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Health outside hospitals: your chance to lead in healthcare

Marilyn Eveleigh
Consultant Editor

Watch out for the new white paper on primary care entitled Health Outside Hospitals due out in the next few months. Contents are vague at present but you can guarantee it will impact on your life, either as an employee or as a patient.
If I were to make a prediction about content and direction in the document, it would be that the virtual monopoly of healthcare being provided by the NHS will be challenged. More private providers of health services will be encouraged.
The provision of general practice may not remain with traditional GP partnerships. Be prepared for private companies taking on the national service that is traditionally delivered by an independent GP partnership  - and employing appropriate staff to deliver the service to patients. Staff, be they doctors, nurses or practice managers, are employed by the private company, and conditions and remuneration of these contracts will reflect the local market forces.
Sounds attractive? Well, there may be more to interest you in the white paper. It is rumoured that there will be a bigger push for others who are not GPs to set up as alternative providers of medical services (APMS) that offer alternative or specialist services. These will be supported with incentives to encourage the move to provide more healthcare outside the hospital setting by alternative providers such as specialist nursing teams. I can see leg ulcer management, COPD rehabilitation and even allergy management being well suited to such a service. Elective minor surgery, endoscopy and anticoagulant management are also possible options for a nurse-led service.
Personal medical services (PMS) provision by GPs has been around since 1997, and a significant number of practices work under this option, providing healthcare tailored to local need. Only a handful of these are led by a nurse or nonmedic. Setting up a PMS if you are not a GP is pioneering, financially difficult and does not always appear to have the encouragement of the PCT. But I predict that this white paper will offer some key challenges to PCTs and innovators to make this easier.
Since the new GMS contract was introduced in 2004, local enhanced services across the country have used GPs to provide the care for identified patient groups, offering specialist care away from hospital in a practice or community setting. I predict such local enhanced services will be encouraged and offered to private and independent providers on the back of this white paper.
Nurses - I think that you should be prepared! If you have a vision, the energy and the business acumen to run a service in healthcare, this government will be interested - just as they will be in established private national and international healthcare companies.
I sound like a fortune teller with all my crystal ball predictions! What I'm not so confident about predicting is the role of primary care trusts, which is being debated at the present time. The move towards practices commissioning the care they want for their patients and the separation of the healthcare provider function of a PCT will mean the map of 302 PCTs will change.
Well, that's just the way of the NHS - changes and challenges!