Lord Darzi S NHS Next Stage Review : Update on BMA Nominations to SHA Clinical Pathway Groups

Appendix 2

NHS NEXT STAGE REVIEW: GENERAL UPDATE FOR LMCs, DECEMBER 2007

This paper outlines developments since the last update on the Next Stage Review given in the September 2007 edition of GPC news. It does not deal with the London review which is following a different process and timescale. The Next Stage Review applies to England only.

1 INTERIM REPORT The interim report of Lord Darzi’s Next Stage Review, ‘Our NHS, Our Future’, was published on 4 October 2007; a summary of the report was considered at the October GPC meeting and shared with LMCs via GPC news in October.

A letter from the chairman of the GPC was sent to Lord Darzi on 4 December 2007 outlining the committee’s views on the proposals in the interim report regarding GP access. A BMA press release was issued in relation to this letter on 12 December 2007. Both these documents were shared with LMCs via the listserver and can be found online: www.bma.org.uk/ap.nsf/Content/lettertodarzi121207 www.bma.org.uk/pressrel.nsf/wlu/SGOY-79RN9C?OpenDocument&vw=wfmms

A separate letter and briefing paper on primary care premises was sent to Lord Darzi by the Chairman of Council on 4 December 2007.

2 NATIONAL ENGAGEMENT

Stakeholder Forum A Stakeholder Forum was held on 12 September 2007, to which the BMA was invited to send 12 representatives. Six national BMA representatives attended, including a member of the GPC.

A report of the event can be found online: www.ournhs.nhs.uk/2007/09/17/stakeholder-forum-a-report-of-the-event-held-on-12-september/

International clinical summit An ‘international clinical summit’ was held in London on 21 and 22 November 2007, attended by over 1,000 people. The event was open to all members of clinical pathway groups across the 9 SHAs. Additional invitations were made to SHAs, PCTs, NHS Trusts and stakeholders, under which the BMA was invited to send up to 11 representatives. Nine national BMA representatives attended, including 2 members of the GPC.

More information on the summit can be found online: www.livegroup.co.uk/internationalclinicalsummit/index.php?view=agenda

Submission of policy ideas An invitation to stakeholders to submit policy ideas to the review was sent from Lord Darzi on 19 November 2007. The themes specified are quality improvement, innovation, workforce, leadership, primary & community care strategy, informatics and systems & incentives. The BMA’s Council Working Group and HPERU will co-ordinate the BMA’s response, for submission by 11 January 2008. A copy of the letter can be found online: www.ournhs.nhs.uk/wp-content/uploads/2007/11/071119_darzi_letter_to_stakeholders.pdf Working groups Four national working groups have been set up to look at primary & community care, quality, innovation and workforce. Four separate work-streams have been set up under the workforce national working group. The Chairman of Council is a member of the quality working group and 1 of the workforce work-streams. Further national BMA representatives are being sought to join the innovation working group and remaining 3 workforce work- streams.

3 REGIONAL ENGAGEMENT

SHA clinical pathway groups The BMA submitted a number of nominations to SHAs for inclusion on clinical pathway groups – maternity and newborn care, children’s services, acute care, long-term conditions, staying healthy, planned care, mental health and end of life care – back in September, many of which were successful. The number of BMA representatives appointed per SHA, across all eight clinical pathway groups, is as follows:

EAST MIDLANDS 01 (1 GP and 8 hospital doctors nominated) EAST OF ENGLAND 14 (includes 4 GPs, out of 8 nominated) NORTH EAST 24 (includes 2 GPs, out of 2 nominated) NORTH WEST 21 (includes 13 GPs, out of 17 nominated) SOUTH CENTRAL 1 (not a GP; 8 GPs nominated) SOUTH EAST COAST 16 (includes 8 GPs, out of 8 nominated) SOUTH WEST 9 (includes 3 GPs, out of 11 nominated) WEST MIDLANDS 12 (includes 3 GPs, out of 13 nominated) YORKSHIRE AND THE HUMBER 0 (8 GPs and 8 hospital doctors nominated)

For clarification and as reported in the September 2007 update, where SHA interest in receiving BMA nominations was low, eight hospital doctor and eight GP nominations were submitted per SHA, making it clear that additional nominations could be provided if required. In other areas, SHAs were keen to receive all BMA nominations.

A BMA briefing pack (electronic) was sent to all BMA representatives on SHA clinical pathway groups consisting of the following documents:  A covering letter from the Director of Representational and Political Activities;  Terms of reference of the review and a letter from the Department of Health to SHAs detailing regional plans including information of the remit of the clinical pathway groups;  BMA response to Lord Darzi’s report ‘Healthcare for London: a framework for action’;  BMA guidance on hospital reconfiguration, the process of commissioning, the framework for procuring support for external commissioners, joint working between local bodies representing hospital doctors and GPs and ‘care closer to home’; 1 East Midlands and South Central SHAs did not share information on the membership of their groups with the BMA. Subsequently, all BMA nominees were contacted and asked to confirm whether or not they had been appointed. In the East Midlands region, none of the nominees responded and in the South Central region, only 1 nominee responded.  Local contact sheet including details of BMA regional services, LMCs, regional committees and LNCs; and  Feedback form.

Despite asking for regular feedback from representatives, on the whole, BMA regional services have received minimal information from the doctors appointed to the groups. National branch-of-practice secretariats have however received some feedback from representatives via LMCs and members of regional BMA committees.

Evidence base In order to inform the clinical pathway groups' deliberations, the Department of Health produced an evidence base for each of the 8 clinical areas. Members of all branch-of- practice committees were given the opportunity to review and comment on the contents of these documents in November 2007.

SHA consultations Clinical pathway groups were expected to meet at least three times between October and December 2007. It is anticipated that the nine SHAs will each be consulting on ‘a vision for improved care pathways across the region’ in late January/early February-April 2008. This will represent the culmination of the work of the 8 clinical pathway groups. The review timetable states that the final local visions will be published in May 2008. These reports will form part of the final review report, which is due in June 2008.

BMA activity and support around these local consultations is currently under consideration.

4 PATIENT AND PUBLIC ENGAGEMENT A report of the findings from the deliberative events for patients, the public and NHS staff held across the country at SHA level on 18 September 2007 is available here: www.ournhs.nhs.uk/2007/11/01/full-findings-from-the-nationwide-engagement-events/

In total, the 9 events involved 1,100 people. Around two thirds of the participants were patients and public, with one third staff, which included a mix of clinical and non-clinical, primary and secondary, junior and senior. Unlike membership of the clinical pathway groups, there was no opportunity for formal BMA representation at these events.

The topics discussed were as follows:

 Satisfaction with healthcare services;  Access to primary health services;  Quality of care; and  Health and wellbeing.

A second series of events has been planned for 24 January 2008.

GPC secretariat 20 December 2007