The fifth report of the Shipman Inquiry was published. It considered the handling of complaints against family doctors, the raising of concerns about them, General Medical Council procedures and its proposal for revalidation of doctors. The government announced a review of the proposed new GMC system of revalidation in the light of the report. (Harold Shipman was a family doctor convicted in 2000 on 15 counts of murdering his patients.)
Source: Shipman Inquiry, Safeguarding Patients: Lessons from the past - Proposals for the future, Cm 6394, Department of Health, TSO (0870 600 5522) | House of Commons Hansard, Written Ministerial Statement 9 December 2004, columns 108-110WS, TSO
Links: Report (links) | Hansard | DH press release (1) | DH press release (2) | GMC press release (1) | GMC press release (2) | BMA press release | Guardian report (1) | Guardian report (2)
Date: 2004-Dec
The Disability Rights Commission began a formal investigation into whether primary health services were addressing the health inequalities experienced by people with learning disabilities and people with mental health problems. Particular areas of interest were family doctor services, essential screening, and health improvement.
Source: Press release 10 December 2004, Disability Rights Commission (08457 622633)
Links: DRC press release
Date: 2004-Dec
Government guidance said that family doctors would be able to keep up to 100 per cent of any savings they made from the direct commissioning of services (rather than the 50 per cent suggested in an earlier draft).
Source: Practice Based Commissioning, Department of Health (08701 555455)
Links: Guidance (pdf) | DH press release | NHS Alliance press release | Guardian report
Date: 2004-Dec
A new book examined issues surrounding the role of family doctors, including whether they should ignore or embrace the social causes of illness.
Source: Patrick Hutt with Iona Heath and Roger Neighbour, Confronting an Ill Society: David Widgery, general practice, idealism and the chase for change, Radcliffe Medical Press (01235 528820)
Links: Summary
Date: 2004-Dec
The government began consultation on possible changes in the law to enable all those working in a pharmacy setting pharmacists, pharmacy technicians, dispensing assistants, counter assistants and others to contribute as fully and effectively as possible to patient care.
Source: Making the Best Use of the Pharmacy Workforce, Department of Health (08701 555455)
Links: Consultation document (pdf) | RPS press release (pdf)
Date: 2004-Dec
A paper said that a new practice-based commissioning scheme in the National Health Service could lead to cost considerations taking precedence over quality or patient choice - in particular to the detriment of mental health services.
Source: Alan Cohen, Practice-Based Commissioning in the NHS: The implications for mental health, Sainsbury Centre for Mental Health (020 7827 8300)
Links: Report (pdf) | SCMH press release
Date: 2004-Nov
An audit report said that there was a strong rationale for modernizing National Health Service dentistry: but significant risks would have to be managed if the new arrangements which had been announced by the Department of Health were to be effective and provide value for money.
Source: Reforming NHS Dentistry: Ensuring effective management of risks, HC 25 (Session 2004-05), National Audit Office (020 7798 7000)
Links: Report (pdf) | NAO press release | Guardian report
Date: 2004-Nov
The government began consultation on proposals to devolve commissioning powers to family doctors in England. From April 2005, family doctor practices would be able to receive an indicative budget from primary care trusts; they would be allowed to keep 50 per cent of any savings they made, and use the money to invest in improving services to patients.
Source: Practice Based Commissioning: Engaging practices in commissioning, Department of Health (08701 555455)
Links: Consultation document (pdf) | DH press release | BMA press release | King's Fund press release | NHS Alliance press release | Guardian report
Date: 2004-Oct
A report said that primary care-led commissioning had the potential to provide a service that was more responsive to patients needs, and more focused on services provided in community settings. But there was little evidence to date that primary care-led commissioning had made an impact on the quality of hospital care.
Source: Judith Smith et al., A Review of the Effectiveness of Primary Care-led Commissioning and its Place in the NHS, Health Foundation (020 7257 8000)
Links: Report (pdf) | Summary (pdf) | Health Foundation press release
Date: 2004-Oct
The government responded to a report by a committee of MPs on out-of-hours services by family doctors. It said that new arrangements for out-of-hours care were not an end in themselves, but represented an important step towards the achievement of a fully integrated model of unscheduled care. The government also announced that patients would continue to be guaranteed access to home visits from their family doctor, if they needed one, when changes to out-of-hours services were brought in at the end of 2004.
Source: Government Response to the House of Commons Health Committee Report on GP Out-of-Hours Services: Fifth Report of Session 2003-4, Cm 6352, Department of Health (08701 555455) | Press release 14 October 2004, Department of Health (020 7210 4850)
Links: Response (pdf) | MPs report | DH press release | King's Fund press release | NHS Alliance press release | NHS Confederation press release | Guardian report
Date: 2004-Oct
The government announced that a new contract for high street pharmacists would go live, subject to a ballot by pharmacists, from 1 April 2005. Under the new deal, pharmacists will be rewarded for the range and quality of services they provided, rather than the volume of medicines they dispensed.
Source: Press release 25 October 2004, Department of Health (020 7210 4850) | New Contractual Framework for Community Pharmacy, Department of Health (08701 555455)
Links: DH press release | Draft contract (pdf)
Date: 2004-Oct
A report examined the future shape of primary care and general practice. It said that commissioners, providers and regulators had to agree their respective roles in order to ensure a patient-sensitive National Health Service. It was also important to analyse the possible interactions of policy initiatives such as plurality of providers, patient choice, payment by results, practice-led commissioning, and localism.
Source: The Future Shape of Primary Care and General Practice, NHS Alliance (01777 869080)
Links: NHS Alliance press release
Date: 2004-Oct
A survey found that new National Health Service out-of-hours services were underfunded in 9 out of 10 primary care trusts.
Source: Press release 1 September 2004, NHS Alliance (01777 869080)
Links: NHS Alliance press release
Date: 2004-Sep
A report called for a re-think on 48-hour access targets for family doctors. It said that, while rapid patient access was important, targets had become more important than genuine, patient-centred care.
Source: John Campbell (ed.), The Future of Access to General Practice-based Primary Medical Primary Care, NHS Alliance (01777 869080) and Royal College of General Practitioners
Links: Report (pdf) | NHS Alliance press release | NHS Confederation press release | BBC report | Guardian report
Date: 2004-Sep
A report reviewed the contribution of nursing, midwifery and health visiting professionals to supporting vulnerable children and young people. It said that there should be at least one full-time school nurse covering every secondary school and its cluster of primary schools.
Source: The Chief Nursing Officer s Review of the Nursing, Midwifery and Health Visiting Contribution to Vulnerable Children and Young People, Chief Nursing Officer/Department of Health (08701 555455)
Links: Report (pdf) | Guardian report
Date: 2004-Aug
A report by a committee of MPs said that primary care trusts were in 'varying states of readiness' for taking on responsibility for providing family doctor out-of-hours services. It expressed concern at reports that the transition was in some circumstances being managed at too junior a level within PCTs; and also that some PCTs were failing to think about more integrated approaches within their wider local health economies.
Source: GP Out-of-Hours Services, Fifth Report (Session 2003-04), HC 697, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | BMA press release | King's Fund press release | NHS Confederation press release | RCGP press release | Guardian report
Date: 2004-Aug
A think-tank report said that primary care trusts needed to be closer to the needs of patients and health staff. Poor management and a lack of capacity in PCTs were undermining decentralization and attempts to reshape and improve services.
Source: Deborah Roche, PCTs: An unfinished agenda, Institute for Public Policy Research, available from Central Books (0845 458 9911)
Links: Report (pdf) | IPPR press release
Date: 2004-Aug
A report expressed concern over a lack of professional training by primary care staff in occupational health issues, and a lack of knowledge about access to appropriate routes for referral of patients.
Source: Rachel O Hara et al., The Profile of Patients' Occupational Health in Primary Care, Research Report 254, Health and Safety Executive, HSE Books (01787 881165)
Links: Report (pdf)
Date: 2004-Aug
A survey found that fewer than half of gay men were 'out' to the staff in their family doctor's surgery; a third of all gay men who were registered with a family doctor said the surgery staff did not know they had sex with men, and they would be unhappy if this information were given to staff. Overall satisfaction with family doctor services among gay men was relatively high.
Source: Peter Keogh et al., Doctoring Gay Men: Exploring the contribution of general practice, Sigma Research (020 7737 6223)
Links: Report (pdf) | THT press release
Date: 2004-Aug
The government began consultation on proposals to to crack down on poor performance by dentists and improve protection for patients. A new complaints scheme, and a dedicated complaints agency, would be set up for patients unhappy with non-NHS treatment.
Source: Strengthening the General Dental Council: A paper for consultation, Department of Health (08701 555455)
Links: Consultation document (pdf) | DH press release | Guardian report | Consumers' Association press release
Date: 2004-Aug
A survey found that almost 9 million family doctor appointments, and just under 4 million practice nurse appointments, were missed each year - at a cost of around 162 million.
Source: Press release 24 August 2004, Institute of Healthcare Management (020 7881 9235)
Links: Guardian report
Date: 2004-Aug
Researchers found evidence that coverage of cervical screening and MMR immunization had become more equitable over the period 1991-2001, stimulated by changes in the organisation of primary care - particularly an increase in the number of practice nurses.
Source: Debbie Baker and Elizabeth Middleton, Does Primary Care Reduce Health Inequalities?, National Primary Care Research and Development Centre (0161 275 0611)
Links: Summary (pdf)
Date: 2004-Jul
The government announced plans to increase the recruitment of dentists by the National Health Service, and to reform their working arrangements - including a new contract making it possible for dentists to spend more time with patients and encourage preventative care. A consumer group criticised the plans as inadequate.
Source: NHS Dentistry: Delivering Change, Chief Dental Officer/Department of Health (08701 555455) | House of Commons Hansard, Written Ministerial Statement 16 July 2004, columns 89-91WS, TSO (0870 600 5522) | Press release 16 July 2004, Consumers' Association (020 7770 7000)
Links: Report (pdf) | Hansard | DH press release | Consumers' Association press release | Guardian report
Date: 2004-Jul
A report identified factors affecting the dental workforce in England, including age structure, number of women dentists, and shape of the dental team. It also discussed supply and demand in the profession, and broad trends in future oral health needs. It said there was a shortage of 1,850 dentists in 2003: it forecast that this would grow to at least 3,640, and perhaps as many as 5,100, by 2011.
Source: Report of the Primary Care Dental Workforce Review, Department of Health (08701 555455)
Links: Report (pdf) | Guardian report
Date: 2004-Jul
A report said that the government should do more to encourage family doctors to take responsibility for commissioning hospital services on behalf of their patients.
Source: Richard Lewis, Practice-led Commissioning: Harnessing the power of the primary-care frontline, King s Fund (020 7307 2591)
Links: Report (pdf) | KF press release | NHS Alliance press release
Date: 2004-Jun
The Northern Ireland Executive published a consultation document which set out a strategic framework for the development of primary care services over the next two decades - with the ultimate aim of providing a 'comprehensive person-centred' system of care.
Source: Caring For People Beyond Tomorrow, Northern Ireland Executive (028 9052 0500)
Links: Consultation document (pdf links) | NIE press release
Date: 2004-Jun
A report said that primary care trusts should be given more credit for the successes they had achieved, and more support to help them face the challenges ahead.
Source: Making a Difference: How PCTs are transforming the NHS, NHS Confederation (020 7959 7272)
Links: NHS Confederation press release
Date: 2004-Jun
The government began consultation on proposals to exclude overseas visitors (including failed asylum seekers) from eligibility for free National Health Service primary medical services in England. Overseas visitors would continue to be entitled to receive emergency or immediately necessary treatment, free of charge.
Source: Proposals to Exclude Overseas Visitors from Eligibility to Free NHS Primary Medical Services: Consultation, Department of Health (08701 555455)
Links: Consultation document (pdf) | Guardian report
Date: 2004-May
An article said that an extra 5,250 dentists might be needed in England and Wales to meet 'barely adequate' levels of National Health Service provision - an increase of more than a quarter. But a survey by the British Dental Association found that most dentists would reduce or completely stop NHS work if proposed government changes to the service were introduced.
Source: Maged Boulos and Guy Phillipps, 'Is NHS dentistry in crisis?: 'Traffic light' maps of dentists distribution in England and Wales', International Journal of Health Geographics, Volume 10 Number 3 | Press release 26 May 2004, British Dental Association (020 7935 0875)
Links: Article (pdf) | Guardian report (1) | BDA press release | Guardian report (2)
Date: 2004-May
The first progress report on primary care services was published by the Primary Care National Director of the National Health Service. It said that NHS primary care was continuing to expand and provide a wider range of services to patients.
Source: A Responsive and High-quality Local NHS: The primary care progress report 2004, Department of Health (08701 555455)
Links: Report (pdf) | DH press release | Guardian report
Date: 2004-Apr
Researchers found that NHS Direct nurses had to depart from the organisational and time strictures of the service to satisfy users. Some patients became dependent by asking permission through the service to contact their family doctor. Patients still trusted medical professionals and their knowledge, but many expected poor service due to resource constraints.
Source: Gerard Hanlon, David Greatbatch, Tim Strangleman, and Donna Luff, NHS Direct: Patient empowerment or dependency?, Economic and Social Research Council (01793 413000)
Links: Report (pdf) | Summary (pdf)
Date: 2004-Apr
A report said that new forms of partnership-based governance were crucial to the success of primary care trusts within the National Health Service.
Source: Making a Difference: Engaging clinicians with PCTs, NHS Alliance (01777 869080) and National Clinical Governance Support Team
Links: NHS Alliance press release
Date: 2004-Apr
The government said that the number of family doctors working in the National Health Service had increased by 2,131 between 1999 and the end of 2003, exceeding the target increase of 2,000 by March 2004. But the organisation representing family doctors said the increase on a full-time equivalent basis was only 1,323.
Source: Press release 23 April 2004, Department of Health (020 7210 4850) | Press release 23 April 2004, British Medical Association (020 7383 6244)
Links: DH press release | BMA press release | Guardian report
Date: 2004-Apr
The healthcare inspectorate said that primary care trusts needed to develop a new generation of talented and capable clinicians and managers if they were to provide top quality services that met the needs of local people. PCTs faced a number of issues, including: difficulty filling senior and managerial posts; shortages of family doctors, leading to closure of practice lists in some areas; shortages of district nurses and health visitors, leading to low staff morale and high workloads in some areas; long waiting lists to see therapists, especially physiotherapists; unsuitable buildings for modern healthcare; and an underdeveloped ability to commission specialist services from other health organisations.
Source: What CHI has Found in: Primary Care Trusts - Sector report, Commission for Health Improvement (020 7448 9200)
Links: Report (pdf) | CHI press release | NHS Alliance press release | NHS Confederation press release | Guardian report
Date: 2004-Mar
An audit report said that more than 4 out of 5 primary care trusts had redesigned at least one speciality - with the result that waiting times for referrals had been reduced to 1 4 weeks, compared with 17 26 weeks for traditional outpatient appointments. A second report detailed the differences among PCTs and family doctor practices regarding the time patients were given with the healthcare professional: consultations typically lasted longer than the 10 minutes formally allocated in most appointment systems - on average between 11.3 and 14.4 minutes.
Source: Quicker Treatment Closer to Home, Audit Commission (0800 502030) | Transforming Primary Care, Audit Commission
Links: Quicker Treatment report | Transforming PC report | Audit Commission press release | NHS Alliance press release | Guardian report
Date: 2004-Mar
A strategy was published for promoting community pharmacies in Northern Ireland.
Source: Making it Better: Strategy for pharmacy in the community, Department of Health, Social Services and Public Safety/Northern Ireland Executive (028 9052 0500)
Links: Strategy (pdf) | NIE press release
Date: 2004-Feb
The government published, for consultation, details of major changes due to be introduced (from April 2005) to the way primary dental services were organised in England. The main change was the introduction of local commissioning of primary dental care by primary care trusts, which would enter into local contracts with dentists, as well as providing some services themselves.
Source: Framework Proposals for Primary Dental Services in England from 2005, Department of Health (08701 555455)
Links: Report (pdf)
Date: 2004-Feb
An evidence briefing provided a review of reviews about the effectiveness of ante- and post-natal home-visiting programmes for improving child and maternal outcomes.
Source: Julie Bull, Geraldine McCormick, Catherine Swann and Caroline Mulvihill, Ante- and Post-natal Home-visiting Programmes: Review of reviews, Health Development Agency (020 7430 0850)
Links: Report (pdf)
Date: 2004-Feb
