NHS reforms : the first six months / foreword by Duncan Nichol.

  • NHS Management Executive.
Date:
[1992]
Catalogue details

Licence: Open Government Licence

Credit: NHS reforms : the first six months / foreword by Duncan Nichol. Source: Wellcome Collection.

    17/24 (page 15)
    Medical and clinical audit A systematic programme of medical audit was set in train by the NHS reforms to improve and maintain standards in clinical practice. For 1991/2, £41 million was allocated to regions (on top of £24 million last year) to get the organisational framework for medical audit in place. Patients and populations will benefit from more patient-centred audit of all elements of care. Early examples of work in hand includes activity in Wandsworth to link health gain, contracts and medical audit in relation to prostatectomies and laparascopic procedures. There are also a number of nursing initiatives in train, in particular standard setting and organisational audit of nursing services. The therapy professions, too, are developing initiatives. Indeed, audit should be seen as an integral part of the work of everyone involved in health care delivery. The indicative prescribing scheme The indicative prescribing scheme came into effect on 1 April 1991. It aims to encourage all GPs to improve the quality and effectiveness of prescribing. The scheme is supported by a number of educational initiatives to help get the most out of the £2 billion-a-year drugs bill. The scheme has built-in safeguards to take account of patients who are old or need expensive medicine, and there is no question of vital medicines being withheld. The data available after six months indicate that the indicative prescribing scheme is working well. Integration of primary and secondary care The NHS reforms made RHAs responsible for family health services as well as hospital and community health services, so that the NHS has for the first time the management structure to make the integrated planning and purchasing of all health care a reality. RHAs are now able to take an overview of the provision of total health care and ensure DHAs and FHSAs work together in securing high quality seamless care for patients to meet local health needs. Examples of the ways in which integration is achieving improved services for patients include: e in many places GPs and hospital clinicians are agreeing protocols to enable services previously only provided in hospital (such as the management of diabetes, asthma and psychiatric care) to be transferred to the community; e the elimination in many places of unnecessary journeys to outpatient departments and unnecessary duplication of diagnostic tests that too many patients experience; and hospital discharge arrangements being improved; ¢ more joint working between DHAs and FHSAs. For example DHAs and FHSAs in both Doncaster and Bromley have made joint general manager appointments; Cambridgeshire FHSA and the three local DHAs have established joint purchasing boards. 1