Management consultants in healthcare do more harm than good, but keep getting rehired – new research

Management consultants in healthcare do more harm than good, but keep getting rehired – new research
The Conversation 17 February 2021

• An examination of the use of management consultancy in the NHS.

A consultancy habit? The use of external management advice in the NHS

A consultancy habit? The use of external management advice in the NHS
University of Bristol December 2020

• The use of paid management consultants in the NHS has become habitual despite having a negative impact on efficiency. This inflation of demand for consulting services occurred even when they failed to improve performance. The research, published in the journal Public Administration, builds on previous work which showed that consultancy use in the NHS leads to inefficiencies. The new findings help to explain why this is the case and why using consultancy remains a popular, but frequently harmful habit.

Next Steps of Integrated Care: Next steps to building strong and effective integrated care systems across England

Next Steps of Integrated Care: Next steps to building strong and effective integrated care systems across England
NHS England/Improvement 26 November 2020

• A consultation document setting out proposals for operational direction of travel for Integrated Care Systems. It also opens up a discussion with the NHS and its partners about how ICSs could be embedded in legislation or guidance.
• Consultation closes 8 January 2021. See https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

More accurate general practice appointment data – guidance

More accurate general practice appointment data – guidance
NHS England 10 August 2020

• This guidance introduces an agreed definition of an appointment, and asks general practice to start applying this now and systematically, as an important first step to improve data quality. The guidance reconfirms that the definition of an appointment includes:
• 1. ALL RELEVANT STAFF. Discrete interactions carried out by any health or care professional, including all roles in the Additional Roles and Reimbursement Scheme (see detail on next page)
• 2. ALL MODES. Discrete interactions that are delivered by all modes - face-to-face, by telephone, via video and online
• 3. ALL SETTINGS. Discrete interactions in any primary medical care setting (including the practice, patient’s home, community, care home, group consultations, local GP extended access hub)

Patient-initiated appointment systems: an alternative for hospital outpatient care?

Patient-initiated appointment systems: an alternative for hospital outpatient care?
PenARC Evidence Synthesis Team 23 April 2020

• Patient-initiated appointment systems (PIAS) enable patients to request a medical appointment when they feel it is needed and could reduce the number of those appointments allowing flexibility in the outpatient health care system. 
• A review of the evidence in 17 RCTs suggest that PIAS may have little or no effect on patient anxiety, depression and quality of life compared to consultant‐led appointment systems. Aspects of disease status, adverse events and patient satisfaction also appear to show little or no difference. There may also be little or no effect on service utilisation in terms of contact with health services but there is uncertainty about the impact on costs. Areas for further research include variations in the benefits and experiences of PIAS due to population characteristics and conditions.

The health commissioner perspective. 14 May 2020

Public engagement in relation to NHS service reconfiguration.

Public engagement in relation to NHS service reconfiguration. 
Mills & Reeves 3 February 2020

• Discussion of a judgement where the appellant sought to argue that two CCGs had breached the statutory duty to involve the public at section 14Z2 NHS Act 2006 (because the consultation needed to have taken place before the “retain services” option was discarded which had been done in committee) and that the consultation exercise undertaken by the CCGs was unlawful because it did not include consultation on a ‘do nothing’ option / did not explain why it had been rejected.

Online consultations implementation toolkit

Online consultations implementation toolkit 
NHS England updated January 2020

• This guide aims to support those individuals implementing online consultations as part of their role - in practices, within PCNs, CCGs or other organisations, with the successful adoption and seamless integration of online consultations alongside face to face and other services.

Advancing our health: prevention in the 2020s - consultation

Advancing our health: prevention in the 2020s - consultation document
Cabinet Office and DHSC 22 July 2019

• The DHSC prevention green paper to "help people live healthier, happier lives for longer" is now open for consultation. Online survey. Closing date 14 October 2019.
• Proposal highlights:
• We are:
• embedding genomics in routine healthcare and making the UK the home of the genomic revolution (new National Genomics Healthcare Strategy in autumn 2019.)
• reviewing the NHS Health Check and setting out a bold future vision for NHS screening
• launching phase 1 of a Predictive Prevention work programme from Public Health England (PHE)
• We are:
• announcing a smoke-free 2030 ambition, including options for revenue raising to support action on smoking cessation
• publishing Chapter 3 of the Childhood Obesity Strategy. In addition, driving forward policies in Chapter 2, including ending the sale of energy drinks to children
• launching a mental health prevention package, including the national launch of Every Mind Matters
• We will:
• launch a new Composite Health Index to help us track the health of the nation, alongside other top-level indicators like GDP, including a decade of active ageing
• modernise the Healthy Child Programme
• consult on a new school toothbrushing scheme, and support water fluoridation

Digital-First Primary Care consultation

Digital-first Primary Care: Policy consultation on patient registration, funding and contracting rules
NHS England, consultation closes 23 August 2019

• Engagement on proposals and options to:
• Change how the system works to ensure the money follows the patient;
• Make it easier for existing GP surgeries to expand and improve their own digital services;
• Ensure that digital-first providers can register new patients in areas where people can’t currently access digital GP services.
• Supporting document Digital-First Primary Care

GP video consultation provider, LIVI, launches in the NHS

GP video consultation provider, LIVI, launches in the NHS
Digital Health 29 October 2018

• Online GP consultation provider LIVI  offers a way to book GP consultations via smartphone or tablet.
• As the largest digital primary care provider in Europe, LIVI has already delivered over half a million GP consultations for patients. It is now available via the NHS to patients registered with GP practices in North West Surrey and the North West of England. Once signed up to LIVI, patients can speak to experienced GPs who can provide medical advice, prescriptions, fit notes and referrals.

Consultation on contracting arrangements for Integrated Care Providers

Consultation on contracting arrangements for Integrated Care Providers (ICPs)

NHS England 3 August 2018

• The consultation provides more detail about how the proposed ICP Contract would underpin integration between services, how it differs from existing NHS contracts, how ICPs fit into the broader commissioning system, and which organisations could hold the ICP Contract.
• Consultation period runs from 3 August to 26 October 2018.
• Documents include:
• The Draft ICP contract
• Particulars
• Service Conditions
• General Conditions
• Explanatory notes to the draft ICP Contract
• Draft Directions
• Draft template GP Integration Agreement
• GP Integration Agreement FAQs
• Draft Equality and Health Inequalities Analysis
• CCG roles where ICPs are established (clarification of the policy positions around: whether ICPs are allowed to manage third party contracts; and the handling of Individual Funding Requests.
• An overview of integrated budgets
• Incentives framework for ICPs

Developing the NHS long term plan: evidence based interventions

Developing the NHS long term plan: evidence based interventions
NHS England Board paper 4 July 2018

• NHS England will consult on the Evidence-Based Interventions programme, developed and jointly led by NHS England, NICE, NHS Improvement, the Academy of Medical Royal Colleges, and NHS Clinical Commissioners. 
• The focus of the programme is on surgical interventions commissioned by CCGs, where there was high variability in the application of clinical guidelines. 
• Priority was given to changes which could test the approach and implement relatively quickly on a large scale. 
• The consultation proposes that four interventions (Category 1) that should no longer be routinely commissioned by CCGs unless accompanied by a successful Individual Funding Request (IFR) and 13 interventions (Category 2) that should only be commissioned by CCGs or performed when specific evidence based clinical criteria are met. It is proposed that Category 1 interventions will be set at zero tariff in National Tariff without a successful IFR. 

Planning, assuring and delivering Service Change for Patients

Planning, assuring and delivering Service Change for Patients
NHS England updated 22 March 2018

• A good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration (including decommissioning).
• It sets out how new proposals for change are tested through independent review and assurance by NHS England, taking into account the framework of Procurement, Patient Choice and Competition Regulations. 
• CCGs are under a statutory duty to have regard to this guidance.

Public voice in health service transformation

Major health service transformation and the public voice: conflict, challenge or complicity?
Journal of Health Services Research & Policy 2017 p 1–8

• Report of research into the design and function of public involvement in two health service “transformation” programmes through interviews with public and professionals, as well as observation.

Abstract

Consultation on Managing Conflicts of Interest in the NHS

Managing Conflicts of Interest in the NHS: A Consultation
NHS England 19 September 2016

• Proposals for change to the way in which conflicts of interest in health are managed to support the increasing collaboration and partnership working between public, private and third sector bodies.
• The consultation period is open from Monday 19 September 2016 to Monday 31 October 2016.

Engaging local people - a guide for teams developing STPs

Engaging local people: A guide for local areas developing Sustainability and Transformation Plans
NHS England 15 September 2016

• This document is for teams developing STPs in each of the 44 footprint areas, and the statutory organisations which form part of them. It is intended to clarify the expectations on stakeholder involvement, in particular patient and public participation. It also covers legal duties around engagement and consultation and will be of particular interest to communication and engagement leads for STPs and footprint leaders.

Court rules that a CCG’s consultation was “extensive and fair”

Court rules that on CCG’s consultation around decision to cut the numbers of community hospital inpatient beds.
Mills & Reeve 9 March 2016

• A High Court judge has refused an application for permission to bring a judicial review, brought by a claimant challenging a CCG’s decision to cut the numbers of community hospital inpatient beds. 
• Grounds for refusal included delay in application and lack of evidence to indicate that the decision-making process was illegal or irrational and therefore the Court would not be used as a tool for re-taking the CCG’s decision.
• "This case underlines the importance of making sure that controversial proposals are clearly and openly aired in a public consultation process that reaches those who may be affected by the changes."

Call to action for General Practice

Improving general practice – a call to action 
NHS England, 14 August 2013

• As part of  the wider ‘The NHS belongs to the people: a call to action’ (11 July 2013) NHS England is seeking views to help shape the future of general practice services in England.
• The survey is open for feedback and comments until Monday 30 September 2013.
• Also included:
• A Slide pack – which describes the case for change and our underlying objectives for general practice.
• An Evidence pack – with information about current general practice and health needs, including maps demonstrating variation across England in a range of areas including patient need, increasing demand, patient experience and access, pressures in secondary care, Inequalities and variation, and workforce variation.
• "CCGs should help develop general practice" 
• Read the comments of Dr Mike Bewick  (NHS England deputy medical director) speaking at a conference on GP federations run by Newham CCG and the RCGP 4 Sept 2013 in gponline. 

Identifying Commissioners’ Learning Needs - a survey

Identifying Commissioners’ Learning Needs
Family Doctor Association, 31 July 2013

• "A snapshot survey (n=66) of health service commissioners, Commissioning Support Unit leads and primary care leaders, reveals the impact of the new system on their unique roles, the challenges they face and suggestions for meeting their learning needs."
• "The respondents highlighted financial sustainability, meaningful stakeholder engagement especially with GPs practices suffering from change fatigue, and questioned the sustainability of the system in the long term."
• Questions included:
• How has your role changed?
• Greatest challenges in 2013/14
• Commissioning learning needs: local or national content?
• Does pharmaceutical sponsorship influence your decision to attend an event?
• What types of event are of most value to you?
• The poll carried out at the Commissioning Show, June 2013 in London.

Health and wellbeing boards - statutory guidance and consultation

Health & Wellbeing Boards statutory guidance
DH, 17 July 2013

• Guidance for health and wellbeing boards including a Summary table of the duties and powers and response to the consultation July to September 2012.