Thursday, October 25, 2007

Wind Blows Over NHS

Wind blows over NHS - September news review
It's been that season of high politics when leaders head to the remotest corners of the country, make speeches and encourage their troops.

From Blackpool, Bournemouth and Brighton the wind has wafted a series of announcements and proposals about the future of the NHS.

In a few weeks, months or even years the public will be invited to pass judgement at the ballot box.

So new Prime Minister Gordon Brown was keen to pledge his commitment to the service.

He revealed how he suffered an eye injury playing rugby as a teenager, and spent five years in treatment.

He stated: "I learned that with a simple twist of fate life can change.

"It was the skills of a surgeon, the care of the wonderful nurses, the attention and yes, the love and care of the NHS staff that managed to save one of my eyes.

"And it is because of the NHS that I can see the words I read today."

Some have detected a change of emphasis in Mr Brown's government, a shift away from using the private sector.

Certainly Mr Brown has proved himself a master politician, taking simple concepts and putting himself at the helm. On health he has had two themes - hospital infection and GP hours.

Last month he personally announced - twice - his plans to deep clean every hospital. He did not leave a great deal to Health Secretary Alan Johnson but it was left to Mr Johnson to explain exactly what the government was going to do about GPs.

"We need more GPs in our most deprived communities. Not just curing illness but working with other healthcare professionals on prevention as well," Mr Johnson stated.

He went on: "GP surgeries should be open at times and in locations that suit the patient, not the practice."

So that's clear enough. Will it be done by extending private companies' role in primary care? Not quite so clear.

But it's definitely one of Mr Brown's big themes. Before setting off for his conference, he told a gathering of some 1,000 citizen jurors in Birmingham: "What I am hearing, and what I am going to act upon is that people want more access to the GP out of hours, and at weekends."

Mr Brown's mastery of his craft was highlighted by the Conservative response the next week. They too announced plans to sort out primary care out of hours services.

Shadow Health Secretary Andrew Lansley, in fact, proved he had a plan to achieve it. His intention is to hand the budget back to practices and renegotiate the GP contract.

The Conservatives also pledged to allow patients to choose a GP - whether close to home or work. It's not clear whether this will extend to allowing patients to register with multiple GPs - at home and work - as expounded by the Confederation of British Industry.

Meanwhile the results of the citizen's jury project are awaited. Will it endorse government health policy?

Nobody is holding their breath - not if blogger Dr Ray is to be believed. Dr Ray had a spy in Birmingham who found out that some jurors were being paid £75 each for attendance. That excluded the one third of the audience who were working doctors or health staff. The payments were later confirmed by the Department of Health - suggesting that Dr Ray did indeed have a spy at the meeting.

The spy also reported the jury voting by two thirds in favour of government policy at every turn. This included: "Would you prefer gynaecological surgery to be carried out in your GP practice even if it meant the closure of your DGH facility?"

Quote of the month therefore goes to Dr Ray: "I can only say that the way the voting was done makes the Blue Peter voting fraud seem like, well, Blue Peter."

Back in the real world, efforts to sort out the medical training fiasco continue.

Both RemedyUK and the BMA have been putting forward points of view to a consultation being undertaken by the Department of Health.

Sir John Tooke's inquiry is due to report this month but the Department of Health did not wait for its findings before quietly launching its own in-house consultation with "stakeholders".

According to the department, Sir John's recommendations will be used to design a new system for 2009 - as the scope for change next year is "very limited".

RemedyUK in its response favoured a return to a deanery based system and confirmed the need to use CV-based applications.

The BMA's Junior Doctors' Committee (JDC), with new chair Ram Moorthy at the helm, suggested even smaller geographical units for applications. It called for multiple entry points for training and piloting of any new ideas. Finally it called for a UK-wide coordinated timetable - and pressed for this to be announced as soon as possible.

The consultation document provides some insights into choppy waters ahead. Amongst options for ST1 shortlisting, it highlights an "invigilated shortlisting test that is machine-marked, similar to the Clinical Problem Solving test used for GP training selection."

It reports JDC opposition to this but states there is good national evidence for its "validity" and "reasonable support" from stakeholders. So it proposed to run pilots of it next when it can get a deanery and speciality to agreed to do so.

A second method that looks as if it will be piloted involves "invigilated assessments for shortlisting (such as those typically used at selection centres) with interview at second stage. Assessments could include written, interactive exercises and/or simulations that have been piloted and validated. " It suggests that selection centres could screen out about half of all applicants.

In effect, these pilots would become part of the local processes of shortlisting that would be available to deaneries and specialties.

As to whether a national MTAS-style computer system will be used again – the question remains open. “The MMC England Programme Board does not currently have an agreed preference on this issue,” it states.

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