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4.28pm – It’s about striving for success and changing culture. ‘Do remarkable things every day, from today,’ Dr James Kingsland tells conference in his closing remarks. We’re at a fork in the road for the NHS and will never have another chance to rejuvenate the health service in this way again. There’s been a lot of enthusiasm at conference. The biggest mistake would be to waste it. 

4.03pm – Just a few minutes into his speech and he’s got all the delegates on their feet doing breathing exercises. What a man.

3.56pm – We’re back on the blog again just as Olympic swimmer Mark Foster inspires delegates to ‘dive’ into commissioning. 

2.42pm – The session has drawn to a close, and it’s the last one of the conference. Some closing remarks remain – join us again at 4.30pm when we cover those. 

2.39pm – Ross Clark says that GPs and CCGs have a lot to learn from conflict of interest management in the private sector – what’s wrong with declaring an interest, and absenting yourself from certain votes?

2.32pm – Can a practice second a GP to a CCG and invoice that cost back to the process? Sure – though there’s a danger that creating a contract for services, you can create an employment contract by the back door. Watch your values and get a tax efficient arrangement.

2.22pm – Now it’s the NAPC’s HR and legal panel. Contract questions will be especially pertinent to our big new story on the GMS today – read it here. 

1.57pm – Nurses take 2 hours to train, recruitment takes 30, and daily monitoring takes just 10 minutes a day, Dr Choudry reports. Net savings were £900 August-present for one practice using telehealth; three machines cost £5,100, but they helped patients avoid hospital admissions (estimated total £6,000) and appprox two hours of GP home visit time. 

1.50pm – NHS Croydon’s criteria was a GP/consultant’s approval of a patient, the patient undergoing one non-elective admission in the last 12 months, and a reasonable standard of English. It was also emphasised that telehealth was not an emergency service. 

1.40pm – Dr Choudry’s wanted to use telehealth to reduce home visits and appointments, and improve the quality of telephone triage and patient satisfaction. For patients, they anticipated improved independence, clinical support and psychological health, as well as quality of life.

1.30pm – Over to Dr Saeed Choudry’s session on telehealth now – he’s a GP in Croydon with experience managing long-term conditions through telehealth in particular.

1.20pm – What do audience members want to see in the Future Forum report? One says she thinks it needs to be recognised how cost-effective general practice is. He responds that there seem to be unacceptable variations in care and that PCTs and CCGs need to create a better offer for patients. 

1.15pm – Lots of good questions being asked about revalidation, especially one about returners (often women returning from maternity or young people returning from travelling). Field says he’s flagged that youngsters and those who’ve taken a career break are finding it hard to get back in – some are put off entirely. He argues that nurses have an even harder time returning to general practice too. Delegates are encouraged that the issue’s been flagged.

12.45 – Professor Steve Field’s running a lunchtime session on commissioning and registrars – we’ll be liveblogging that before the afternoon streams.

10.40 – Audience agrees CCGs needs geographical boundaries, and also feels that the £25 a head running cost is unreasonable. Room votes that health and wellbeing boards will be CCGs’ best allies. Now we’re logging off for coffee! Back in half an hour. 

10.38 – Field calls for more integrated care such as mental healthcare and care for the elderly – ‘We’ve got to make local solutions work – it’s about people trusting one another, building up those relationships.’

10.18 – Is a budget of £25 per head reasonable? Prof Edwards says he feels an admin cost of that size encourages CCGs to merge. Prof Field says to get innovative, and recommends collaboration and networking to make the most of the money. 

10.04 – Prof Corrigan very critical of plans for health and wellbeing boards – feels they won’t sit well with local authorities. Furthermore, both the board and the LAs will want to shape the authorisation of CCGs to truly suit local populations. But localism takes faith and hard work, he warns. Secondly, CCGs will need to have a good relationship with patient groups to get the powers they want from the National Commissioning Board.

9.58 – Prof Steve Field obviously convinced by the need to change the NHS to suit the changed population – not simply for older patients, but also for the much larger child population we have now. 

9.56 – Prof Edwards’ bugbear, it seems, is bureaucracy – he feels it’s not being reduced in the way politicians have promised it would. He also doesn’t feel we can ever kick off centralism

9.46 – Now it’s time for a debate with Professor Paul Corrigan, consultant and health adviser to the previous government, Prof Nigel Edwards, a senior fellow at the King’s Fund, and Prof Steve Field, chair of the NHS Future Forum. The big question: ‘Is clinical commissioning set for success?’

9.36 – The floor’s open to questions now. One GP compliments Mr Lansley on the reforms but asks, ‘Why has 111 implementation been so top-down?’ The health secretary remarks that the GP will have the power to commission 111 and urgent care himself, choosing his own provider and even software for handling local emergencies. 

9.33 – Closing remarks: this is about clinical leadership and cultural change, not the bill. Mr Lansley talks about sharing objectives and the shared journey he’s taking with healthcare professionals now.

9.28 – ‘You have a responsibility to retain the best staff for patients’, Mr Lansley says, and the emphasis is clearly on PCT and former PCT staff.

He also announces a new draft document on commissioning support, with final guidance following by the end of the year. 

9.23 – CCGs will have £25-35 running costs per head, and can hire the staff they want, Mr Lansley has announced. He accepts that CCGs will directly employ some but partner other local groups to work together in clusters. He promises public health expertise will not be lost to commissioners. The emphasis is most definitely on partners to court CCGs – ‘offer’ being the operative word in this segment.

9.19 – He’s turned to the GP-patient relationship, citing it as the basis for making population health decisions, but he agrees tools such as tariff development and quality frameworks are ‘vital’ if GPs want to select the best treatments and pathways. 

9.14 – The health secretary’s keynote speech today is on ‘Leading the implementation of NHS modernisation. He’s currently explaining what primary care providers have in common with him – his message is one of shared responsibility with him – duty of care, and duty to reform the health service if it improves care for patients. 

Wednesday 9.12 – We’re back in Birmingham for Day Two of the NAPC conference 2011. Andrew Lansley MP has taken to the stage, and as yesterday if you want to join the conversation on Twitter, you can use the hashtag #NAPC.





5.00 – We’re signing off now but we’ve left you with a video interview featuring Dr James Kingsland. Watch it here – we’ll be back tomorrow. 

3.00 – In a discussion on managing practice risks at the NAPC conference in Birminingham, Julie Wilson, clinical risk programme manager at the Medical Protection Society, said GPs should not be contacting patients to remind them of appointments or advise them without receiving explicit consent first due to confidentiality issues. Full story here. 

1.00pm – Afternoon sessions now taking place – we’ll be back with more updates later

12.30 – Leading medical accountant and Pulse regular Bob Senior tells GPs to ensure partnership agreements are up-to-date to avoid legal disputes. He says GPs will be less tolerant of partners that refuse to change because of financial penalties that could ensue through CCGs.

11.40 – Practical Commissioning editor Sue McNulty is on the conference floor and said she found Sir David Nicholson’s speech ‘interesting’: ‘He spoke of need for GPs to be accountable officers, that there are discussions on how CCGs can be more involved in primary care commissioning and how, while the focus so far has been on commissioning, the “radical bit” will be the impact of the reforms on provisions.’ What did you make of it? Let us know in the comments.

11.06 – Question time…

10.56 – Sir David warns that decisions in commissioning will be tough – he cites the news stories about Barking and Redbridge as examples of that criticism beginning already. ‘You’ll find yourself in town halls debating this – very tough to do, faced with your local population,’ he says. Something for delegates to look forward to?

10.51 – Sir David has just announced that budgets for CCGs will be out the week after the operating framework is published and that the Government is prepared to look again at the feasibility of having local consultants on CCG boards, as long as they can demonstrate no conflicts of interest. Full story here.

10.41 – Authorisation may seem technical but it’s not just jumping through hoops, he continues. It’s a mechanism to help you feel confident you can commission well for your population in the future. The faster the better, he adds – that way patients will feel the benefit sooner.

10.37 – Reforms will not work unless the centre of gravity in primary care is moved out locally, Sir Nicholson says, and it’s vital CCGs do that. Relationships are key to the NHS of the future.

10.33 – Sir David now turns to long-term conditions and the 10 million patients who cope with them. He predicts an explosion of health data – some of which, he says, will be really helpful. Peer support and discussion are the most powerful mechanism for change, he says.

10.31 – ‘The NHS is going to have to live within its means for the next few years – and you don’t need me to highlight the significance of that’, he tells conference. It’s a real challenge, he says, the kind of which the NHS has never faced before. Quality, productivity and prevention should be the health service’s keywords.

10.27 – He vacates the stage for Sir David Nicholson, the chair Hartley-Brewer introducing him as a man ‘once said to be able to crack walnuts with his eyelids’…

10.26 – The NHS leadership focus should be on partnership, he reiterates, a strong service based on strong links.

10.20 – Now onto the NHS Commissioning Board, Dr Marshall puts the emphasis on localism over a one-size-fits-all model. He wants CCGs to enjoy more autonomy than the PCTs had. The NHS Commissioning Board needs to be accountable to CCGs. The NAPC has been working with the NHS Alliance to make its voice heard. It’ll publish a good governance report for CCGs later this year in partnership with the King’s Fund.

10.14 – Dr Marshall says he felt the reforms were necessary – and that cultural change will be too. He calls for a move to collective responsbility must be pursued through building new relationships. Practices in partnership will be the foundation for CCGs, he continues. ‘The practices ARE the CCGs and the CCG is the practices – anything less risks recreating PCTs’. Read the full story here.

10.12 – Dr Johnny Marshall, the NAPC chair, takes to the stage. His opening address focuses on building relationships, he says a key skill in the new commissioning-led world of primary care provision.

10.09 – Julia Hartley-Brewer kicks off proceedings – if you’re at the NAPC, you can Tweet your thoughts to the bigger conversation using the hashtag #NAPC.