Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
is that commissioning is replaced by service planning
and delivery by the health boards representing seamless
working between primary and secondary care. Social
services remain outside the NHS in Wales. Specialist
andtertiaryservicesarenowplannedcollaboratively
by these organisations through a body called the Welsh
Health Specialised Services Committee.
In Scotland, the ultimate responsibility for the NHS
(NHS Scotland) has been with the Scottish Parliament.
The Scottish Government Health Directorates have
strategic responsibility for NHS Scotland as well as
directing and implementing health and community care
policy. They provide the statutory and financial
framework and hold NHS Scotland to account for its
performance. Currently 14 NHS boards plan and
provide services and concentrate on strategic leadership
and performance management across the local NHS.
There is not the sharp distinction between purchasers
and providers that exists in the English NHS, so there is
no internal market or commissioning in healthcare in
Scotland. Seven special health boards provide services
nationally for such things as training Scotland’s
workforce (NHS Education Scotland) or quality
standards (Healthcare Improvement Scotland).
Community health partnerships have been set up to
manage primary and community health services and
forge partnerships with local authorities and the
voluntary sector – every board has one.
The Royal College of Physicians of Edinburgh and the
Royal College of Physicians and Surgeons of Glasgow
work on professional issues in Scotland and seek to
influence health policy there. Together with the Royal
College of Physicians of London they form the
Federation of the Royal Colleges of Physicians of the
UK, which oversees the training of doctors.
The systems in the different parts of the UK are
increasingly different, but the RCP is committed to
working for high-quality care in whatever system is
provided. Although commissioning/planning
arrangements are different in different parts of the UK,
the principles of a quality service will be the same.
The descriptions of the specialties in Chapter 2 can be
modified to apply to the different parts of the UK.
Even if there is no formal separation of the purchaser
and provider, services still have to be planned and the
principles of a high-quality service applied.
4
New ways of working
One development in all parts of the UK has been ‘Care
closer to home’, 8 with some services moving from
hospitals into the community. Where there has been
active partnership between commissioners/planners,
GPs and consultant physicians, evidence suggests that
these initiatives have been productive in developing new
services for patients and new ways of working for the
future. 9
Financial environment
After a decade of growth in funding, the NHS is facing
future years of austerity, as the settlement on the health
services will amount to zero growth. As there has always
been upwards of 3% year-on-year increases for the
health service budget, this means that in order to cope
with inflation and rising demand, £20 billion of
efficiency savings have to be made in England over the
next 3–4 years. This will prove very challenging, and
need all the resources of professionals, working closely
with managerial colleagues to redesign systems of care
which are more efficient and less costly. Services which
are patient focussed, have less duplication and less
waiting can be more cost effective but this is a huge
challenge – the alternative is indiscriminate cuts and a
lowering in quality.
Medical education
Arrangements for medical education have recently
changed. Regulation of postgraduate medical education
has been moved to the General Medical Council (GMC)
from the Postgraduate Medical Education and Training
Board (PMETB). The application system for medical
trainees and the allocation of trainees to training
programmes is now running more smoothly, after the
debacle of the original implementation of Modernising
Medical Careers. The recommendations of the Tooke
enquiry 10 have been implemented and the RCP has led
the way in making access to training in the medical
specialties a smooth and fair process. In England, there
is a government consultation on new proposals for the
organisation of medical education, with more local
involvement from health service providers. It is
important that the medical workforce and education is
planned with an overall national strategy and the RCP
will be closely involved in trying to ensure that any new
C○ Royal College of Physicians 2011