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Our Health, our care, our say: a new direction for community services
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The central aims of the proposals set out in the white paper are to improve and expand health and social care services in the community and make access easier particularly for those areas, which are currently poorly served.
At the same time, the Government also aims to reduce the need for professionally provided care through prevention and support for self-care.
The aims focus on a wide range of actions, which can be grouped under the following headings:
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Promoting health
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Better access to general practice and other community services
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Support for people with long term conditions
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Transfer of services from acute hospitals to community settings
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The Government proposes to develop:
2.30 ….. a new NHS ‘Life Check’ service to help people particularly at critical points in their lives – to assess their own risk of ill-health.
The NHS ‘Life Check’ will be based on a range of risk factors, and an awareness of family history.
It will offer:
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An initial assessment for people to complete themselves
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Offers of specific advice and support on the action people can take to maintain and improve health and, if necessary, referral for more specialist diagnoses for those who need it.
The Government is also aiming to place a greater emphasis on prevention both of physical and mental illness including measures taken in related fields such as housing, transport and leisure and policing. Primary Care Trusts (PCTs) are to be charged with the development of plans for preventative services.
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The Government’s broad intention is to make access easier to all community based services, including social care, urgent or emergency care, sexual health services, mental health services, services for those with learning disabilities and other groups and services.
The white paper also sets out a number of measures designed to make it easier for patients to choose the general practice where they wish to be registered. To do this will require changes in existing financial arrangements to create an incentive for practices to take on new patients where services are good and patients want to switch.
Where services are currently poor, PCTs will be tasked to actively commission services from existing providers, or new providers including the private sector, social/not for profit organisations and the voluntary sector. The Government also aims to make all practices more accessible in terms of booking times and opening times and more speculatively by locating them in supermarkets and high street locations.
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The Government intends to promote patient self-management, in particular to triple spending on the expert patient programme, to enhance the availability of information to patients and to provide more professionals trained to support self-care.
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Transfer of Services – care closer to home
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The white paper identifies a number of services, which can be safely provided outside the acute hospital setting. Identified services include:
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Ear, Nose and Throat
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Dermatology
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Urology
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Gynaecology
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General surgery
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In July 2005, the Department of Health launched Commissioning a Patient-Led NHS, the government’s intention to reconfigure Primary care trusts (PCTs) and Strategic Health Authorities (SHAs). This initiative was an attempt to place more emphasis on community-based primary services.
It set out to create a primary care economy that is ‘fit for purpose’. The context for this ‘fitness’ are the Government’s Choosing Health White Paper, its response to the Wanless Report on the long-term funding of health care and the White Paper, Our Health, our care our say which focuses on care outside hospital. All these documents stress the need to provide for health improvement and effectively shift emphasis from hospital services to the community.
The governments move towards a patient-led NHS and community based health services will include practice-based commissioning, PCT based service commissioning and joint commissioning arrangements involving the health sector and Local Authorities which are all designed to move commissioning power and resources to the community level.
These proposals form part of the Government’s wider reform programme to where health services are designed around the need of the patient rather than the needs of the patient being forced to fit around services. Services it is hoped will be flexible and responsive to individual need.
The white paper also places great emphasis on prevention and early intervention on ill health. This it is hoped will help close the health gap and set a new direction for health and social care services to meet demographic challenges. This shift will change the way money is spent, as more services will be delivered locally where people need them.
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The current position and a move to better joining up of local services
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Currently, primary care is commissioned solely by the local PCT with social care commissioned by the Local Authority. This will change under new proposals contained in the White paper.
There will be more joint commissioning between PCTs and Local Authorities using a new procurement model and best practice guidance to underpin a joint commissioning framework for health and well-being.
This will be achieved by budgets being streamlined by the aligning of planning cycles of PCTs and Local Authorities as well as a shared outcome-based performance framework and aligned performance assessment and inspection regimes.
Local Area Agreements will be a key mechanism for joint planning and delivery of these aims. LAAs will need to reflect the long-term strategy set out in the white paper, and propose action to promote better health and tackle health inequalities.
These proposals will be central to the development of better links between health and social care which will be achieved by local government and the NHS working closer together.
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Joint Commissioning of health services
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More joint commissioning between Local Authorities and PCTs will be encouraged through Practice Based Commissioning and Health Act flexibilities. By the end of 2006, the Department of health will produce guidance on joint commissioning for health and well-being and recommend services that are most effective. By 2008, performance management systems for health and social care will be aligned to support joint commissioning.
Local Authorities will be encouraged to work with Regional Centres of Excellence to support their procurement and commissioning activity.
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Practice Based commissioning (PBC)
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PBC’s will give GP’s increased responsibility on local health budgets to develop more local services to meet local need and provide better value for money. Under PBC, GPs and primary care professionals working closely with PCTs will have greater freedom to commission health and social care services for the individual.
PBC gives GPs direct responsibility for managing the funds that PCTs pay to hospitals and other care for their patients.
Primary care practices will under PBC’s be able to control the bulk of local health resources and will be able to use them to meet local need.
There will be changes to the Payment by Results Tariff (PBR) so that it will now provide incentives to support these proposed changes.
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Changes to service providers – a role for VCS’s
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The White paper encourages innovative approaches to service development by using new providers to meet local need.
The procurement of new service providers by the PCT is expected to increase the quality and quantity of primary care services.
PCTs and Local Authorities have been given the task to drive this forward by encouraging the independent and voluntary sectors to get more involved with delivery.
Although the White paper makes a number of references to encouraging the ‘third sector’ to become more involved in the planning and delivery of services, it also recognises that there are still considerable hurdles in making this aspiration a reality and promises to report by the summer of 2006 on new arrangements to remove these hurdles.
The white paper also recognises that procuring health services from a wider range of providers will bring more capacity, more innovation and new ways of working.
The development of a wider range of primary and community services, including those provided by PCTs, will also provide new and innovative models of care.
The paper states the importance of the third sector in driving up quality within the delivery of health services. This they say will be achieved by using third sector providers currently involved in the provision of social care and extend this to the NHS.
To enable this the Third Sector Commissioning Taskforce will address ‘key barriers’ to commercial arrangements between the public, voluntary and private sectors that presently bar entry to the provision of NHS services.
It is also likely that health services will be compelled to support Local Area Agreements, which Local Authorities already have a statutory duty to participate in. This is designed to bring together health and social care planning.
Although the white paper makes several references to greater opportunities for the voluntary sector in the delivery of community based health services, they do not provide for the infrastructure support VCS’s will need to be able to deliver.
However, the white paper does provide an opportunity for VCS’s to promote their work and begin discussions with their local PCTs.
VCS’s should ensure that they monitor new developments within their PCT and especially look out for services to be commissioned both by the PCT and by GP practices.
VCS’s can also explore developing partnerships with other organisations in the sector to put in tenders to provide services.
Local Authorities and PCTs will soon begin their strategic assessment of the health and social care needs of their communities and how services can be more closely integrated. VCS’s should be involved in this process so as to make sure that local needs are identified.
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Delivering the new agenda
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Between now and 2008, the proposals contained in the white paper are expected to make a significant impact in health service delivery.
‘System rules’ for 2006/7 and 2007/8 will be published and these will reflect progress made in implementing the proposed reforms. There will also be a gradual introduction of incentives and flexibilities within the context of ‘system rules’ which it is proposed will enable the delivery of increased benefits for patients and taxpayers as well as ensuring financial stability and building organisational capability.
The reforms may well provide many opportunities for the Voluntary and Community Sector but this will only be achieved by increased infrastructure support for these organisations to be able to deliver innovative health services for the very different and diverse communities that exist in London.
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