Primary care in the Eastern Region

Sharing news and views

Welcome to the Eastern Region primary care and public health webpage. Many of the current health service reforms are focused on primary and community care. Currently with both world class commissioning and transforming community services there are rapid developments and changes.

This page will keep you up to date with new developments in primary care in the Eastern region. The RCN needs your help to achieve this, so please send your news and comments on what is happening in your area to: kellie.norris@rcn.org.uk.

Transforming Community Services

Transforming Community Services is a programme focused on improving community services. The policy supporting this reform is Lord Darzi's, 'High Quality Care for All (2008)'. Lord Darzi defines quality of care as: clinically effective, personal and safe.

Quality is a central theme to these changes; there is now a national quality board to lead this. Additionally, there is a quality framework to support this with proposed quality indicators for use in the community, Transforming Community Services quality framework - guidance for community services [PDF 230KB] [see how to access PDF files].

In June 2008 six practice guides were released by the Department of Health. The purpose of these guides is to enable practitioners to make a real difference to patient care in the community. Please access the Department of Health website to download this document.

Transforming Community Services - new patterns of provision

This may be of particular interest to members as it focuses on the commissioning provider split in primary care trusts and the development of new provider organisations. All primary care trusts have started the process of separating their commissioning function from their provider arms.

In the East of England (EoE) the decision has been made that provider arms will need to completely separate from their commissioning PCT. This means that the provider services need to explore different organisational models.

Further information on this subject can be found in this document Transforming Community Services, enabling new patterns of provision (Word 48KB), which may be of particular interest to members as it focuses on the commissioning provider split in primary care trusts and the development of new provider organisations.

In the EoE the following models are being proposed by PCTs:

West Essex PCT - is balloting staff on becoming a social enterprise.
South West Essex PCT - foundation trusts have been asked for expressions of interest in hosting the provider services, and there are eight interested parties.
South East Essex and Mid Essex PCTs - boards have agreed the organisations will work in partnership. They are looking to appoint a managing director internally, they will then explore what organisational form to take.
North East Essex PCT - want to pursue the social enterprise model.
Suffolk PCT - is informing staff that they are going to be a social enterprise.
Luton PCT - is to ballot staff on becoming a social enterprise.
Norfolk PCT - wants to be a CFT (community foundation trust) and integrated care organisation.
Peterborough PCT - proposes to join with social services and form a CFT.
Cambridgeshire PCT - is a CFT pilot with huge financial challenges.
Gt Yarmouth and Waveney PCT - is going for managed dispersal, everything is going out to tender.
Bedfordshire PCT - managed dispersal.
Hertfordshire PCT - aspires to be a CFT.

There was a deadline for all PCTs plans to be signed off by October 2009, because of concerns about organisations focusing on organisational form instead of their function. The deadline has been lifted nationally.

Staff consultation and RCN Eastern straw poll

Government guidance states: "Early consultation and engagement with staff is a requirement in any initial consideration, appraisal and development of proposals for the future delivery of services provided by PCT provider arms."

Please take part in our straw poll which we hope will give us a top line indication as to whether staff feel adequately consulted by their employers on proposed changes.

Supporting documents for Transforming Community Services

The following documents are available from the Department of Health website, www.dh.gov.uk.

Transforming community services; enabling new patterns of provision
Transforming community Services and World Class Commissioning
Transforming Community Services, currency and pricing options for community services
Social enterprise making a difference: a guide to the right to request
A national contract for community services

You could also go to Transforming Community Services in support for you for further information.

Primary care is at the heart of the NHS operating framework for 2009/10

The publication of the operating framework for the NHS sets the agenda for the health service in the coming year, and primary care is at its heart.

The introduction by the NHS chief executive, David Nicholson, makes clear that in 2009/10, the NHS is ready to move into the the next major phase of a reform programme that has its roots in the NHS plan of 2000.

High quality care for all remains as the guiding principle: safety of patients and staff, effectiveness of care and the experience of patients underpin every stage of development and reform.

Primary prevention based on better education and support in areas such as smoking cessation, obesity and alcohol abuse is recognised as the main driver of better health outcomes, as the focus of the NHS continues to shift from better care to better health.

You can download or read a copy of this document on the Department of Health website.

Personal health budgets

Lord Darzi announced in High Quality Care for All (2008) that personal health budgets would be piloted in 2009, as a way of giving people greater control over the services they use and who provides them. Personal budgets have been piloted in social care with mixed results.

The DoH thinks personal health budgets could give patients a better experience and better care by giving them as much control over their healthcare as is appropriate for them. Personal health budgets could work in three main ways:

notional budget. No money changes hands. The individual finds out how much money is available and talks to their doctor or care manager about the different ways to spend money on meeting their needs.
real budget held by third party. A different organisation or trust holds the money for the individual, helps them decide what they need and then together they buy the services the individual has chosen.
direct payment. The individual gets the cash to buy the services that they and their doctor or care manager decide they need. They have to show what they spend it on, but they buy and manage the services.

There are many unanswered questions about personal health budgets, not least the workforce issues, ie terms and conditions, professional support and training for staff directly employed by patients. The DoH has announced a number of personal health budget pilot sites. The sites in Eastern Region are:

Bedfordshire - long term conditions
Hertfordshire - mental health, learning disabilities and physical disabilities
Mid Essex - mental health
North East Essex - long term conditions
Norfolk - mental health and learning disabilities
South West Essex - end of life

Further details can be found on the Department of Health care network website.

Integrated care pilots

Promoting better public services through integration has been an aspiration of recent government legislation, policy and initiatives. All services: health, social care, housing, transport and education, need to work in partnership in order to provide the opportunity for individuals to have improved quality of life. Integration is not an end in itself, but a vehicle for achieving improvement.

In April the DoH announced 16 pilot organisations who have been selected to put their proposed care models into practice. These pilots will be evaluated by Ernst and Young and Rand Europe. In the East of England the pilot sites are:

Assura Cambridge - will look at how different organisations across health and social care and the third sector can communicate and improve co-ordination across end of life care. Patient and public involvement will also form part of this pilot.
NHS Norfolk/Norfolk County Council - the focus of this pilot will be on joint working between the county council and the PCT integrating care for the elderly.