| Following road testing the DH has published the 2012-13 PbR. The NHS Deputy Chief Executive's 16 February covering letter states:
Dear Colleague
I am writing to notify you that the final tariff for use from 1 April 2012 is published on the Department of Health website.
Final guidance is also being published which includes amendments following comments received as part of the recent road test exercise. I hope that these changes will help you in implementing Payment by Results in 2012-13.
I would like to take this opportunity to confirm our approach for 2012-13 in relation to two areas.
Firstly, the draft guidance published for road test recognised that the policy of non-payment for emergency readmissions has been complex to administer, and referred to some pilot work which was designed to give us a firmer clinical basis for the application of the policy. This work is now complete and has informed our revised approach which is set out in the guidance that is published today.
The revised approach centres around a review of emergency readmissions carried out by a team which is led by an independent clinician and which can give providers and commissioners a better understanding of why readmissions are happening, and provide a basis for agreeing the proportion of all the eligible readmissions which could be avoidable through action by the whole health economy. The pilot reviews demonstrated the benefits to all parties of having a broad-based review including commissioner and GP representation.
Building on the good practice identified through these pilots, we are therefore recommending that the operation of the emergency readmissions policy in 2012-13 should be based on a clinical review of readmissions.
I should like to stress that the savings arising must be reinvested in rehabilitation and reablement services to help avoid readmissions, with providers to be involved in this process. PCTs must account for how this money is spent.
Secondly, having reviewed feedback we are amending the operation of the marginal rate emergency tariff by addressing an unintended consequence where a provider may have an overall value of emergency admissions which is below the 2008-09 baseline, but continues to have funds deducted because of fluctuations in small volume contracts. Although we do not have an obvious evidence base to help manage this, we have sought to address this through an amendment to guidance. Contracts worth 5% or less of the 2008-09 baseline should not attract the marginal rate, where the overall value of emergency admissions is below the 2008-09 baseline. We will keep this under review during the year.
Our road testing of the tariff and draft guidance has resulted in some presentational changes to the tariff information spreadsheet. In addition, there have been a small number of changes to the prices that were shared at road test, and these price changes are summarised in the table at Annex A. Comprehensive details are contained in the tariff information spreadsheet.
Yours sincerely
David Flory NHS Deputy Chief Executive
For full detail go to:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132654 |
| Dear Orthopaedic Colleague,
The management of patients with a fractured neck of femur is a challenging group to treat well and quickly. NICE introduced guidelines on their management last year. Our District General Hospital is interested to know how other Trusts are dealing with this patient group and the NICE guidelines and would appreciate your help in completing this short questionaire on the subject. Many thanks Mr Gary Hannant ST2, Mr Ricardo Pacheco Consultant Orthopaedic Surgeon, Scunthorpe District General Hospital.
http://www.surveymonkey.com/s/7WQF6BM
Many thanks for you help
Gary Hannant |
| On behalf of Council the PPC owns the BOA practice strategy and maintains a focus on professional standards in four key areas: - Good Practice Guidance – by endorsing, regularly reviewing and where necessary commissioning Blue Book guides to good practice (BOASTs are overseen by the Trauma Group). The focus here is particularly important as we move towards NHS Evidence accreditation of our guidance development process.
- Code of Ethics – covering all aspects of T&O surgeons’ professional behaviours – including the important interaction with industry, and Good Medical Practice as codified by the GMC.
- NHS practice – by maintaining awareness of all relevant issues including:
- NICE guidance and the Quality/Outcomes Framework
- MHRA guidance on devices and implants
- Clinical audit
- Private practice – by maintaining a focus on issues through engagement with FIPO and the BMA.
Committee Chair- In the interests of continuity the Chair is an elected Officer of the Association, normally in the Presidential line, and is selected by the President in consultation with the Executive Group.
- For that reason the tenure of the appointment is usually two years (prior to assuming the Presidency).
- Supported by the CEO, the Chair spearheads the Practice Strategy.
Membership- There are up to eight members in addition to the Chair; the CEO is in attendance.
- The following two constituencies have ex officio representation:
- BODS – as nominated by the BODS Chair.
- BMA CCSC T&O Sub Committee.
- The remaining six members are appointed through an open application process, or by presidential nomination of elected Council members. This ensures an appropriately representative cross section and democratic transparency.
- The tenure of the appointment is three years, with appointments staggered in the interests of continuity.
Meetings- Meetings are held quarterly with support provided by the BOA staff.
- The venue will be determined by the Chair, with maximum sensible use made of telephone conferencing.
Member Job Description- PPC members contribute to development of the BOA’s Practice Strategy in the four areas highlighted above.
- Each member can expect to be assigned lead clinician responsibility for a particular strand of strategy development.
- This is a real opportunity to make a contribution to the profession’s standing.
Person SpecificationEssential: - A real and demonstrable interest in the four areas of strategy development.
- A working knowledge of NICE, the MHRA, GMC and BMA.
- Five years’ experience as a Consultant.
Desirable: - Previous experience as a Clinical Director.
- Previous or current membership of a NICE committee.
Applications Process Applications should comprise a CV and covering letter of one side of A4 setting out how and what you would contribute to the PPC. They should be e-mailed to reach Rosanna Raison, BOA Corporate Affairs Assistant – r.raison@boa.ac.uk by 20 February 2012. |
| Whilst Evidence Updates do not replace current accredited guidance they do highlight new evidence that might generate a future change in practice.
The latest Evidence Update ‘Venous thromboembolism: reducing the risk, Evidence Update February 2012’ www.evidence.nhs.uk/evidence-update-6 focuses on a summary of selected new evidence relevant to NICE clinical guideline 92 ‘Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital’ (2010).
In producing the Evidence Update, more than 2,000 pieces of evidence were searched, of which 25 have been chosen for publication. An Evidence Update Advisory Group, comprised of subject experts (including BOA Council member Don McBride), has reviewed the prioritised evidence and provided a commentary.
Dr Mike Durkin, National Clinical Director for Venous Thrombo-Embolism said: "I am delighted to welcome this Evidence Update from NICE as an important contribution to our National Venous Thromboembolism (VTE) Prevention Programme in England.
It is important to recognise the evidence that has emerged since the publication of the NICE clinical guideline CG92: 'Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital’ (2010) and I would like to acknowledge the clinical experts who have contributed to this Evidence Update led by Professor Tom Quinn
It is national policy in England that all adults receive a risk assessment for Venous Thromboembolism in order to reduce the risk of them developing a blood clot after admission to hospital. This Evidence Update from NICE will help improve our clinical understanding of the most appropriate and effective interventions so that we can continue to save lives and reduce long term disability from Venous Thromboembolism."
By producing Evidence Updates, NHS Evidence seeks to reduce the need for individuals, managers and commissioners to search for new evidence and to inform guidance developers of new evidence in their field.
www.evidence.nhs.uk/evidence-update-6
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| John R Tongue MD yesterday assumed the AAOS presidency with the following words: "We orthopaedic surgeons have the best specialty in medecine. We help everyone - people of all ages, backgrounds and lifestyles. Being able to improve people's quality of life is a very positive experience."
He then focused on the three core messages for his year, all of which have a familiar ring:
- enhancing communication between patients and surgeons - something the BOA is taking forward through our multidisciplinary work on MSK clinical networks.
- using the opportunity provided by healthcare reform to demonstrate the clear societal benefits and added value to national economies of timely orthopaedic interventions - a theme that the BOA has been developing for some time.
- improving patient safety and outcomes through high quality care - an area where the BOA has been very active, engaging closely with NICE and the DH to develop the trauma and orthopaedic element of the healthcare quality agenda. |
| A letter recently sent to all NHS employers has urged that Boards "look favourably upon requests from doctors for absence" in order for them to undertake national work of benefit to healthcare systems across the UK. The full letter can be viewed by copying and pasting the following URL into your browser: http://www.boa.ac.uk/LIB/LIBPUB/Documents/Letter%20to%20NHS%20employers%2023%20January%202012.pdfThe letter was signed by a number of key individuals: Sir Harry Burns, Chief Medical Officer, Scottish Government Dame Sally Davies, Chief Medical Officer, UK Government Dr Tony Jewell, Chief Medical Officer, Welsh Assembly Government Sir Bruce Keogh, Medical Director, National Health Service (England) Dr Michael McBride, Chief Medical Officer, Department of Health and Social Services (Northern Ireland) Sir Peter Rubin, Chairman, General Medical Council
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| The DH has issued a reminder of maximum waiting time right for consultant-led non-emergency treatment. David Flory has written to NHS Chief Executives to re-iterate the expected performance on referral to treatment waiting times in 2012/13 and to set out some of the good practice that should be in place to ensure that performance is maintained, and where necessary improves. The letter specifically highlights orthopaedics.
To see the letter to Chief Executives copy and paste this URL into your browser:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132492.pdf |
| The annual meeting of the BOA Council with the SAC, Regional Advisers and Training programme Directors will take place on Wednesday 25th April 2012 in Lecture Theatre 2, Royal College of Surgeons of England, 35-44 Lincolns Field Inn, Holborn, WC2A 3PE
The provisional programme is as follows:
10:00 Chairman’s Welcome Prof. Joe Dias, President BOA
10:05 Guest Speaker: Prof. Norman Willims - The College View on Surgical Training and Education
10:30 BOA Education Strategy 2012 - introduced by Prof. Tim Briggs
a) Undergraduates, FYs & CTs
10.35 BOA MSK Instructional Course - David Limb
10.40 Orthopaedic Students Network (OSNet) - David Limb & Hussain Kazi
10.45 Career Intention Project - Paul Manning & Hussain Kazi
10.50 Recruitment for CTs - Prof. Simon Frostick
b) Pre CCT
10.55 Simulation - Profs. Damian Griffin & Simon Frostick
11.00 Communication of the Curriculum - Prof. Simon Frostick
c) Post CCT
11.05 BOA Transitional Post CCT fellowship - Prof. Simon Frostick & Hussain Kazi
11.10 E-Learning - Prof. Tim Briggs & Bhaskar Bhowal
d) Nurses, AHP
11.15 Developing the Multi Disciplinary Team - Prof. Tim Briggs
11.20 Primary Orthopaedic Care - Prof. Simon Frostick
11.25 - - - BREAK - - -
11.30 SAC update - Mark Goodwin
11.45 BOTA update - Hussain Kazi
12.00 CoPSS update - Prof. Phil Turner
12.15 Training Programme Directors' Forumupdate - Paul Manning
12.20 Getting the most from the e-logbook - David Large & Mike Reed
12.35 Discussion
12.45 - - - LUNCH - - -
13.15 The GMC Consultation: Recognition and Approval of Trainers - Dr. Vicky Osgood, Assistant Director of PG Education
13.35: Q&A
13.45: Recruitment Process for National Training Programmes - Prof. Tim Briggs & Julie Honsberger, Yorkshire and the Humber Deanery
14.00: Q&A
14.15: Closing Remarks - Prof. Joe Dias, President BOA
For more information please contact the British Orthopaedic Association (BOA) on 02074056507 or corporateaffairs@boa.ac.uk.
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| The DH has just communicated further details of the proposals for clinical networks in the new system and the next steps. The BOA will comment on the proposals through ARMA before the outline plans are presented to the NHS Commissioning Board at the end of March.
NHS Commissioning Board (NHSCB) prescribed networks will be called Strategic Clinical Networks (SCNS). They will be accountable to the NHSCB and kept under review
It is expected that there will be approximately 15 geographical patches in England and there will be an overarching ‘umbrella’ organisation for all SCNs in each geographical patch. Reviews will be carried out every six months by the umbrella organisation to ensure effective network functioning in each geographical patch.
SCNs will be established and reviewed on a five yearly basis. Where they remain purposeful their Terms of Reference will be renewed. Where their work is concluded they will be disestablished.
The criteria for an SCNs being established are:
- A clear link to a national outcome ambition
- The need for a change process and / or co-ordination across complex pathways
- Significant potential for quality improvement through a network model, involving multiple professionals and organisations
- The need for a pan-England approach
- Clear rationale for why quality improvement cannot be driven by another means (e.g. by a clinical commissioning group)
- An assessment of how the absence of a SCN would result in a lack of continuous quality improvement
A major part of the pathway will be commissioned by the NHS CB
Existing clinical networks will be retained providing they meet these criteria
The NHS CB medical director will be responsible for deciding the case for a SCN along with the domain directors. Professional groups, or others, who wish to make a case for a SCN will need to provide evidence that a condition or patient group meets the agreed criteria
Their role will be to:
- Assess need and agree priorities for improvement across member organisations.
- Deliver quality improvement programmes of work:
- Adapting evidence based, best practice pathways for local implementation
- Supporting commissioners and providers with change and pathway co-ordination
- Supporting quality assurance processes
- Publish the outcomes of their programmes of work
Effectiveness will be measured by a combination of process measures (for which SCNs will be directly responsible) and outcome measures, commissioned by commissioners and which are delivered by providers.
National funding will be provided for infrastructure and support initially, moving to a membership model over time.
In terms of next steps, the following timeline is envisaged:
- Comments invited on proposals through webinar on 13th February 2012
- Recommendations presented to the NHS CB before the end of March 2012
- Confirmed plans shared, together with operational detail, in April 2012
- SCNs confirmed mid 2012
- Move to full implementation, including workforce change, aligned to NHS CB transition programme timetable through 2012
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| The BOA’s Medicolegal
Committee has recently been discussing the issue of medical indemnity insurance
policies and, in particular, how insurers are measuring ‘risk’. In order to
gauge the current level of discrepancy and variation that surrounds medical
indemnity insurance policies, the Chairman of the Medicolegal Committee, Martin
Gargan, has devised a survey which he would like to invite all BOA members to
complete. The survey should only take 2 minutes to complete and can be found here: http://www.surveymonkey.com/s/DDBWR22
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| I'm the Chief Executive of the British Orthopaedic Association. This blog will be updated often and is the place to check all of the most recent BOA happenings. |
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