Clinicians to get some control back?
So claims the DoH with the release of guidance for PECs today stating that clinicians must be in the majority & that they should have a say.
Clinicians on new professional executive committees (PECs) will gain greater control over local NHS priorities, policies and investment plans under new guidance published today designed to ensure that clinicians from a multi-professional background are firmly part of primary care trusts’ (PCTs) decision making process.
New guidance for PECs, issued today by Health Minister Andy Burnham, advises that all PEC members should be appointed on the basis of their skills, competencies, and ability to lead. Clinicians must also be in the majority on the committees.
Strategic Health Authorities (SHAs) will oversee the new arrangements to ensure that PCTs are effectively engaging their clinicians and using their PECs to design and deliver local services.
Historically, many PECs have made a broad and valued contribution to the strategic direction and operational delivery of PCTs and to the wider healthcare agenda. However, other PECs have acted purely in an advisory capacity, functioning narrowly around a requirement to add clinical perspective to decisions that are taken elsewhere in the PCT.
Health Minister Andy Burnham said:
“Today’s guidance will re-establish and reinvigorate professional executive committees, giving clinicians from a multi-professional background a greater say on local NHS decisions.
“Whitehall will do less dictating on what these committees will look like. PCTs will be free to decide how many members they need to have and the NHS will be able to bring in extra members to tackle specific challenges.
“With the introduction of practice based commissioning and the delegation of budgets, there needs to be a stronger emphasis on commissioning. Strong professional executive committees can play a vital role in providing the effective managerial and clinical leadership needed.”
Dr Michael Dixon, NHS Alliance chair, said:
“This new guidance ensures clinicians are at the centre of all major decisions in PCTs. Hopefully, its spirit will be followed elsewhere in the NHS. We particularly welcome the department’s own commitment to support the ‘three at the centre’ PCT leadership team and the advice contained within the guidance for SHAs.
“Most importantly, this guidance will reassure PEC clinicians that their role and input is valued and essential. It will also encourage frontline clinicians to support the PEC and their PCT. That is particularly important for the success of practice based commissioning. The NHS Alliance is pleased that it was able to contribute significantly to the department’s review of the PEC.”
Dr Peter Melton, NHS Networks chair, said:
“NHS Networks was pleased to be able to support the formulation of “Fit to lead”. We had over 80 responses from a wide mix of individuals and organisations that we fed into the review. We believe that this document reflects the consensus view of re-energising, empowering and embedding clinical leadership into effective local NHS organisations. “The PEC Chair Network hosted by NHS Networks has drafted a proposed PEC Performance management framework. This framework is intended to support PCTs and SHAs with their effective implementation of “Fit to Lead”.”
The main guidelines for the new PECs are:
- PCTs to get the freedom to determine the structure and format of PECs according to local needs.
- Members to be appointed against competencies, placing the emphasis on individuals’ skills.
- PEC membership will be based on clear job descriptions, with appointments made on the basis of competencies.
- PECs should not be dominated by one clinical group.
- PECs to have a key role in driving forward practice based commissioning, including advising and contributing to the overall direction.
PCTs are expected to implement the new guidance by 1 October 2007.
This is one step better than current practice, having been involved in a few initiatives where the SHA has not been interested at all in letting clinicians anywhere near the decision making process. I am not convinced that this will do enough but it is a first step.
It still leaves out the roles of SHAs which in my experience has been to push unwilling PCTs down politically inspired routes.
In other news, Christie Hospital NHS Trust, York Hospitals NHS Trust, Dorset Healthcare NHS Trust have been granted Foundation status & there are now nine more applicants waiting in the wings. Heart of England Foundation Trust have taken over Good Hope Hospital.
But in the list of bright ideas thought up by armchair generals far from the front, this must rank fairly high.
Ministers are preparing to unveil a secret weapon in their campaign to woo dentists back to work for the NHS in England. Every practice that is able to provide a quality service and show commitment to the NHS is to be given something money cannot buy. A new kind of plaque.
Department of Health officials are convinced that dentists would treasure the opportunity to brand their premises with the NHS logo - one of the most recognised symbols in the land.Those treating a high proportion of NHS patients will be allowed to screw the NHS plaque to the front door of their surgeries and use the brand to add extra professional kudos to their letterheads. As a badge of quality, the logo may also serve as an advertisement to private patients, who pay higher fees for fillings and extractions
Yup, I am sure that this will be as popular as the plague.
Ben Goldacre looks at direct to consumer advertising of pharmaceuticals.
Doctors are trained to spot bullshit, and this is one area where paternalism, I would argue, is acceptable. Pharmaceutical companies produce next-level, postgraduate bullshit. Drug reps brandish literature that is the comedic parallel of the promotional stories you get in the media for supplement pills, but the tricks are far more complicated: they cherry pick the literature - looking only at the positive studies - they use surrogate endpoints - a blood test rather than a stroke - they use inadequate controls - a lower dose of the competitor’s drug. They do all this far more subtly than the homeopaths, or the fish oil gang, because they are addressing a critical audience.
Another illustration of why targets are bad:
Ambulance staff in Wiltshire routinely and systematically altered data to make it look as if the service was meeting targets.
A report from the Audit Commission found that in less than 15 months between April 2005 and July 2006 staff altered the timing of 594 emergency calls to make it appear that ambulances had reached callers within the target of eight minutes.
Last August the Department of Health admitted widespread altering of ambulance figures. A report showed that six out of 31 trusts had misreported response times. Wiltshire was not among them.
C. Diff raises its head again:
A virulent strain of the Clostridium difficile superbug has been linked to the recent deaths of 17 elderly patients at a hospital.
A further eleven who have the bug are being treated and five more sufferers have had bowel surgery at the James Paget University Hospital in Gorleston, Norfolk.
Health experts at the hospital said yesterday that they had not identified the source of the 027 strain of Clostridium difficile, commonly known as C.diff, and could not say whether patients contracted it in the hospital or in the outside community.
And finally a write up in the Telegraph of a survey of doctors’ approaches to rationing.
A survey of more than 1,000 GPs and hospital doctors showed that 70 per cent said that the NHS should not pay for every type of operation but there was no consensus on what the NHS should fund.
“The vast majority of doctors still believe that the NHS should fund the majority of care for surgical procedures, but only a minority think that fertility treatment, gender reassignment and illnesses related to lifestyle should be fully funded by the public purse.”
Dr Jonathan Fielden, the chairman of the NHS consultants’ committee, said the time was right for a debate on how the health service should be funded.
“There would probably be agreement on providing core services and agreement on not providing services such as cosmetic surgery or fertility treatment, but there would be grey areas. I believe these would need to be decided democratically at a local level, but this would have the effect of increasing the post code lottery,” he said.
Where do you draw the line?