Patients’ assessment of the quality of care they receive will affect general practice funding in England, and patients will have a legal right to choose their GP practice under proposals in Lord Darzi’s Next Stage Review final report published today (30 June 2008).
The minimum practice income guarantee (MPIG) will also be phased out completely. The report states that practices’ income guarantees “do not necessarily bear relation to the size or needs of the patient population they now serve”.
After a 12-month review, led by 2,000 clinicians and staff across the country and involving 60,000 patients, public and staff, Lord Darzi’s final report, entitled High Quality Care for All, calls for patients to be given more say over their care, and for NHS staff to have more freedom to shape high-quality care based around their patients’ needs.
Setting out the direction of the NHS for the next 10 years, the report also introduces the following changes:
- Patients will have a new right to all drugs approved by the National Institute for Health and Clinical Excellence (NICE), which is called on to speed up its approvals process and make its decision-making more transparent.
- “Personal care plans” will be introduced for all 15 million patients with a long-term condition (LTC). Five thousand patients with complex LTCs will also pilot new personal budgets to manage their illnesses.
- New approaches will be piloted to enable GPs, community nurses, hospitals, local authorities and others to work across traditional boundaries to provide more joined-up services and better health outcomes for people with conditions such as diabetes.
- Every provider of NHS services will need to systematically measure, analyse and improve quality, displaying it to staff through “clinical dashboards” to measure their performance and use the information to make continuous improvements.
The report does not introduce additional top-down targets beyond the minimum standards – the changes are to be delivered by giving responsibility to staff at a local level.
Lord Darzi (pictured) said: “By setting clearer standards, and recognising and rewarding innovation in quality, we can keep pace with the very latest advances in medicine and technology.
“By investing in additional health centres and services for GPs, the NHS will diagnose illness faster and help people to stay healthy, as well as treating them when they are sick.”
Secretary of State for Health Alan Johnson said: “These locally driven, clinically led plans show how quality of care will be raised right across the country, with doctors and nurses supported to offer big improvements in treatment at the bedside. Quality of life will be improved and more lives will be saved.”
The proposals were largely welcomed as being positive by leading primary care representatives, although there were reservations.
The NHS Alliance, the independent primary care body, welcomed the review “wholeheartedly”, but warned that the report’s interpretation of “local” may mean strategic health authorities take the lead for decision-making, rather than PCTs or practices.
“We need to take care that SHAs do not become the new centralists, imposing their own top-down decisions,” said NHS Alliance chairman Dr Michael Dixon.
“Local must mean what it says. Local professionals and patients working together and making decisions about the services their communities need.”
Dr Hamish Meldrum, Chairman of the British Medical Association, said: “There is much here that could bring about improvement – if it can be delivered.
“That will depend on the details, and on the true engagement of NHS staff in implementing change. If they are sidelined, these are little more than fine words and we won’t see the improvements the NHS desperately needs. In some areas there was insufficient consultation with the public or staff on changes to local NHS services during the review process and we don’t want to see that repeated in the future.”
“We are pleased the government has stated its intention to move away from target-driven health policies and to focus instead on the quality of patient care. There will clearly be a lot of detail to examine and many practical issues to consider, and we look forward to working with the government as part of the consultation process.”
Your comments: (Terms and conditions apply)
“I agree wholeheartedly with Allan [comment below]. You couldn’t make it up! Once again they show their complete lack of knowledge of how primary care actually works. ‘Clinical dashboards’ to measure staff performance. For goodness sake … do us all a favour and speak in English for a change!” – Carole Bonney, Lancashire
“Not printable! I would be more impressed if there had been any REAL consultation. We constanly hear that the health service will not be a one-size-fits-all service, yet the same structures are to be applied across the country. This practice is in an area of high deprivation, many non-english speaking immigrants, one third of our ‘native’ patients cannot read or write, drug abuse rates are phenomenal. In a period of a year we have had a doctor shot, others threatened with a knife and earlier this week our door kicked through by soneone just because Social Services (across the hall way) had refused to see him because of his abusive behaviour. In spite of all this we are a high acheiving QOF practice with excellent patient survey results. Can you honestly tell me that the same structures and approach will work here as will work in leafy suburbs? Patients should be educated as to their rights – fair enough – what about educating them about their responsibilities too?” – Name and address withheld
“I find it hard to understand what is meant by patients having the legal right to chose their GP. Certainly, in this part of the country they already have that right. The only restriction is they must live within our defined catchment area. If we are required to take patients within the entire PCT area this would cause major problems in relation to home visits. So far as closed list and ‘open but not taking new patients’ is concerned we would have to agree with the PCT before we can take this course of action and extenuating circumstances would apply. Does this refer to Ben Bradshaw’s allegation that GP practices have agreements not to take each other’s patients? That certainly does not happen here and is probably, like many other things, a figment of Mr Bradshaw’s imagination” – Allan Stewart, Wirral