The BMA and Healthcall have ended their joint agreement to provide out of hours services in primary care. Healthcall plans to set up a network of local clinical governance groups and will invite all local providers of out of hours care, particularly GP cooperatives, to join.
The BMA has had a contract with Healthcall plc and its predecessor since 1966. In 1990 the contract was renegotiated until 2000. BMA members receive a discount and Healthcall gives a percentage of the turnover to the association. The service has provided care on behalf of GPs for about 20 million patients.
In a joint press statement the BMA says that it welcomes this development and will encourage its members, local medical committees, and primary care groups to become involved. It points out that the initiative is the logical consequence of the 1995 changes to GPs’ terms of service which gave family doctors responsibility for ensuring the quality of the out of hours care.
The chairman of the BMA council, Dr Ian Bogle, said, “Healthcall can proudly boast of being the original provider of commercial deputising services, enabling GPs to cope with their 24 hours’ commitment.”
Two years ago the BMA’s annual representative meeting called on the BMA not to renew any existing contracts with deputising services because of the potential conflict of interest (BMJ 1997;315:132).
Healthcall has agreed that BMA members should continue to receive a discount.
The decision has been welcomed by the National Association of GP Cooperatives, which has called on the BMA to support and encourage the development of cooperatives and to get them effectively integrated into the NHS.
NHS staff planning to be integrated
Workforce planning for the NHS in England is to be overhauled to give a more comprehensive view of the professional skill mix, the health secretary, Frank Dobson, told the Commons select committee inquiry into NHS staffing last week.
Mr Dobson attributed a large proportion of the recent winter crisis in the NHS to shortages of staff, particularly nurses. He noted that nurses’ workloads had been increased, partly because of the recent reduction in junior doctors’ hours.
Apart from recommending special efforts to recruit more nurses, Mr Dobson said that workforce planning for the NHS was not satisfactory. Too many official bodies had a hand in it, he argued. “I want to set about making it more orderly, understandable, and joined up than it is at present. This is not to criticise people from the professions who have done a very good job on these committees, but we really do need to bring it together in a way that would make it possible for the NHS Executive to have a hand in things rather than responding to advisory bodies.”
Mr Dobson said that he suspected that at the time when decisions were taken to cut junior doctors’ hours, the likely impact on the workload of other staff and how they were going to cope was not looked at thoroughly.
A survey of staff shortages should be done to discover the scale of the problem, suggested Mr Dobson. Under the health improvement programme, local assessments by health authorities and primary care groups will pinpoint local workforce needs to develop a national strategy.
Mr Dobson also advocated local pay variations related to responsibility. He announced a review of the nurse grading system to reduce the present six grades to three, to be known as registered, advanced, and specialist nurse practitioners.
Scottish GPs will be consulted on NHS white paper
The Scottish health minister has agreed that GPs in Scotland will be consulted about guidance on implementing the Scottish white paper, Designed to Care. Until now doctors have been left in the dark about the government’s plans for local health care cooperatives (LHCCs) and primary care trusts. Despite repeated assurances guidance on the impact of the reforms has not been produced; the implementation date is 1 April.
The minister, Mr Sam Galbraith, has also agreed that doctors working for LHCCs will be paid an honorarium and locum costs at the same rate as clinical assessors and that GPs will be have a role in appointing LHCC staff. The minister has confirmed that the introduction of LHCCs will not threaten GPs’ independent contractor status and that the level of investment in ringfenced general medical services cash limited funds will be maintained for a minimum of three years.
BMA gives evidence on private health care
All independent hospitals should have a medical advisory committee (MAC) to represent all the specialists who have admitting rights to the hospital. This is one of the BMA’s recommendations in its written evidence to the House of Commons health select committee’s inquiry into the regulation of private and independent health care.
The BMA welcomes the inquiry and suggests that the committee should also address alternative treatments, residential and nursing homes, and organisations such as dietary and impotence clinics.
As independent hospitals do not have full time medical directors or clinical directorates the chairmen of MACs will have to fulfil a similar role to that of medical directors in NHS trusts in relation to local professional self regulation. MACs should audit the practice of local specialists in independent practice.
The BMA would like to see a formal procedure for patients to pursue complaints about the clinical care received in the independent sector. There should also be agreed arbitration procedures which are binding on all parties for dealing with non-clinical complaints.
The association says that all private medical facilities should be subject to inspection, and that there should be national standards and a similar inspection regimen for NHS facilities, NHS pay bed units, independent hospitals, and any establishment used for medical or surgical treatment.
Figure.
Mr Sam Galbraith