How radical was the Future Forum?

Susie Sell reports on how health professionals reacted to the NHS Future Forum's proposals for healthcare reform.

Andrew Lansley: Future Forum report offers a 'genuinely valuable contribution' to government policy
Andrew Lansley: Future Forum report offers a 'genuinely valuable contribution' to government policy

Right from the outset, NHS Future Forum chairman Professor Steve Field promised to come up with 'radical ideas' for his second report on how the NHS should evolve.

But when the report emerged last week, there were mixed feelings about whether this objective had been achieved.

Much of the report reiterated long-standing debates in the NHS, such as plans for practices to federate and to extend GP training.

But sections did suggest a radical departure from the status quo, particularly the recommendation that the GMS contract should be used to incentivise integration (GP, 11 January).

Nevertheless, the government was impressed, backing all of the proposals included in the report. Health secretary Andrew Lansley says the report offers a 'genuinely valuable contribution' to government policy and has committed to work to ensure all of the proposals become a reality.

But GP leaders say the key marker of its success will come from measuring how the proposals are implemented.

GPC deputy chairman Dr Richard Vautrey says: 'We have seen many of these reports come and go and one of the themes is what will actually happen in reality.

'Much of what is in this report is not rocket science and appears quite straightforward. But delivering it could be another matter altogether.'

Here GP takes a look at how GPs and other health experts reacted to proposals in each of the report's four workstreams.

Integration

Proposals

  • Overhaul GP contract to promote integration.
  • Look at ways to pool health and social care budgets.
  • Clinical commissioning groups (CCGs) must show ability to integrate before being authorised.

Reaction
The DH has backed the NHS Future Forum's recommendation to update the GMS contract to encourage integration, but GP leaders remain unconvinced. GPC deputy chairman Dr Richard Vautrey says using the contract to encourage integration is the 'wrong way to go about it'. He says many practices already have arrangements in place to work together. He says: 'There isn't a need for contractual change. It would also bring into question the independence of individual practices, which is what patients value.'

Meanwhile, Wessex LMCs chief executive Dr Nigel Watson says it is right that CCGs demonstrate an ability to integrate before they are granted full statutory powers. But he says it is inappropriate to pool health and social care budgets. He says joint commissioning should only be carried out on certain services. 'There are insatiable needs for both health and social care and the concern would be how you would control that if whole budgets were pooled,' he says.

 

 Public Health

Proposals

  • 'Make every contact count' and use every consultation to promote healthy lifestyle choice.
  • Build promotion of healthy living into day-to-day NHS work.
  • Strengthen public health QOF indicators.

Reaction
RCGP chairwoman Dr Clare Gerada was the first to voice her concerns about the 'make every contact count' proposals. She remains unconvinced by the evidence for the proposals and says lecturing on lifestyle choices may deter patients from making appointments.

'There's some evidence for low-level drinkers and for smoking that brief intervention works,' she says. 'But for exercise and obesity the evidence is minimal. We need a population-based approach - looking at issues such as pricing and advertising.'

But Jo Webber, NHS Confederation deputy policy director, agrees that the NHS needs to focus more on prevention.

'Healthcare professionals can play a big role in encouraging healthier lifestyles through their day-to-day contacts with patients,' she says. 'They need to think about preventing the next health problem as well as dealing with the illness that is in front of them.'

 

 Information

Proposals

  • All patients to have access to medical records by 2015.
  • Hospital discharge summaries made available to GPs.
  • Use patient comments on all forms of social media as means of improving services.

Reaction
Dr Vautrey says that while most patients already have access to their records, the plan to allow them to access and edit records online raises a number of security issues.

'It's a principle that I generally support, but there are a number of issues around actually developing a system that is safe and appropriate,' he says.

Dr Watson also casts doubt on whether it is a service that patients genuinely need. He says: 'There are things in the patient record that are sensitive and I don't find an overwhelming desire from patients who want to look at their full record and make notes on them.

'It would be far more appropriate if the NHS focused its energies on ensuring all GPs get discharge summaries from hospitals.'

Dr Vautrey also says proposals to use patient comments on Twitter and Facebook to inform how services should be improved should be handled with caution.

'We would get very skewed results if we simply relied on these comments. We must ensure we get a balanced view rather than just hear from those who shout the loudest,' he says.



Education

Proposals

  • Extending GP training should be looked at as a matter of urgency.
  • More flexible NHS career pathways.

Reaction
The issue of extending GP training has been rumbling on for many years, but it now looks likely to be thrust into the spotlight again. The DH has backed the NHS Future Forum's call for the issue to be looked at as a 'matter of urgency'. Unlike other recommendations, this call has received unanimous support.

Dr Watson says extending GP training must not just result in 'extra hurdles or exams' for trainees. 'It must allow trainees to get better exposure to different patients and have the protected time to learn from that,' he says. 'It must also offer experience in commissioning and leadership.'

Dr Watson welcomed the fact that the report did not specify how long GP training should be, as it is unlikely it would be extended to five years in the present economic climate. 'It means it can be up to negotiation and could be extended to four years,' he says.

 


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