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by Stuart Gidden
29 November 2007

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Heralding a new era of primary care – NHS Alliance Conference 2007

Last week I attended the NHS Alliance annual conference, which took place at the Manchester Central Convention Complex on Thursday and Friday. The event was titled “into the new era – primary care under the spotlight”, and the theme of the two-day conference was very much on the development of general practice and its position at the “frontline” of the NHS.

Practice-based commissioning (PBC) was the hot topic of the conference, and this dominated the key speeches, including that of Health Secretary Alan Johnson. In his keynote address, Mr Johnson announced that “PBC is here to stay”, and urged primary care commissioners to look to the needs of their local population, rather than top-down targets – though some may argue that such a demand is rather paradoxical!

Fighting hags and harridans
Dr Michael Dixon, NHS Alliance Chair, introduced the conference with a robust defence of, and argument for the advancement of, primary care, which he said was “leading the NHS”. Advocating localism – in contrast to the “tyranny of the old, centralised NHS” – he berated the “hags and harridans of gloom” who say PBC won’t work.

Dr Dixon said it was encouraging to see several practices getting involved with PBC, but that PBC should not depend on a few enthusiasts, and greater co-operation was required between PCTs and practices to assist the “organic change” that was taking place in primary care. As he stated, “introducing policy is not the same as changing culture”, so it will take time for PBC to be fully adopted and show its potential.

Man with commission
Mark Britnell, Director General of Commissioning and System Management at the Department of Health (DH), introduced the DH’s new operating framework, “World Class Commissioning” (see link below). This outlines the government’s plans to strengthen commissioning capabilities, which include asking PCTs and practice-based commissioners to formulate their plans to improve the health of their local population.

Mr Britnell said that “the engine room of world-class commissioning is PBC”, and that he wanted to “knock on the head any idea that the government is trying to undermine PBC”.

He also addressed the contentious issue of access/opening hours, saying that practices must improve this. One delegate pointed out that patients’ wants were not necessarily the same as patients’ needs – and while surveys may indicate they would like longer surgery opening hours, this didn’t necessarily indicate the requirement for it.

But Mr Britnell was quite steadfast on this topic – while stressing that the government was not expecting all practices to be open 24 hours a day, he said that he didn’t think extending opening hours “were a lot to ask”, asserting that “this is not a threat, but an opportunity.”

NHS Alliance Practice Managers’ Network
An exciting development at the conference was the launch of the NHS Alliance Practice Manager’s Network, which is an alliance of practice managers who seek to “give an influential voice to practice managers throughout the UK”.

The Network plans to have quarterly discussions with leading figures from the Department of Health, including Alan Johnson. At these meetings, they will collate and present feedback gathered from UK practice managers, so potentially it signifies a real change in the way practice management is considered and recognised.

This is not, however, a political group – Wendy Evans, Practice Manager Lead for the NHS Alliance, said it was “a union of practice managers, but not a Union”, but it could allow a focus for practice managers who would like to express their views to government on how changes in primary care have affected this profession. We plan to cover this Network and the opportunities here in more detail in a forthcoming issue of Management in Practice.

Premise of change
One of the workshop sessions focused on GP premises, in particular on the “polyclinics” that Lord Darzi announced earlier this year (large, shared, centrally located facilities that house a wide range of primary care services) and on how these will develop.

Steve Minion, Joint Chief Executive at Ashley House PLC, described the operation structure at Westchester Group Practice in New York, which has been the model for Lord Darzi’s proposals. With a focus on competition and the patient as a “customer”, it seems things will change rapidly in UK primary care if we follow suit.

The trend is very much towards serving very large patient areas – Sir William Wells, Chairman of Ashley House PLC, spoke of polyclinics situated in areas serving a minimum of 50,000 patients. The concept of “integrated care” was also highlighted, with a much more seamless pathway service planned. For instance, in the Westchester Group Practice, a patient could visit their GP in the morning, have diagnostics taken afterwards so that they have a diagnosis and follow-up treatment planned when they leave the same day.

Such a transformation of premises has interesting implications for how healthcare professionals work – in a polyclinic setting, it would be feasible for local consultants and GPs to work closely together in integrated practice units. As one delegate pointed out, though, are there not negative implications for local hospitals? If patients are going to receive secondary care treatment in primary care polyclinics, could hospitals lose income?

Sir William Wells said that an inevitable outcome would be the downsizing of hospitals, and that politicians would have to prepare for a possible secondary care backlash. I can only hope this is something the government has considered …

Alan Johnson pledges support to practice managers
On Friday morning, Health Secretary Alan Johnson gave a keynote conference address. He said the government’s aim was to secure “genuine transformation” for primary care, with a new focus on an increasingly elderly population and those with long-term conditions. He also announced plans to increase the number of GP surgeries in deprived areas in a bid to tackle health inequalities.

And here Mr Johnson echoed Dr Dixon’s earlier stress on serving the needs of local populations, and on the significance of PBC in contributing to this. Mr Johnson stressed that PBC was “here to stay”, and called it “one of the most important innovations in recent years”. However, he acknowledged that PBC is “still very much in its infancy”, and urged PCTs to take the lead by forming close alliances with practices. Indeed, he asked all delegates to “go even further and faster” with PBC, and asked delegates to “spend more time looking at your patients for better solutions rather than seeking answers from Whitehall”.

In the Q&A session that followed, practice manager Caroline Kerby (a member of the NHS Alliance Practice Managers’ Network) accused the health secretary of “slighting” practice managers by not mentioning their daily contribution to primary care. She said practice management was “the most stable part of primary care”, and deserved to be recognised, asking the health secretary to back the aims of the new Practice Managers’ Network.

Mr Johnson apologised for not mentioning practice managers, and said he would indeed back the Network “in principle” – adding that he could not at this time pledge government finances towards this commitment.

This was followed by the announcement of the winners of the Improvement Foundation’s Guy Rotherham Award and the NHS Alliance CHD QOF and Acorn Awards – more details on these award winners can be found in our recent news story on this.

All in all, this conference provided more than food for thought about where primary care is headed – it showed that practice managers need be aware that PBC isn’t going to go away, and that commissioning and primary care provision is really going to change in the next few years – and that, at last, practice managers could have a voice in all this!

Department of Health – World Class Commissioning