Vol 8 No 9 p237
October 2001

Review of circulars and official publications
by Alex Bower, MRPharmS

The NHS in England is undergoing further major organisational change. Details were set out in "Shifting the balance of power within the NHS; securing delivery" which was issued by the Department of Health in July. The existing 95 health authorities and eight regional offices will be abolished. The new structure will replace these with four new regional directors of health and social care, about 30 strategic health authorities (SHAs) each covering a population of about 1.5million, and about 150 primary care trusts (PCTs). SHAs will be responsible for the performance management of PCTs and NHS trusts, and will take the lead on strategic development of the local health service. PCTs will become the lead organisations in assessing health need, planning and securing all health services and improving health. PCTs will have responsibility for medical, dental, pharmaceutical and optical primary care services. NHS trusts will continue but will be expected to devolve greater responsibility to clinical teams, and to encourage the development of clinical networks across NHS organisations. SHAs will be in place by April, 2002, with other changes being completed by 2003.

The document can be accessed here. In addition to the changes indicated, other organisational changes may be under way, depending on the local situation. These include the transfer of functions from community trusts into PCTs, new arrangements for the provision of mental health services, the formation of care trusts and perhaps mergers of local acute trusts.

Hospital pharmacists are increasingly becoming involved in working on prescribing issues across the primary/secondary care interface. This work will remain important but it may now be necessary to adapt in order to work with the new organisations and individuals involved.

It is recognised that the organisational changes indicated will have significant implications for staff. Reference is made to further guidance which was issued at the same time entitled "Shifting the balance of power; securing delivery — human resources framework". This sets out arrangements for the filling of posts in the new structures. Many staff will be displaced by the new arrangements but every effort will be made to avoid redundancies and ensure that valuable skills and experience are not lost to the service. Permanent staff who have not secured a post in the new organisations by April, 2002, will be transferred to the new SHAs on a temporary basis for 12 months until their future arrangements are secured.

Continuing the theme of organisational change, attention is drawn to a document issued in March, this year, on "Care trusts; emerging framework" which can be accessed here. Care trusts will work across organisational boundaries and can be formed following an accepted joint application by local councils and a NHS body such as a PCT. The bodies should enable services such as health and social care to be better integrated and so improve patient care. The document recognises that policy about care trusts is still being developed but sets out the process by which applications can be made.

Many hospital pharmacists will be involved in implementing guidance on drugs from the National Institute for Clinical Excellence (NICE). In this respect, the publication issued in July by the National Prescribing Centre and entitled "Implementing NICE guidance: a practical handbook for professionals" will be of value. This sets out the steps involved in implementation and those who might need to be involved. Examples of approaches taken across the NHS are given, and a range of checklists and aids which can be tailored to specific circumstances are included. The variations which now exist in organisational structures within the NHS mean that it is not possible to promulgate a single framework to indicate how NICE guidance should be implemented. Each organisation needs to develop its own approach but the publication will be helpful in this respect. A structured framework is essential to ensure that NICE guidance is appropriately considered and implemented. Where this does not already exist, hospital pharmacists should consider whether they should initiate or lead a piece of work to put this in place for their NHS trust.

"Modernising regulation in the health professions: consultation document" was issued in August, and is available here. It is considered that there are weaknesses in current arrangements.These need to be addressed by reforms to the regulatory bodies, better co-ordination of their work and more robust accountability mechanisms. The document notes that the Royal Pharmaceutical Society of Great Britain (RPSGB) is considering new powers to improve fitness to practise procedures. The government proposes to create a council for the regulation of health care professionals to ensure that regulatory bodies act in a consistent manner. The regulatory bodies, including the RPSGB, would be accountable through the council to Parliament. The possibility of council functions extending to education, training and development is being considered. Responses were sought by September 30.

Mr Bower is assistant director of strategic development at Wakefield Health Authority