Friday 15 November 2013

A new contract for GPs will see the return of "proper family doctors

A new contract for GPs will see the return of "proper family doctors," responsible for round-the-clock care and with dedicated help for the elderly, the Health Secretary says
The deal agreed with the British Medical Association (BMA) has been heralded as the biggest shake-up since Labour introduced changes which allowed thousands of doctors to abandon responsibilty for out-of-hours care.
Under the contract four million elderly patients and those with complex conditions will be given a named GP, personally accountable for their care at all times.
Ministers say the change is crucial because the failure to care for older patients has causing a spiralling crisis in NHS emergency care, with millions of patients admitted to hospital because they could not get help in time from their GPs.
Under a deal introduced by Labour, the majority of family doctors dropped responsibility for out-nstantly by almost one third.
BMA negotiators later admitted the terms, which brought average GP incomes to more than £100,000 were so generous that they thought the Government was "having a laugh".
Since then, there have been a succession of scandals in which patients were failed by locum doctors, including a notorious case when a pensioner was killed by an overdose of painkillers administered by an overseas medic working his first shift.
The new deal will mean that GPs are personally responsible for the care of all patients aged 75 and over, around the clock, regardless of who delivers it - as well as for the care for younger patients with complex health needs.
Older patients will also be promised same-day access to their doctors, via telephone consultations, while GPs will be instructed to draw up "personalised care plans" so all frail and elderly patients are properly looked after.
Jeremy Hunt said last night: "Labour's 2004 GP contract broke the personal link between GP and patient. It piled target after target on doctors, took away their responsibility for out-of-hours care and put huge pressure on our A&E departments. This Government has a plan to sort this out. Today's announcement of a new GP contract is a vital step."
Ofsted-style ratings measuring the performance of GP practices as outstanding, good, requires improvement or inadequate, will be published in every surgery by 2015, while data will be published scrutinising the quality of out-of-hours care for all patients.
Government sources said the reports would be detailed and "unapologetically frank" informed by close observation and conversations with professionals and patients.
Mr Hunt said: "We are bringing back named GPs for the vulnerable elderly. This means proper family doctors, able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital. This is about fixing the long-term pressures on our A&E services, and freeing hardworking doctors to improve care for those with the greatest need."
Since 2004, GPs pay has been dictated by hundreds of targets. Under the system - derided by critics as "points mean prizes" - income can be dictated by how many patients are weighed, asked about their alcohol intake or given lifestyle advice.
Under the new deal, which will be introduced in April, more than one third of the indicators will be scrapped, which the BMA said would allow thousands of GPs to attend to their patients, instead of their computer screens.
Dr Chaand Nagpaul, Chairman of the BMA's GP committee, said: "This is resurrecting what used to happen: it means tailored and personalised care."
"The 2004 contract brought unprecedented bureaucracy and chasing of targets and box-ticking. We have removed a swathe of targets: what this is doing is giving GPs time - time to care. Doctors will be able to look at the patient in front of them, not the computer screen."
Under the targets framework, doctors have been paid for improving their handwriting, or ensuring staff undergo training, or for asking patients how often they do activities such as DIY, cooking or gardening.
Dr Nagpaul said: "Even today GPs up and down the land are asking these questions - how often patients cycle, garden or cook, how often they walk - and how quickly - checking the blood pressure of fit and healthy people, all the while measuring rather than providing care."
The deal agreed yesterday involves some compromises, as ministers had orginally indicated that they wanted GPs to take back responsibilty for out-of-hours care for all patients, and further changes are likely to be negotiated in future years.
Dr Nagpaul said: "Given the workforce crisis among GPs it's right to focus on the patients with the greatest need. I think the Government understsands that with a limited workforce GPs need to use their time wisely."
The BMA said the terms would not increase funding for doctors - who on average earns £103,000, with more than 600 earning more than £200,000 - but would shift existing resources, so GPs could make better use of their professional judgement.
Andy Burnham , Labour's Shadow Health Secretary, said: "No amount of spin can hide the fact that David Cameron has made it harder to get a GP appointment. There is nothing in this new contract to correct that."
"David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours. "This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment - many of whom, not happy with a phone consultation, will still turn to A&E."

GPs take on extra role for frailest patients

GPs take on extra role for frailest patients

Jeremy Hunt said he hoped this would be part of a "much bigger change"

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The 100,000 most frail patients in England will be identified and given a named GP to co-ordinate their care.
The move has been agreed by the British Medical Association and NHS England in talks over next year's GP contract.
Ministers had been pushing for doctors to take greater responsibility for the most vulnerable patients in society to relieve pressure on hospitals.
An analysis by NHS England showed many of the winter pressures on A&E came from frail elderly patients.
Contrary to common perception, it found that summer was the busiest time for A&E units in terms of numbers, but winter was when the difficulties arose because of the rise in the numbers of elderly patients needing care.
A third of emergency admissions are among the over-75s - many of which could be avoided if they received earlier and better care in the community.
This is where the agreement with GPs - which will kick in next April - will help, ministers say.
'Old-fashioned' approach
Under the terms of the deal, doctors have agreed to carry out a trawl of their registers to identify the frailest 2% of patients.
Dr Richard Vautrey from the BMA: "This will mean GPs will spend less time focusing on box ticking... and more time on the needs of their patients"
This is likely to include people at the end of life, in care homes and those who are frequently in and out of hospital.
They will then take responsibility for overseeing their care across the NHS and social care sectors.

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This will free up GPs to spend more time focusing on treating patients”
Dr Chaand NagpaulBritish Medical Associaton
The aim is to create a much more proactive services whereby their needs - from home adaptations to intensive nursing support - are met much more quickly.
They will also need to offer these patients same-day telephone consultations as well as checking up on them after discharge from hospital.
This contrasts with what the government and doctors' leaders agree is the more reactive service many patients are currently getting.
A further four million people over the age of 75 will be given a named GP - at the moment patients are registered to a practice rather than individual doctor. It is hoped this will lead to greater continuity of care for those patients who visit GPs the most.
'Phone frustration'
Health Secretary Jeremy Hunt hailed as the return of the "old-fashioned family doctor" and an end to the current "box-ticking" culture.
"We are bringing back the named GPs for the vulnerable elderly. This means proper family doctors able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital."

GP FUNDING

GP practices are small businesses - and contracts are held by the practice, rather than individual GPs.
Funding comes from a number of different sources and is weighted so a practice with, say, lots of elderly people on its books will receive more than one which looks after a relatively young and healthy population.
The main source of income, accounting for around half the funding a practice receives, is the 'global sum'. This is a payment based on the estimated workload from the patients registered.
Next comes QOF - the Quality and Outcomes Framework which is at the centre of these latest contract changes.
This is in effect a points system where practices accumulate a score from meeting requirements such as monitoring how many of their patients have a certain condition or ensuring checks such as blood pressure readings are carried out on a regular basis.
These contract changes would cut QOF - and move funding of around £290m into the global pot.
Other funding streams include extras services such as flu and childhood jabs, which are not part of the contract but which most offer, are funded separately.
Seniority payments for long-serving GPs, and funding for premises make up the rest of a practice's income.
Out of this pot, a practice has to pay staff costs and other bills - as well as GPs' pay.
Those GPs who have responsibilities for practice management earned on average across the UK £103,000 in 2011/12.
Salaried GPs, who do not, could this year earn a maximum of £81,969.
In return, doctors have been freed from what they considered some of the most burdensome aspects of the form-filling they had to do for their performance-related pay.
This means requirements such as having to annually ask men with diabetes if they experienced erectile dysfunction at their check-ups will be removed, as will the need to ask those with high blood pressure in detail about their activity levels, with what doctors say were often irrelevant questions.
But Labour's Shadow Health Secretary Andy Burnham told BBC Radio 4's Today programme: "The bottom line is under this government, it has got harder to get a GP appointment. And nothing in today's announcement will correct that.
"People will still face the frustration of phoning the surgery at nine o'clock in the morning, being told there's nothing available for days and then some having to turn to A & E."
He added: "David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours," Mr Burnham added.
"This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment - many of whom, not happy with a phone consultation, will still turn to A&E.
"People will fail to see how this package delivers the public commitment David Cameron gave last month to keep GP surgeries open from 8am to 8pm."
Dr Richard Vautrey of the British Medical Association's GPs committee, told the BBC: "It will help to a degree. It certainly won't be a panacea but it will start to focus on the needs of the most vulnerable and those patients who do go into hospital more frequently.
"And it will give GPs that bit more time to be able to spend with their patients to try and meet their needs."

Thursday 14 November 2013

Birmingham children's services takeover warning

Birmingham children's services takeover warning


Keanu Williams died in January 2011 after being found with 37 injuries

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Children's services at Birmingham City Council could be taken over by the Department for Education before Christmas if standards do not improve.
The takeover will happen if Ofsted inspectors do not see improvements when they return later this month.
The department is the biggest of its kind in England and has been rated as "inadequate" for four years.
Department head Peter Hay said the city council had to be involved in its running but there were no easy answers.

Analysis

The moment of reckoning for Birmingham is near. There has been a clamour for years from some campaigners for Whitehall to do something, but that is far easier said than done.
Earlier this year, Mr Gove announced he was to create an independent trust to run Doncaster's equally-troubled child protection services. But the model has now been watered down amid concerns about accountability and potential legal challenges.
Birmingham is far, far larger and there simply isn't a ready-made solution out there. It would be a brave private company that would approve running services in a city with nearly 2000 children in care and 300,000 young people living here.
Anything can happen at any time. And any contract would need to have a lot of zeros at the end of it, which is money the government probably doesn't have. So while the problems are clear, the solution is anything but.
Earlier this week, Michael Gove signalled a significant shift in direction in the way his government will deal with failing child protection services.
He suggested in a speech that more children's services departments could be taken over - in the same way that Doncaster began the process earlier this year.
Doncaster children's services is set to be taken out of council control, with the services to be run by an independent trust, in the mean time the council is working with a management consultancy firm to improve its services.
There have been a number of high-profile child deaths in Birmingham in recent years, including those of Khyra Ishaq in 2008 and Keanu Williams in 2011.
Rebecca Shuttleworth is serving a life sentence for murdering Keanu after he was found with 37 injuries at his home in Ward End, Birmingham in January 2011. A serious case review concluded last month there were "a number of significant missed opportunities" to save the two-year-old.
Khyra died aged seven in 2008 after being starved at her home in the Handsworth area of the city. Her mother, Angela Gordon, 35, and her ex-partner Junaid Abuhamza, 31, were jailed in 2010 for her manslaughter.

Khyra Ishaq weighed just 2st 9lb (16.5kg) when she was discovered at her home in 2008
'National disgrace'
Birmingham children's services has been rated as inadequate by Ofsted since 2009.
Mr Hay, who took over as head of the department in July, said shortly after starting that improvements had not been made and he could not guarantee the safety of children in the city.

Analysis

Is a government takeover of Birmingham's children's services the best solution for its problems?
Firstly, there is not a fully-tested or functioning model as only a couple of councils have had the control of their children's services taken away.
Even in the case of Doncaster Council, the most advanced case where the government has stepped in, the takeover is more of a half-way house.
An independent management consultancy runs the department but Doncaster retains responsibility for commissioning out services.
This is because a change in the law is required to enable a third party - not the local authority - to issue the life-changing court orders that take a child away from their parents and place them in care.
The education secretary says he is planning more intervention in struggling authoritie, and considering allowing successful authorities to innovate by commissioning outside organisations such as social worker practices.
So perhaps the dawn of fully privately-run children's services is nearer than we thought.
Last month Ofsted chief inspector Sir Michael Wilshaw said the city's failure to protect vulnerable children was a "national disgrace".
A spokesman for the DfE said it had warned the council that unless Ofsted identified signs of improvement in its next inspection in the coming weeks it would have to take further action.
Speaking to BBC Radio 4's Today programme, Mr Hay said the department was "very clear that performance is inadequate" and it had been trying to establish a greater transparency so it could "get governance right of how we improve services".
He said there should be a role for the city council because it could "bring the relationships and the money and the investment".
"But it can't do what it's always done and I absolutely respect that the secretary of state has a very difficult decision," he said.
The key was having "enough social workers to do great social work" but his department currently had vacancy rates for qualified staff of more than a quarter and experienced supervisors of more than a third, he added.
"I've heard people thinking about jobs say that they've been told not to come to Birmingham because it's a blot on their CV. I think that's unacceptable," Mr Hay said.
Computer-generated image showing four injuries to Keanu's headA computer-generated image shows some of the injuries inflicted to Keanu's head
He said social care involved many "risky decisions" and "fine calls".

Key dates in 'failing' social services

  • May 2008: Khyra Ishaq, seven, dies after months of abuse by mother and mother's ex-partner
  • Feb 2009: Council served with improvement notice by government
  • Feb 2010: High Court judge rules Khyra "might still be alive if had not been failed by social services"
  • July 2010: Serious case review says Birmingham social services is still failing to protect vulnerable children
  • Oct 2012: Ofsted inspection shows council's child protection services are "inadequate"
  • Feb 2013: Report reveals 431 children's services staff were on long-term sick leave in 2012
  • Oct 2013: Serious case review finds opportunities missed to save two-year-old Keanu Williams, who was beaten to death by his mother
  • Oct 2013: Ofsted singles out city for criticism for 23 serious case reviews over past seven years
  • Nov 2013: Council says children's services budget to be protected despite £600m cuts from budget over six years
  • Nov 2013: BBC learns council could be taken over if standards do not improve
"We sometimes expect people to have had a crystal ball. All I'm expecting them to have done is to have made a judgement - an analysis of the information - and to live with that risk," he added.
Khalid Mahmood, Labour MP for Birmingham's Perry Barr constituency, said the takeover warning was a "complete and utter political move" by the government.
"If they are going to do it they should just do it instead of making leaks and threats," he told BBC Radio 5 live.
He said the government could instead look at devolving the department to constituency level, as there were some constituencies with more than 100,000 people.
With a population of 1.1 million, Birmingham is the British city with the most residents outside London.
Former Tory MP Tim Loughton said he had visited Birmingham more times than any other authority when he was children's minister and the major problem was "the city was in denial about the extent of the problem".
He said Birmingham had to contend with challenges such as its size and its ethnic diversity, as well the the lack of consistent leadership with four leaders in as many years.

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Listen to The Report, broadcast on BBC Radio 4 on Thursday 14 November at 20:00 GMT
Sue White, a professor of social work at Birmingham University, said the city would "not get better simply by being shamed by Ofsted inspections".
"In my view that process has made the patient sicker. The medicine is killing the patient," she said.
Tony Rabaiotti, of Unison West Midlands, said the idea that the Department for Education "could do a better job than the people on the ground" was "ridiculous" and the move was "purely ideological".
In 2010, Birmingham was ranked 13th in a government list of deprived areas, behind authorities such as Hackney and Tower Hamlets in London.

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