NHS groups "paying millions to private firms that block GP referrals"

NHS organisations are paying millions of pounds to private firms that stop patients being referred to hospital by their GPs, an investigation has found.

Controversial referral management centres are used by some clinical commissioning groups (CCGs) to scrutinise patient referrals to hospitals by family doctors.

Supporters say they can reduce inappropriate referrals, saving the NHS money, but critics argue that adding an extra layer of scrutiny risks delaying diagnosis. There is also doubt over the effectiveness of such schemes.

In an investigation, the British Medical Journal (BMJ) sent freedom of information requests to all 211 CCGs in England. Of the 184 that responded, 72 (39%) said they commissioned some form of referral management scheme.

Almost a third (32%) of the schemes are provided by private companies, while a further 29% are provided in-house and 11% by local NHS trusts. Some 69% of the CCGs with schemes gave details of operating costs. These CCGs combined have spent at least £57m on schemes since April 2013.

Most CCGs were unable to provide evidence showing the scheme saved money. Only 14% could show that the scheme had saved more cash than it had cost to operate, while 12% showed that their schemes had not saved money overall.

Meanwhile, 74% of CCGs (53 groups) failed to supply figures to show whether any money had been saved, the BMJ reported.

Some CCGs did not collect data on savings, some said their referral scheme was designed not to save money but to improve the quality of referrals, and others declined to disclose details of savings on the grounds of commercial confidentiality.

Overall, there were 93 referral management schemes in operation across 72 CCGs, with some CCGs having more than one.

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, told the BMJ: “[CCGs] are leaping at these schemes without any clear evidence of benefit. They are just hopeful that it might reduce their costs.

“It is a very short-term approach to healthcare management. We need to see much more evaluation … and not just keep making the same mistakes year after year. As public bodies, there should be an expectation on every CCG to account for what it is doing.”

Vautrey said some schemes were helpful because they gave GPs rapid access to advice from local specialists.

Graham Jackson, co-chair of NHS Clinical Commissioners, the membership organisation representing CCGs, said referral management was only one way of managing demand for services.

“In many cases they provide a useful and effective role which is more than a redirection service,” he said. “CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice.”

In October, Roberta Blackman-Woods, Labour MP for City of Durham, criticised a local scheme to screen referrals for conditions including cardiology, gynaecology and gastroenterology.

The North Durham CCG has awarded a contract to the private firm About Health to manage referrals.

NHS groups "paying millions to private firms that block GP referrals"

Women"s groups urge Scotland to scrap two doctors abortion rule

The Scottish government should scrap the legal requirement for two doctors to approve a termination, effectively decriminalising the procedure, and consider regulating abortion drugs for use by women in their own homes, according to a report by a coalition of women’s rights organisations.

With abortion law devolved to Holyrood as part of the Scotland Act 2016, the report argues that the SNP government must now “be bold in creating a distinctive approach” by removing it from criminal statute and regulating it like any other healthcare procedure.

The campaigners – including Amnesty Scotland, NUS Scotland and Scottish Women’s Aid – are calling on politicians to “make a woman’s legal right to choose a reality” by removing the two doctors rule.

Under UK law abortion is permitted for non-medical reasons up to 24 weeks and with the permission of two doctors. The SNP reaffirmed its commitment to current legal protections and to maintaining time limits in line with the rest of the UK in its spring manifesto.

But the report insists it is time to go further, arguing: “There is an opportunity within the devolution of abortion law to develop a distinct Scottish approach to women’s reproductive health and the strengthen women’s rights.”

Since the devolution of abortion law was announced last November, some pro-choice campaigners have raised concerns about the risk of anti-abortion groups exploiting cross-border differences.

Others have suggested the surge in political engagement, particularly among women, brought about by the 2014 independence referendum campaign could bolster any forthcoming drive to extend abortion rights in Scotland.

On a visit to Dublin two weeks ago, Scotland’s first minister, Nicola Sturgeon, said her government would explore how to allow Northern Irish women to obtain free access to abortions in Scotland’s NHS hospitals.

Abortion is legal in Northern Ireland only when the pregnancy poses a direct threat to the mother’s life. The NHS has so far refused to pay for abortions for Northern Irish women who travel to Britain.

Emma Ritch, executive director of the feminist campaign group Engender, which spearheaded the report, said: “It does seem there is a very unique status given to abortion, in that it is the only type of healthcare in which this criminalisation exists. We would want to see decriminalisation happen so that abortion was regulated in the same way as any other type of healthcare.

“Any Scottish approach to abortion should be based on international best practice, so we could adopt a situation as in Canada where there is no criminal law when it comes to abortion. While the debate around time limits is not a focus of the report, there is no compelling evidence of a reason to have time limits at all. Research shows that women want to access abortions at the earliest possible stage, and allowing later-term abortions does not significantly increase demand.”

The report criticises NHS Scotland for lagging behind England in its provision of later-term abortions, with terminations for non-medical reasons not normally available after 20 weeks, forcing some women to travel south.

It also suggests the Scottish government should consider regulating the provision of medical abortion drugs to allow terminations in early pregnancy to be carried out at home. A total of 12,082 abortions were carried out in Scotland in 2015, about 80% of which took place before 12 weeks of pregnancy.

The report counters the assumption that Scottish social attitudes, influenced by strong religious traditions, are more anti-choice than elsewhere in the UK. It says that according to polling carried out in the last year, 75% of Scots support a woman’s right to choose.

Women"s groups urge Scotland to scrap two doctors abortion rule

Secular groups fight exclusion from AA: "The best support system in the world"

The Almighty plays a central part in the hallowed 12 steps of Alcoholics Anonymous. Six of them make reference to God, Him or Power. In one step, members vow to hand “our will and our lives” to God while another implores Him to remove their shortcomings.

Now the organisation’s religious undertone – and its utility in fighting alcoholism – has come under fire in Canada, where an atheist has lodged a human rights complaint alleging AA discriminated against him.

For more than two years, Lawrence Knight has watched his complaint snake through the Ontario Human Rights Tribunal. Earlier this year, the tribunal said the complaint raised a number of complex legal issues and recommended it go to a full hearing.

More than 23 years sober, Knight says he always found that the world of AA was an uneasy fit. “I come from a long line of humanists,” said the 59-year-old.

We Agnostics, a Toronto secular AA group created in 2010, seemed the perfect solution, offering all the support and companionship of AA but without the trappings of God. Here the 12 steps were still followed – each carefully rewritten to scrub out any mention of God or prayer.

But the group’s separation of church and sobriety didn’t sit well with some. In 2011, We Agnostics and Toronto’s other secular AA group, Beyond Belief, were delisted from the Toronto AA website and directory, in effect removing them from the city’s network of 500 weekly meetings.

The decision prompted tears and shock among the three dozen or so people who had embraced the secular groups. “It was painful. It’s shunning,” said Knight. “It was unbelievable that an organisation that can’t kick anybody out, and that prides itself on that, had kicked us out.”

Members of the secular groups – worried that their hard-won efforts at staying sober were now in jeopardy – vowed to push forward. What emerged was a parallel system of sorts, one that has today swelled to about 350 members in 12 secular AA groups across Toronto.

As the secular movement grew in numbers, Knight and others continued to push to be brought back into Toronto’s AA fold. They appealed to the city’s coordinating body, urging them to reconsider the decision. “We ran into a brick wall,” said Knight.

Frustration drove him to lodge a human rights complaint two years ago, claiming that AA had discriminated against his group on the basis of creed. While directed at Toronto’s coordinating body, the complaint also names the highest levels of the organisation in North America. “They didn’t make any decisions directly,” said Knight. “But there is something that they did do, in my opinion, and that is the fact that there have been agnostic meetings for 40 years, but they haven’t clarified anything; they didn’t have any human rights protocols in place.”

The result is a scattered approach to secularism around the world. In some places, such as New York City, secular groups are allowed to operate freely and under the umbrella of the local AA hierarchy. Other secular groups – from Des Moines to Vancouver – have been treated similarly to those in Toronto, pushed out and left to their own devices over their rejection of God.

Knight’s complaint will head to mediation in the coming weeks. To date, AA has argued to the tribunal that it is a special interest organisation, a status that affords it the right to restrict its membership.

The dispute hints at a broader question being asked among the group’s two million members worldwide as they seek to incorporate 12 steps first penned in the 1930s into modern times: How important is God and religion in AA’s quest to empower people to fight alcoholism?

Some, like Knight, argue that AA’s curative power lies not in religion, but instead in the fellowship it fosters. A growing body of research, he pointed out, now suggests that the roots of addiction are tangled in isolation and loneliness.

The argument clashes with the Toronto coordinating body, which has argued to the tribunal that a belief in the higher power of God is a bona fide requirement for groups in Toronto.

Officials in Toronto declined to comment, while a spokesperson from AA World Services in New York City said the organisation was unable to comment as the matter was before the Human Rights Tribunal.

Knight is hoping that the human rights complaint will force the organisation to definitively address the long-simmering issue. “Alcoholism kills more people than it saves. It’s killed a lot of my friends, it’s killed a lot of my family, it’s an insidious thing. And the best support system in the world is AA.”

But the strength of that support hinges on AA being accessible to all. “The point is that anybody should be able to go to a meeting and not feel intimidated, not feel forced out or that they have to believe in something that somebody else believes,” he said. “Because that’s just ludicrous in this day and age.”

Secular groups fight exclusion from AA: "The best support system in the world"

Leading ocean advocacy groups join forces to tackle microfiber pollution

Two leading clean ocean advocacy groups have joined forces to stop tiny synthetic clothing fibers from polluting the world’s waterways and poisoning the food chain.

Plastic Soup Foundation (PSF), a Dutch nonprofit, and New York-based Parley for the Oceans announced Tuesday a partnership to tackle the issue of microfiber pollution and to create a global alliance of companies, governments, NGOs and scientists. Microfibers – tiny, often synthetic threads shed from laundry, industrial clothing manufacturing and fishing nets – have been found in alarming numbers in recent studies of microplastic pollution.

“Microfibers pose a massive and complex threat,” said Cyrill Gutsch, founder of Parley for the Oceans, in a statement. “It’s all about funding, supporting and boosting new technologies… [and] the best way to achieve this is together.”

The partnership comes after PSF launched its Ocean Clean Wash campaign earlier this year to educate washing machine manufacturers, fashion brands, environmental organizations and the public about the problem. PSF says already 100 nonprofits and other organizations have signed on to support the campaign, including Greenpeace UK and Austria, Plastic Pollution Coalition and Fauna & Flora International.

A June study found that synthetic fleece jackets release, on average, 1.7 grams of microfibers each wash. These small fibers aren’t easily filtered out at local wastewater treatment plants. The study, funded by outdoor clothing company Patagonia, found that up to 40% of these small fibers land up in oceans, rivers and lakes, threatening wildlife and ultimately our food chain.

Synthetic fibers such as acrylic, polyester and nylon pose the most danger because they don’t disintegrate and disappear over time. Instead, they break down into smaller, increasingly toxic pieces, allowing them to be consumed by fish and other animals. These tiny fibers have the potential to build up and lead to a potentially poisonous accumulation of chemicals in larger species. A study from the University of Exeter found that crabs contaminated with microfibers ate less food and that the polypropylene plastic broke into smaller pieces when ingested, leading to a greater spread in the body – and consequently a greater threat to human health.

Clothing companies have been slow to lend their support to the issue, although that’s starting to change. Patagonia says it continues to fund research and provide grants to explore ways to reduce the release of microfibers into waterways. Dutch clothing brand G-Star Raw announced earlier this year it was supporting PSF to raise awareness among fashion and textile companies about the damage their clothing can pose to the environment and to public health. According to PSF, nearly 40 fashion brands have agreed to collaborate as part of the partnership with Parley. The brands involved will be announced during a Call to Action event early next year.

PSF and Parley will work with other organizations to launch a competition next year to encourage scientists, inventors and clothing makers to come up with ways to stop the release of microfibers in the wash. The winners will be announced in 2018, and will receive a cash prize to implement their ideas.

According to PSF and Parley, possible solutions to the issue include a mechanical filter in washing machines to catch tiny fibers, synthetic yarns and fabrics that don’t release fibers in the wash and environmentally safe coatings that prevent microfibers from releasing when rinsed.

Leading ocean advocacy groups join forces to tackle microfiber pollution

Ideas to chill out licensing laws lambasted by medical professionals and alcohol groups

The proposals would allow local community groups offer ‘small’ amounts of alcohol for sale at fundraising events they run and allow B&ampB owners offer visitors an alcoholic drink on arrival. Photograph: Nigel R Barklie/Rex Characteristics

Ministers are underneath fire because of programs to let the Women’s Institute, bed and breakfasts and charities start off promoting alcohol, which medical doctors and local councils warn could worsen Britain’s drink issue.

The British Health care Association stated relaxing the licensing laws was wrong, given the enormous damage alcohol currently brings about and its heavy burden on the NHS.

“There is nothing at all incorrect with moderate alcohol consumption, but we do not need to have to be comforting the laws on the promoting of alcohol. We want a properly-managed licensing program that assures alcohol is offered in suitable conditions,” said Dr Andrew Thomson, a member of the BMA’s board of science.

The House of Lords is due to debate the plan, which is contained in a clause in the deregulation bill, on Monday. If passed it will allow neighborhood groups offer you “tiny” amounts of alcohol for sale at fundraising occasions they run and allow B&ampB owners provide visitors an alcoholic drink on arrival.

Norman Baker, the House Office minister responsible for alcohol, told MPs last month it would make it less complicated and more affordable for designated groups and organizations to get a new “community and ancillary sellers observe” – a license to sell drink. Church choirs wanting to provide a glass of wine to audience members in the interval of a efficiency or regional groups putting on events could stay away from having to pay up to £1,900 for an annual alcohol licence beneath the new scheme, Baker additional.

“Groups such as the Women’s Institute, thriving church organisations and other local charities are not just about ‘jam and Jerusalem’. Often they may also be about a glass of warm beer or chilled chardonnay,” he stated.

But the Neighborhood Government Association, which represents nearby authorities, has warned that the prepare “could be explained to boost the availability and accessibility of alcohol, contributing to the high amounts of alcohol-relevant harm that exist”.

A new survey by Stability, an alcohol group in the north-east, located that an overpowering vast majority of folks in the location are against extending further the number and sort of places that promote alcohol. It is worried that much more tiny organizations could apply for the new licences.

Colin Shevills, Balance’s director, stated the proposed licensing law changes could see a lot more youngsters ending up in hospital right after drinking too a lot. “Ancillary licences will only make matters worse. It will take away barriers specified organizations at the moment encounter when obtaining licences, generating it tougher for regional licensing officers to object.

“If this legislation is implemented it will efficiently indicate that the government is encouraging much more alcohol consumption rather than much less,” Shevills additional.

Katherine Brown, director of the Institute of Alcohol Scientific studies, an independent thinktank, said that, coming soon after some motorway service stations had been permitted to consist of a pub, the move would be a further unwelcome widening of the kind of premises permitted to promote drink.

“At a time when alcohol-related hospital admissions and deaths are on the rise, we need to ask: is it sensible to inspire individuals to drink more?

“Maybe even far more essential is the affect this legislation could have on normalising alcohol as need to-have for each occasion.”

Baker denies consumption will rise as a result of the move, which he says is “a radical new licensing authorisation that will help to obtain the government’s aims of assisting community groups and certain small businesses even though at the very same time sustaining important public health and public security safeguards”.

Kelvin Hopkins, one of a amount of Labour MPs who are concerned, advised MPs final month: “It is all very effectively to say, ‘Have a drink when you arrive at your B&ampB – a tiny tincture to warm you up for the evening and get you started prior to to have your bottle of wine with dinner later on,’ but it encourages a a lot more relaxed culture of alcohol consumption when we should rather be raising concerns about it.”

Ideas to chill out licensing laws lambasted by medical professionals and alcohol groups

Clinical commissioning groups are key to transforming the NHS

In Corby, the CCG has introduced a new urgent care facility, and local people no longer have to travel eight miles for an x-ray. Photograph: Hans Neleman/Getty

For the past year clinical commissioning groups (CCGs) have been working hard to make a difference in a system that isn’t set up to support them. But in spite of increasingly unstable finances and an NHS that is still embedding and adapting to new ways of working, CCGs are making responsible, clinically-led decisions in partnership with GPs, patients and providers which are making a difference to the care being delivered to their communities. Our Taking the Lead publication highlights 16 CCGs across the country who are unleashing the power of clinical leaders, working with local government, the voluntary sector and other key partners.

The 16 examples show what results for patients the innovation, enthusiasm, energy and clinical leadership of CCGs can have – for example, in Corby, senior GPs now work part of their week in a new urgent care facility, and local people no longer have to travel eight miles to A&E for an x-ray. Or take Oldham, where the CCG is working with the local council and a housing association to lift people out of fuel poverty so that 1,000 households stay warm in the winter. In Leicester, health coaches are helping people with chronic lung disease to look after themselves, and in east London people recovering from mental ill-health can now be seen out of hospital in their GP surgery.

These are just a small sample of the range of integrated and innovative work that CCGs are leading all over the country. I’m not pretending that creating a high-quality and sustainable NHS is going to be easy, but the ambition and appetite from CCGs to make services the best they can be for patients is real.

Our members regularly tell us the good, the bad and the ugly of what is happening at the local level, so on 1 May we launched our CCG manifesto, Making change happen. The manifesto, which was developed by NHSCC members, is a system-wide call to ensure CCGs are supported to realise their potential and create a transformational NHS. The NHS chief executive, Simon Stevens, welcomed it and committed to working with CCGs to make it a reality. We were pleased to hear his announcement of new powers for CCGs in primary care, which recognises the need for a more integrated approach across the whole system.

The manifesto, which highlights eight challenging and critical asks, stresses the importance of every part of the NHS working with each other, and respecting the value that CCGs bring. All too often people don’t see clinical commissioning as an equal player in the system, but if we are going to transform services locally for the benefit of patients, CCGs must be at the centre of decision making.

The eight asks are:

1. Free clinical commissioners to act in the best interest of patients.
2. Make local system leadership a priority.
3. Health and well-being boards as the focus of joined-up commissioning.
4. CCGs must not be a risk pool for the NHS.
5. Support to deliver large-scale transformation at pace.
6. Connecting national and local commissioning.
7. Better alignment of local commissioning to healthcare quality and the new inspection regime.
8. Competition in the NHS in the best interest of patients.

With the general election due in 2015, we will also pursue the aims of the manifesto. We need to make sure that whichever party or parties are leading the country after the election understand the value and impact that clinical commissioners are having and why it’s critical that we don’t go backwards or face another massive reorganisation of the NHS.

The whole system – providers, local authorities, regulators, thinktanks, as well as NHS England and the Department of Health – needs to recognise the system leadership role that CCGs play at the local level, and appreciate their clinical expertise and patient understanding.

Our manifesto for change has some of the answers to those difficult and critical questions, and with more than 75% of CCGs in membership we have a loud, strong and collective voice, but working with each other, and not against each other, is the only way we can ensure the NHS transformation continues in the best interests of patients and local populations.

Dr Steve Kell is co-chair of the NHSCC Leadership Group and chair of NHS Bassetlaw CCG

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Clinical commissioning groups are key to transforming the NHS

Are clinical commissioning groups coping with the adjustments in the NHS?

Are CCGs straining under the weight of their responsibilities? Photograph: Victor Fraile/Getty Photos

Are clinical commissioning groups coping with the adjustments in the NHS? The response is very mixed. CCGs are nevertheless fairly younger organisations. They have just completed their 1st year as commissioning bodies accountable for setting strategic priorities for their patch and commissioning care for secondary (acute and psychological overall health) and local community care, and for co-ordinating closely with public wellness and social care.

This is no small activity. There are several cultural, organisational, budgetary and policy boundaries that divide and disintegrate care for sufferers and for populations. It is genuinely also early to tell whether or not CCGs will have the capability to give the daring regional leadership to make the changes essential to integrate care seamlessly for their population. The purpose should be to manage the care landscape so that men and women can navigate the various sectors with no encountering barriers or boundaries.

I have been impressed with the practical preparing that GP-led CCGs have proven. Their programs are among the best I have witnessed in the NHS as they are grounded in the expertise GPs have of their regional patient population and are centered on commissioning for outcomes, not merely process and outputs. By this I indicate they are interested in delivering optimistic influence on the well being and wellbeing of their population.

Regrettably, to do so at a time of reducing fiscal resources indicates there will be losers. The NHS has failed to deal with decommissioning efficiently. As quickly as a planned closure is recognized, there is a political and public outcry and most are quashed. CCGs and NHS England should be better at empowering local clinical leaders to lead decommissioning efforts on the basis that security and good quality of the care presently being delivered can be vastly improved through realigning delivery.

I see numerous barriers to CCG effectiveness. CCGs in my view are also small to have the impact they look for on managing a well being population. There should be mergers among CCGs, but it’s also important at the identical time to keep the regional target and flavour.

Disconnected patient degree information will be the bane to effective integration. A quick and low-cost remedy to linking patient care information at the level of services is essential. NHS England has been focusing on bringing all patient data collectively into a single large database. This has failed in the previous and will fail once more, as well as alienate the public.

CCG GP leadership is still fragile and I query whether it is sustainable. I have been very impressed by the zeal and commitment of neighborhood GP CCG leaders who are not compensated for the hrs of day and evening meetings they need to attend. Even more, if future governments reorganise the NHS again, I believe an whole generation of GP leaders will be alienated and misplaced.

Well being and wellbeing boards must be rethought. These are non-organisations with no spending budget and no personnel and but they have a sort of veto energy more than CCGs. Perhaps the reply is to require nearby politicians, as properly as public wellness leaders, to sit on CCG boards.

If there is severe curiosity in integration across well being and social care, and I believe there should be, then budgets should be aligned and ringfenced.

Thinking about how new CCGs are, local GP leaders by and massive have done a stellar job at identifying the most essential strategies to increase the health of their populations. The effectiveness of commissioning can only be fairly assessed in excess of time. Significantly is nevertheless to be completed to clarify the commissioning landscape amongst CCGs and NHS England. Moving to substantive integration of wellness and social care will consider bold clinical and administrative leadership that collectively can face up to the politicians, as solutions will have to be decommissioned. That will threaten the quite existence of some acute care trusts.

David Goldberg is global associate for Excellent Governance Institute

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Are clinical commissioning groups coping with the adjustments in the NHS?

Private hospital groups braced for break-up ruling

“We are hunting forward to possessing a different referee [in the Competition Appeals Tribunal] and we think we have each likelihood of getting a distinct game and distinct end result,” he explained.

Stephen Collier, boss of BMI, in January vowed to get “whatever actions are proper to guarantee [competitors authorities] do not undermine our organisation”.

“[Any choice requiring divestments] is going to go through a variety of legal difficulties and it is most likely going to get drawn out to an extent because the groups will battle to avoid it,” stated Philip Blackburn, economist at healthcare consultancy Laing &amp Buisson.

Competition authorities concluded in August that charges for insured individuals are also large because many private hospitals encounter tiny competition in local locations across the Uk, but personal healthcare bosses have derided their analysis as flawed.

Mr Collier has argued that rising competitors will not reduce charges because the expenses already reflect the expenses of providing private healthcare.

He has accused competitors authorities of “massively undervaluing” the investment necessary to give “higher top quality personal healthcare”, saying the examination suggested that “hospitals ought to be valued as if they stood in farmers’ fields”.

Paul Saper, chief executive of wellness consultancy LCS Global stated the competition inquiry, which started 3 many years in the past, had currently achieved important alter in the industry and questioned the need for authorities to demand the sale of all 9 hospitals as outlined in January, especially since any such order is likely to outcome in legal action. “The competition authorities have acquired to be sensible about what they conclude,” he said.

A single in eight Britons is presently a member of a private health insurance scheme.

Private hospital groups braced for break-up ruling

Clinical commissioning groups the one-year health check-up

GPs are best able to lead on transforming the way healthcare is delivered, says Rick Stern. Photograph: PHOVOIR / Alamy/Alamy

In April 2013, CCGs were introduced to replace primary care trusts as the commissioners of most services funded by the NHS – and they now control about two thirds of the NHS budget. The key change is that clinicians play a greater role in deciding how funds are spent on commissioning services and all general practices in England are legally obliged to be a member of a CCG.

Not all GPs are involved with their local CCGs and therefore the extent to which GPs are actually engaged in making decisions about the management of the NHS varies. Kate Adams, a GP in Hackney, thinks overall engagement between GPs and CCGs is growing under the new arrangements. “GPs are working more closely together between practices and there is closer working between doctors and managers, which is a good thing,” she says. GPs have an important role to play in giving “clinical input to redesigning care pathways”, she adds.

According to a report by the King’s Fund and the Nuffield Trust, GPs who have got involved with CCGs have seen a definite impact – 66% of GPs who led CCGs felt that their CCG was “owned” by its members, compared with 35% of those without a formal role in the CCG.

Nicholas Hicks is chief executive of Cobic, a consultancy advising commissioners and providers on outcome-based healthcare services, which aims to secure “both value for money and better outcomes for patients”. He thinks that GPs will be instrumental in changing the way services are commissioned: “GPs are far more involved with commissioning than before and they bring fresh perspective, not least because they are less inclined to accept central directions that they do not believe make sense.” He adds that: “A fresh eye has meant that CCGs are far more open to adopting innovative approaches to commissioning than were the majority of their predecessor PCTs.”

Rick Stern, chief executive of the NHS Alliance, thinks the strength of the CCGs is their clinical focus and “different style and approach in leadership”. PCTs, he says, were felt to be “too distant and bureaucratic, and the real test for CCGs will be to show they are radical and different, and a break with the past.”

CCGs have two main roles – commissioning services and supporting improvement in general practice.

There is the opportunity here, Adams says, “to address the bigger issue of society, health and wellbeing – GPs understand how important this is and how to make an impact on people’s lives.”

Hicks agrees: “A growing number of CCGs want to commission in a different way – they are taking steps towards letting contracts that pay providers on the quality of the outcomes they achieve for people that use the services rather than on the volume of activity.” 

Traditionally, PCTs and CCGs place one-year contracts with providers such as hospitals in which the value of the contract is determined by the number of patients a hospital treats. Under the outcome-based model, Hicks explains, the provider (which may be a new alliance of hospital, community and social service providers) is given a “longer-term contract, a base sum of money for the care of a group of people (such as older people, people with drug and alcohol problems), and money for improving the outcomes for the people using the services.”

How services are commissioned is integral to managing change and we need a different style of commissioning, says Rick Stern. “CCGs must work with their patients and the wider community and work through difficult decisions – there will be massive problems with budgets in years to come and we need to look at transforming the way healthcare is delivered – this is a big and complex debate.” And it’s a conversation that the GPs are best able to lead, he says. “Are people willing, for instance, to let go of the sacred position of their local district hospital and have more services offered in the community and in specialised centres?”

Trying to improve and measure outcomes for people who use NHS services will be an area that every CCG will be working on but it will take time. As Adams says: “The future is about transforming services – giving benefits to patients and freeing up money for things that really matter – preventative and community health and wellbeing.”

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Clinical commissioning groups the one-year health check-up

Loved ones arranging groups in developing nations set for Bloomberg increase

Assisting hand … Nicaragua is one of 4 countries chosen for Bloomberg’s family members arranging and reproductive overall health help scheme. Photograph: Mike Goldwater/Alamy

Grassroots organisations are to share in a multi-million dollar project to enhance loved ones arranging and reproductive overall health providers for ladies and girls in Africa and Latin America.

Groups in Uganda, Burkina Faso, Senegal and Nicaragua will be capable to apply for advocacy grants as part of a three-pillar, $ 50m (£30m) package to assistance loved ones arranging companies. The scheme was announced on Thursday by Bloomberg Philanthropies, set up by Michael Bloomberg, the former mayor of New York.

Bloomberg will work with the Planned Parenthood Federation of America to identify groups that could advantage from extra funding in each of the 4 nations. Organisations working amongst marginalised groups such as youthful men and women and unmarried women will be a certain target for the scheme, which will also support companies that lobby their governments for legislation and policies that help access to providers.

As part of the package, Bloomberg is partnering with the UN Basis to launch a rapid-response grants programme to assistance governments and companies in delivering reproductive health providers in 69 of the world’s poorest countries. This could incorporate offering grants to pay for emergency supplies of contraceptives when there is a stockout at a well being centre, or having to pay for specialised instruction for health workers.

The UN Foundation supports the Household Organizing 2020 (FP2020) worldwide partnership, which was set up as a outcome of the 2012 London family preparing summit with the aim of escalating access to contraception for 120 million more ladies and girls in developing nations.

According to the UN population fund, at least 200 million females and girls are unable to accessibility loved ones arranging services that would permit them to management when they have young children and to area their pregnancies. The company predicts that unmet need will increase by forty% over the up coming 15 many years if action is not taken.

At the 2012 conference, hosted by the UK’s Department of International Advancement and the Bill and Melinda Gates Basis, wealthy countries committed $ 2.6bn in excess of the following eight many years to assist plug the gap in poorer nations.

The four nations to advantage from the Bloomberg funds, pledged to the FP2020 initiative, have substantial unmet contraceptive needs and, consequently, higher fertility rates. According to Planned Parenthood, females in Uganda and Burkina Faso will, on common, give birth to far more than six children above the program of a lifetime. Burkina Faso has a contraceptive prevalence price of just over 16%. In Uganda, 24% of 15- to 19-yr-outdated women are either pregnant with their very first little one or currently mothers.

Nicaragua has the highest adolescent fertility price in Latin America, with 109 births for each and every one,000 15- to 19-year-olds. About half of youthful females give birth ahead of they are 20. The nation has higher incidences of sexual violence, and abortion is illegal.

Kelly Henning, who heads the public health programme at Bloomberg Philanthropies, said targeting money in the direction of local organisations was essential to make certain specific country wants are met. “Neighborhood groups comprehend what the troubles are for ladies and the considerations for females in these nations, and they comprehend the policymakers and what they are thinking,” she said. “We want this work to be sustainable.”

Bloomberg, mayor of New York City from 2002 to 2013, said: “By providing vital health services closer to mothers’ homes, and by empowering ladies to make informed choices about when they want to have youngsters, we can support conserve 1000′s of lives.”

Bloomberg Philanthropies also announced ideas to increase its perform in Tanzania, a nation it has worked in because 2006. It will enhance its help for comprehensive reproductive overall health solutions, like publish-abortion care, in the ten rural clinics with which it has existing back links. Bloomberg’s function in Tanzania has so far integrated education much more than one hundred physician assistants and nurses to complete life-saving operations, which includes caesarean sections, as effectively as creating operating amenities.

Loved ones arranging groups in developing nations set for Bloomberg increase

three Chemical Groups Leading to Brain Disorders in Youngsters

Toxic chemical substances may be triggering the latest increases in neurodevelopmental disabilities amongst children—such as autism, focus-deficit hyperactivity disorder, and dyslexia—according to a new review from Harvard School of Public Health (HSPH) and Icahn College of Medication at Mount Sinai. The researchers say a new international prevention method to handle the use of these substances is urgently essential.

“The greatest concern is the big numbers of children who are affected by toxic harm to brain improvement in the absence of a formal diagnosis. They suffer diminished focus span, delayed growth, and poor college functionality. Industrial chemical compounds are now emerging as likely leads to,” mentioned Philippe Grandjean, adjunct professor of environmental wellness at HSPH.

The report follows up on a similar evaluation carried out by the authors in 2006 that identified 5 industrial chemicals as “developmental neurotoxicants,” or chemicals that can lead to brain deficits. The new examine delivers updated findings about those chemical compounds and adds details on 6 newly acknowledged ones, including manganese, fluoride, chlorpyrifos and DDT (pesticides), tetrachloroethylene (a solvent), and the polybrominated diphenyl ethers (flame retardants).

The review outlines attainable links between these newly acknowledged neurotoxicants and damaging well being effects on children, including:

• Manganese is linked with diminished intellectual function and impaired motor abilities


• Solvents are linked to hyperactivity and aggressive habits


• Specified sorts of pesticides might cause cognitive delays

Grandjean and co-author Philip Landrigan, Dean for Global Wellness at Mount Sinai, also forecast that numerous much more chemical substances than the acknowledged dozen or so identified as neurotoxicants contribute to a “silent pandemic” of neurobehavioral deficits that is eroding intelligence, disrupting behaviors, and damaging societies. But controlling this pandemic is tough since of a scarcity of information to guidebook prevention and the massive amount of evidence necessary for government regulation. “Very couple of chemical substances have been regulated as a outcome of developmental neurotoxicity,” they compose.

The authors say it is critical to control the use of these chemical compounds to defend children’s brain advancement worldwide. They propose necessary testing of industrial chemicals and the formation of a new global clearinghouse to evaluate industrial chemicals for prospective developmental neurotoxicity.

“The dilemma is international in scope, and the remedy need to therefore also be global,” explained Grandjean. “We have the strategies in place to test industrial chemical compounds for damaging effects on children’s brain development—now is the time to make that testing necessary.”

Supply: Harvard School of Public Well being (HSPH)

Jordan Markuson is the Founder of Aqua Overall health Labs. He has been a nutritionist, conservationist, writer and entrepreneur for over ten many years. He is an activist supporting consumption of raw, renewable, and organic foods. Jordan believes that based on all obtainable scientific proof, when food is processed it loses the majority of the essential nutrients. He is really interested in marine-based mostly phytoplankton as a fish oil substitute due to the fact of the pure omega-3 EPA &amp DHA important fatty acid it produces.

three Chemical Groups Leading to Brain Disorders in Youngsters

What can clinical commissioning groups find out from Oxfordshire?

‘Disrupting the health workforce in securing alter … is essential. New patterns of care will produce winners and losers,’ says Richard Vize. Photograph: Tom Jenkins

The unravelling of the plans by Oxfordshire clinical commissioning group to introduce outcomes-primarily based service contracts shows that even though commissioners have the money, companies are still running the program. What will it consider to break their energy?

Oxford well being basis believe in and Oxford University hospitals trust’s forceful objections to ideas for outcomes-based mostly commissioning of adult mental overall health, maternity and older people’s providers integrated the truth that the modifications would introduce new economic and clinical risks and impact the local wellness workforce. But they supported the general aims, of program.

Tell any discussion on public service reform that the public sector demands a new mindset to threat, and you can be sure that your comment will be greeted with vigorous nods. But commissioners and companies require to flip those sentiments into action. If introducing new dangers is going to be an acceptable cause for torpedoing reform proposals, then we will remain lumbered with the old hazards of working out of money whilst fitting our patients into solutions as an alternative of creating solutions round patients.

Disrupting the wellness workforce in securing adjust isn’t just a risk – it is vital. New patterns of care will generate winners and losers among personnel.

A gateway overview of Oxfordshire’s proposals by the Division of Wellness in light of the providers’ objections has far more than a whiff of political expediency. Drinking deep from the well of civil services clichés, it concludes that the CCG ought to see 2014-15 as “a transition year” with a “want to review the scale and variety of providers”. All this should be completed “having carefully imagined by way of all the implications”. And of course it calls for piloting.

Tellingly, the evaluation recommends involving the current suppliers in developing the new providers. While this might nicely be the right strategy on numerous events, it must surely be up to commissioners to decide whether or not it is in the greatest interests of sufferers. If, for example, a CCG believes an incumbent does not have the vision or expertise to build a new kind of services, certainly it must have the discretion to pursue a diverse route.

So the DH talks hard about enhancing the patient expertise, focusing on outcomes and employing competitors to carry about adjust, but when it comes to politically contentious selections – particularly ones affecting the prime minister’s constituency – it runs away.

The unravelling of the Oxfordshire strategies is very likely to be seen as a victory for inertia. It gives the message to trusts that if they resist difficult the DH and commissioners are probably to back down. It also reinforces the belief that in spite of the wellness reforms rebuilding the total NHS close to a commissioning program, the power of companies is undiminished. A mere act of parliament is no match for them.

CCGs could very easily consider away the lesson that ambitious changes this kind of as demanding incumbent providers and commissioning for outcomes will fail, and that they should opt alternatively for incremental adjust.

But if that takes place, clinical commissioners will have demonstrated that they are incapable of reforming the health service. Rather they ought to understand from Oxfordshire’s expertise about how to put together the ground for change.

It is clear from divisions in Oxfordshire CCG’s own ranks that it could have made a much better job of creating a coalition of support for its radical programs. Contracting is only a strong tool for large-scale change if it is accompanied by convincing clinical evidence and political support.

Many providers and CCGs are beginning to create robust and trusting relationships, on which they are developing a shared vision of the require to alter. But the place the partnership is much less constructive, CCGs simply do not have the clout to batter by means of modify in the encounter of concerted opposition. If pushing through adjust involves having a scrap with the incumbent provider it will need political guile, and tons of it. Commissioners cannot let providers to be witnessed as possessing the exclusive right to represent patients’ interests.

This article is published by Guardian Specialist. Join the Healthcare Professionals Network to obtain regular emails and exclusive delivers.

What can clinical commissioning groups find out from Oxfordshire?

Boys" cancer danger improved without having identical vaccine as ladies, say overall health groups

The HPV vaccine is routinely offered to women of 12 and 13 to decrease the risk of cervical cancer, but overall health groups say boys not given the vaccine are at higher threat of viruses linked to other cancers Photograph: Burger/Phanie/Rex

Boys are becoming denied protection towards the chance of cancer simply because they are not routinely provided the very same vaccination as girls, a coalition of 25 patient groups and health organisations has claimed.

The coalition has launched an on-line petition for a “gender-neutral” technique with the HPV vaccine, which is previously presented to ladies of twelve and 13 to lessen the risk of cervical cancer.

Numerous backbench MPs backed the idea final year and vaccination advisers to the United kingdom government have currently pledged to consider the move but now HPV Action is stepping up the strain on ministers to adhere to the example of the US, Australia and some Canadian provinces.

The vaccination combats a family members of viruses that are also linked to a variety of cancers prevalent in guys such as anal and penile cancer and genital warts. Peter Baker, campaign director for HPV Action, stated: “Vaccinating girls alone is not ample to tackle HPV. Guys can even now get the virus from unvaccinated females from the United kingdom and other countries or from other men.

“It is basically unfair to deny boys in the Uk the identical level of safety as ladies or as boys in Australia and other countries in which the two sexes are now routinely vaccinated. The HPV vaccination is one of the easiest approaches of stopping cancer.”

An on the web poll of one,336 parents by YouGov for the organisation final month located 64% agreed with boys and women currently being vaccinated, with 11% disagreeing and 25% uncertain, stated HPV Action, which contains the Royal College of Obstetricians and Gynaecologists the British Association for Sexual Health and HIV, the British Dental Association, the Terrence Higgins Trust and the Throat Cancer Basis.

Boys" cancer danger improved without having identical vaccine as ladies, say overall health groups