List members may be interested to know that the start up details of NHS Plus
are now posted at http://www.doh.gov.uk/nhsplus/

Most interestingly there is a service delivery specification for NHS
customers, which is expected to be achieved by NHS clients of an OH service
before it can participate in external work.  The standards include audit
protocols and an expectation of year on year quality improvements.  There is
also a regional audit system alluded to, but no detail as to how it will
operate as yet (I understand several Faculty Officers are part of those
looking at this).

NHS Occupational Health Departments will need to convince their Chief
Executives that they achieve these internal standards before they can apply
to become part of NHS Plus.  It seems very sensible that the internal
customers should be entirely satisfied before external work is contracted.
On a commercial footing; written agreements are required with each customer,
the work must carry professional indemnity insurance and services are
expected to be fully costed according to local NHS Financial Accounting
rules.

The site should be interesting to other OH providers as an example of how
Corporate Governance will impact on our activities.  I suspect that as the
Faculty had a large hand in developing these documents that they will form
the basis of a re-write of their guidance on Quality and Audit (which is
currently out of print).

My personal view is that the developments in NHS Plus will provide a
platform to take over the services currently provided by unqualified
practitioners when they become subject to revalidation.  This will roll out
between 2004 and 2008 for Medical Practitioners - if like me you have a GMC
number ending in zero or five, revalidation comes 2004, one and six is 2005
etc.  The burden of revalidation in each sub-speciality practised may make
part-time OH very unattractive for many GPs.

The main choke point I believe will be (as ever) qualified OH staff; the
quality standards have for example a second level of expecting 50% of nurses
to hold specialist practitioner.  There is a basic requirement for
Consultant OH Physician involvement in Clinical Governance (not just service
delivery), and for access to a full OH team including qualified Hygienists.
Unless we can deal with a massive increase in all professional training we
cannot expect to substantially increase the market penetration of OH into
those businesses which clearly need our services.

This is a very welcome quality improvement initiative of OH in the UK, and
should be fully supported by all of us.

Dr. Geoff Helliwell MB ChB CIH FFOM MIOSH
Medical Director
WellWork Ltd. UK