I disagree. The full quote from the White Paper makes it quite clear that
the HIP is not a contract as we know it (-:
Long term agreements between PCGs and trusts will replace contracts, (para
9.14) and the awkward and much derided ECR system will be abolished. PCGs
will have input into the HIP as it is a rolling three year plan, and they
will also have input into the agreements, as they are rolling three year,
er, agreements. Active PCGs should actually set the agreements from April
2000 on.
It will depend on the PCGs state of development how much influence it has.
With the elimination of ECRs, in theory any GP will be able to refer
anywhere in the country after April 1st.
I append most of the relevant bits of the White Paper after your message!
A
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of
> [log in to unmask]
> Sent: 24 June 1998 22:22
> To: [log in to unmask]
> Subject: RE: Millburns Letter Summary
>
>
>
> > > From: "Andrew Herd" <[log in to unmask]>
> >
> > > OK, first, the HIP is a health improvement plant, not a
> contracts document,
> > > so it will not specify which hospital you have to refer to.
> > >snip>
> > Sorry, read the White Paper. Haven't got it at home, but it is there
> > in black and white, the bit about HAs and the HIP:-(
> >
> I've got the quote now:
>
> 4.9 The Health Improvement Programme will cover:
>
> <snip>
>
> the range, location and investment required in local health services
> to meet the needs of local people.
>
>
> This will be in the form of 3 year contracts (sorry service
> agreements). So there is NO commissioning for PCGs to do.
>
> Someone at my HA told me today that they *have* guidance on HIPs, but
> is *confidential* so he couldn't share it with me.
> It should have been out in the public domain 8 weeks ago.
>
> Any bets it's released next week i.e. *after* the LMC conference.
> This could be a case for Mulder and Scully;-)
>
> Dr David J Plews
--------------------------------------------------------------------
4.9 The Health Improvement Programme will cover:
the most important health needs of the local population, and how these are
to be met by the NHS and its partner organisations through broader action on
public health
the main healthcare requirements of local people, and how local services
should be developed to meet them either directly by the NHS, or where
appropriate jointly with social services
the range, location and investment required in local health services to meet
the needs of local people.
4.10 The initial Health Improvement Programme will cover a three year
period. It will be updated progressively, with a part of it reviewed each
year. It is envisaged that the first Health Improvement Programmes will be
in place by April 1999.
9.11 In the new NHS, the short-termism of the market will be replaced by a
more stable framework based on longer-term relationships. Locally the Health
Improvement Programme will set a shared context - within which Health
Authorities, Primary Care Groups and NHS Trusts will reach long-term
agreements. These agreements will last for at least three years, but could
extend in some circumstances for five to ten years, if that was the
appropriate time horizon for implementing a programme of development and
change.
9.14 Long-term agreements will replace the annual contracts of the internal
market, which wasted so much time, effort and resources throughout the NHS.
They will increasingly reflect dialogue between clinicians in primary and
secondary care, rather than purely between managers. They will be based
around specific services - linked where appropriate to the new National
Service Frameworks - rather than whole hospitals. The move away from the
annual round to a pattern in which a number of agreements are due for
renewal each year will make it possible to look in more depth at service
issues and to engage clinicians in planning for improvements over a sensible
time horizon.
9.16 The combination of new high-level commissioning arrangements for
specialist services (as outlined in chapter 7), and long-term agreements
which reflect the views of all local GPs, should ensure that all but a small
minority of GP referrals to hospitals are covered by these new agreements.
On occasion, however, a patient's special clinical needs or personal
circumstances will require a GP to make individualised arrangements. It is
important that the new system should allow for such cases, but without the
bureaucracy associated with the old style 'extra contractual referrals'
(ECRs) of the internal market.
9.17 In the ECR system, patients could often find themselves the subject of
heated debate between GPs, Trusts and Health Authorities about whether they
were covered by a 'contract' and, if not, whether their care would be paid
for. These arrangements added substantially to the bureaucracy of the
internal market. The ECR system will be abolished and replaced by simplified
arrangements that minimise bureaucracy and eliminate incentives to 'play the
market'. A new system will be introduced, based on adjustments to Primary
Care Group and Health Authority allocations, rather than invoicing. This
will align clinical and financial responsibility, coupling the freedom to
refer with the ability to fund. The NHS Executive will issue guidance on the
details of implementation by summer 1998, to enable new arrangements to be
put in place from April 1999.
NHS Trusts, the bodies that provide patient services in hospitals and in the
community, will be party to the local Health Improvement Programme and will
agree long term service agreements with Primary Care Groups. These service
agreements will generally be organised around a particular care group (such
as children) or disease area (such as heart disease) linked to the new
National Service Frameworks. In this way, hospital clinicians will be able
to make a more significant contribution to service planning. National model
agreements will be developed. NHS Trusts will have a statutory duty for
quality.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|
