board can begin to reduce the workload and duplication for health care providers in providing evidence of outcomes for quality assurance. This was a key aim set out in the General Practice Forward View, NHS England’s strategy for GP services.

We need to do better on social care

The Secretary of State for Health, Jeremy Hunt, has outlined in his speech the seven key principles that will guide the Government’s thinking ahead of the social care green paper. The paper is due to be published later in 2018.

The seven principles are:

  1. Quality and safety embedded in service provision;
  2. Whole-person integrated care within the NHS and social care systems operating as one;
  3. The highest possible control given to those receiving support;
  4. A valued workforce;
  5. Better practical support for families and carers;
  6. A sustainable funding model for social care supported by a diverse, vibrant and stable market; and
  7. Greater security for all – for those born or developing a care need early in life and for those entering old age who do not know what their future can needs may be.

NHS stuck in survival mode as focus remains on short-term fixes

The House of Commons Committee of Public Accounts has published a report on sustainability and transformation in the NHS. The report finds that DHSC, NHS England and NHS Improvement are too focused on propping up the system and balancing the books in the short term and have not paid enough attention on transforming and improving patient services in the long term.

Key findings include:

  • DHSC’s system for funding and financially supporting the NHS focusses too much on short-term survival and limits the NHS’s ability to transform services to achieve long-term sustainability;
  • staff shortages across the NHS are having a serious and negative impact on both the sustainability and transformation of services; and
  • the financial pressures facing NHS providers has led to the Department using money to prop up services but not to transform them to provide better care.

Signs of improvement but some concerns remain regarding providers of online GP services

The Care Quality Commission (CQC) has published a report on its overall findings of online primary care services based on 55 inspections since November 2016.

The findings indicate that online primary care services has improved over the last 12 months but further action from providers and the wider system is needed to ensure they are as safe as general practice in physical premises.

Key facts include:

  • in February 2018, it was found that 43% of providers were not providing ‘safe’ care according to the relevant regulations – an improvement from the first inspections when this was 86%;
  • specific concerns included:
    • inappropriate prescribing of antibiotics and prescribing high volumes of opioid-based medicines without talking to the patient’s registered GP;
    • unsatisfactory approaches to safeguarding children and those who may not have the mental capacity to understand or consent to a consultation;
    • not collecting patient information or sharing information with a patient’s NHS GP; and
    • inappropriate prescribing of medicines for long-term conditions.

Dramatic annual surge in online GP services as patients sign up for convenience

NHS England has reported that nearly 14 million patients across England are now securely using online services to book appointments, order repeat prescriptions and view their records.

Key facts reported include:

  • an average of one million appointments are being made or cancelled online every month;
  • nearly 2.3 million prescriptions are ordered online;
  • GPs whose practices have embraced online services are already seeing some of the benefits, with fewer patient calls and fewer people failing to attend – saving time that could be used on other activities within the GP practice.

The article highlights one GP practice as an example which has managed to sign up 1,200 patients as part of a campaign and offers test results online. As a result, daily phone calls reduced from around 50 a day to 25 which has given staff an extra 75 minutes of time a day to spend on other areas of their work.

New medical schools to open to train doctors of the future

Health Education England (HEE) has announced that five new universities will be home to new medical schools offering undergraduate places to boost the number of doctors in specific regions. There are 1,500 new training places allocated across the country.

The new medical schools are at:

  • The University of Sunderland;
  • Edge Hill University;
  • Anglia Ruskin University;
  • University of Lincoln; and
  • Canterbury Christ Church University.

NHS Digital funding awarded to projects that help ease delayed transfers of care

NHS Digital has announced the local authority (LA) and NHS partnerships that have been successful in bidding for funding to help digitise their assessment, discharge and withdrawal notices. The successful partnerships are Dorset, Hackney, Lancashire, Wirral, Worcestershire, Hertfordshire and Rotherham.

The £1.4 million funding will help smooth the process of moving key information from a healthcare setting to LA social care.

NHS gets funding green light for new buildings, wards and beds

The Secretary of State for Health and Social Care has announced new funding available to 40 NHS hospitals and community centres to modernise and transform their buildings and services.

The £760 million investment will be spent on programmes to meet local demand, such as new urgent care centres and refurbishing mental health facilities.

Women to have dedicated midwives throughout pregnancy and birth

The Secretary of State for Health and Social Care has announced that the NHS plans to train more than 3,000 extra midwives over four years. The intention is that the majority of women will receive care from the same midwives throughout their pregnancy, labour and birth by 2021.

The first step towards achieving this will see 20% of women benefiting from a ‘continuity of carer’ model by March 2019. Research suggests that women who use this model are:

  • 19% less likely to miscarry;
  • 16% less likely to lose their baby; and
  • 24% less likely to have a premature baby.

Help people make informed decisions when they want to quit smoking, says NICE and PHE

PHE and the National Institute for Health and Care Excellence (NICE) have published updated guidelines for health practitioners and stop smoking services on the best ways to help people quit smoking.

The new guideline recommends prioritising specific groups who are at the highest risk of harm from smoking, such as women who are pregnant and people with mental health problems.

It also recommends that:

  • people should be asked about their smoking and encouraged to stop every time they see a health or social care worker;
  • stop smoking services set existing targets, such as treating at least 5% of the estimated local population who smoke each year; and
  • evidence-based interventions should be available to adults who smoke.

New calculations confirm lifestyle changes could prevent 4 in 10 cancer cases

Cancer Research UK has published a new landmark study led by its researchers which looks at the causes of cancer and how many cases in the UK are linked to each risk factor.

The findings, published in the British Journal of Cancer, show that more than 135,000 cases of cancer could be prevented in the UK each year largely through lifestyle changes (around 4 in 10 cases).

In total, more than 135,000 cases of cancer could be prevented through changes such as:

  • stopping smoking;
  • keeping a healthy weight;
  • eating a healthy diet;
  • enjoying the sun safely;
  • avoiding certain substances at work;
  • protecting against certain infections; and
  • cutting back on alcohol.

What makes us healthy?

The Health Foundation has published a briefing on the social determinants of health and explores how a person’s opportunity for health is influenced by factors outside the health and social care system. it contains suggestions for further reading and, with the help of short case studies, highlights how action can create improvements in the health of the whole population, for the lasting benefit of individuals, society and the economy.

Hepatitis C in the North West report released

PHE has published a new report presenting annual data for hepatitis C in North West England.

The most recent estimates suggest at least 40,000 people across the North West acquired hepatitis C infection, and of those 27,000 have developed chronic infection. The number of infected people who have not been diagnosed is estimated to be 16,000 (a total of 40%). The highest burden of disease was found to be in the Greater Manchester area, while Lancashire and Liverpool also have high numbers of people living with hepatitis C.

Media monitoring:

On Monday 19th March 2018, the following stories were published:

  • Theresa May has spoken of her gratitude for the NHS and other public services whilst addressing the Conservative Spring Forum, reports Sky News. This story was also covered by The Mail.
  • Draft legislation is being introduced to help protect NHS whistleblowers, reports The Times.
  • The Telegraph reports that a million patients a year could be needlessly enduring major surgery because the NHS is not adopting modern practices.
  • The Times reports that a number of medical representatives are launching a lobbying campaign to ask ministers to consider the implications for Britons’ public health as they negotiate Brexit.
  • The President of the Royal College of Paediatrics and Child Health has called for a 100-fold increase in NHS weight loss surgery for teens to fight an ‘obesity apocalypse’, reports The Mail.
  • The Independent reports that, within two years, 1,000 elderly people a day will be taken into hospital after a fall.
  • Changing the clocks leads to more people missing their hospital appointments, reports The Telegraph.
  • The Mail on Sunday reported that pregnant woman could soon be offered a vaccine to prevent respiratory syncytial virus (RSV), which is responsible for one in six infant hospital admissions every year.
  • The Times reports on artificial intelligence software which can accurately diagnose prostate cancer almost as accurately as specialists.
  • The Mail reports that regular servings of oily fish can cut your risk of premature death by 33%.
  • Children’s vitamins tablets can contain more than a quarter of a child’s daily sugar allowance, reports The Sun.

On Tuesday 20th March 2018, the following stories were published:

  • The Mail reports that nearly 13,700 people have been placed in mixed-sex wards in the past year, despite ministers promising to end the use of these wards in 2010.
  • The Women’s Institute (WI) has called for more flexible opening hours to better support patients with dementia, reports The Express.
  • The Mail reports on a study that found a link between poor oral health and developing diabetes.

On Wednesday 21st March 2018, the following stories were published:

  • The Mirror and The Mail report that an overhaul of GP services later this year means patients will be referred to hospitals with the shortest waiting lists.
  • The NHS ombudsmen has found mental health patients are being failed on a daily basis by ‘appalling’ care, reports The Times. This story has also been covered by The Guardian, The Independent and The Mail.
  • The Telegraph reports that drugs to vaccinate everyone over the age of 50 against Alzheimer’s would cost the NHS £9 billion. This story has also been covered by The Times, The Sun, The Express and The Financial Times.
  • The Mail reports on a study that claims lesbian, gay and bisexual adults are 36% less likely to have good heart health than heterosexual adults. This story has also been covered by The Independent.
  • The NHS claims there is no evidence the 5:2 diet prevents heart disease despite study’s claims, reports The Independent.

On Thursday 22nd March 2018, the following stories were published:

  • The Mail reports that millions of back pain sufferers are needlessly given painkillers or undergoing unnecessary surgery, costing the NHS £2.1 billion a year. Whilst evidence shows that exercise and stretches are much more effective for easing symptoms, studies published in The Lancet found treatments often go against international guidelines. This story has also been covered by The Times, The Independent, The Telegraph, The Express, The Sun, iNews and the BBC.
  • Researchers find that consuming at least 24 ounces of sugary drinks a day makes you twice as likely to die from heart disease, reports The Independent. This story has also been covered by The Telegraph, The Mirror and The Sun.
  • Some blueberry muffins contain more than an adult’s daily allowance of sugar, reports the BBC.

On Friday 23rd March 2018, the following stories were published:

  • The Telegraph reports that the Care Quality Commission is warning that online health services are prescribing high volumes of painkiller without sufficient checks being made.
  • The Times reports that NICE is calling on councils to repair potholes and pedestrianise streets to encourage more people to walk and cycle. Suggestions included widening pavements and imposing more 20mph limits. This story ahs also been covered by The Independent, The Telegraph and The Mail.

On Monday 26th March 2018 the following stories were published:

  • The Telegraph reports that GPs need to be trained about the importance of nutrition and healthy eating, so they can better address health problems linked to lifestyle and diet.
  • New data reveals that the number of heart operations carried out on the NHS has now reached over 10,5000 per year, reports The Express.
  • Cuts in NHS budgets for tonsil surgery is leading to an increase in emergency admissions for children with more serious throat infections, reports The Mail.

On Tuesday 27th March 2018, the following story was published:

  • NHS desperately calls for blood donations as ‘Beast from the East’ causes stocks to plummet, reports the Mirror. The recent bad weather has meant stocks are well below normal.

On Wednesday 28th March 2018, the following stories were published:

  • NHS to recruit 24,000 teens in meningitis vaccine bid, reports the Telegraph. The NHS is attempting a bid to test the first new vaccines for adolescents against the most common form of meningitis following a public outcry. Also reported in the BBC.
  • Doctors should prescribe e-cigarettes on the NHS to show they are less harmful than smoking, reports the Sun. The charity Action on Smoking and Health told the Commons Science and Technology committee that there would be significant benefits to prescribing e-cigarettes on the NHS.
  • Nine in ten children with mental illness struggle to get NHS help, reports the Times. Survey finds just 3% of parents of children with a mental illness say the NHS does enough to look after them. Also reported in iNews and the Sun.
  • Obese mothers less likely to breastfeed than other women, reports iNews. A review of research papers suggests that obese women are less likely to breastfeed than those of average weight.

On Thursday 29th March, the following stories were published:

  • Health bosses say the NHS does not have enough beds or staff, reports the BBC. NHS providers warned that hospital waiting lists would grow and long A&E waits would continue. Also reported in the Times, Independent, iNews, and Guardian.
  • NHS watchdog says doctors must send smokers to quitting classes before operations, reports the Sun. New guidelines say patients should be referred for an appointment for stop smoking sessions even if they do not want to attend.

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