Annex B
The Department is "keen" to see NHS
spend rise to match the EU average of 8 per cent of GDP. This
is the unweighted, arithmetic mean of EU countries' percentage
spend. The weighted mean, calculated by the OECD, was 8.7 per
cent in 1997. Both of these figures are a moving target—as
the UK's expenditure on healthcare increases, so the European
average will increase. Will NHS funding continue to rise to follow
this moving average? If not, will future NHS funding be based
on the average spend of the EU outside the UK (9.1 per cent in
1997)?
The Government's aim is to move towards the
EU unweighted average health care expenditure of 8 per cent, as
calculated by the OECD. The resources announced in the latest
Spring Review will increase UK average health care expenditure
as a percentage of GDP to an estimated 7.6 per cent by the year
2003-04. Decisions on future spending will be taken at the next
Spending Review.
— The EU average is sensitive to changes
in health care expenditure in all EU countries, not just to UK.
The EU average can fall as well as increase. The latest data actually
suggests it is lower now than it has been since 1991 (see table
1). The Government will make decisions about future health care
expenditure at the next Spending Review.
Table 1
AVERAGE EU HEALTH CARE EXPENDITURE AS A PERCENTAGE
OF GDP 1991-97
|
| Year | 1991
| 1992 | 1993
| 1994 | 1995
| 1996 | 1997
| 1998 |
|
EU average health
care expenditure as a
percentage of GDP
| 7.91 | 8.17
| 8.29 | 8.15
| 8.11 | 8.21
| 8.04 | 7.99
|
|
8. Personal Medical Services (PMS) Pilots
The NHS (Primary Care) Act 1997 allows those who wish to
have the flexibility to explore the different models for the provision
of "Personal Medical Services" (PMS), to test the practical
implications of these models and the benefits they could bring.
"PMS" was a new term, introduced by the Act, to
describe the same types of services that are currently known as
"General Medical Services", and provided by general
medical practitioners under Part II of the NHS Act 1977. The use
of "PMS" is simply to make it clear that the services
are to be provided under the Act.
There are currently 269 PMS pilots in operation.
More than 70 of the second wave pilots are nurse-focussed,
either being managed and developed by nurses, or relying on nurse
practitioners to deliver new services to vulnerable populations
such as the homeless, asylum seekers and those with substance
misuse problems. They include:
(i) two nurse-led practices, in Salford and Derbyshire,
with nurses as independent contractors, employing salaried GPs
and other staff;
(ii) two nurse partner models, in Stoke-on-Trent and Ormskirk,
Lancashire in which the nurse is an equal partner in the practice
with the GP;
(iii) nurse practitioners providing care for homeless
people, in Stoke-on-Trent, Brighton and Grays, Essex; and
(iv) nurse practitioners and nurse clinicians providing
services to a wide range of vulnerable populations including the
homeless, asylum seekers, older people and people with chronic
conditions.
In December 2000, John Denham announced that a further 1,231
PMS schemes had been approved to start in April 2001.
All pilot proposals for this wave were required to be explicit
about the utilisation of the skills of the primary care team,
and proposals were particularly welcome if they were designed
to deliver new approaches to nurses' role and skills mix within
primary and community care. Eighty nine per cent of the new schemes
aim to make better use of nurse practitioners, practice nurses
and other staff.
The NHS Plan promises to "encourage a major expansion
of PMS contracts". All the current pilot schemes that are
successful will become permanent, and it is expected that, over
the next four years, the number of GPs working to PMS contracts
will grow steadily.
EXAMPLES OF
PMS PILOTS
Tower Hamlets Healthcare NHS Trust
The majority of patients benefiting from this pilot are local
single homeless people who previously had difficulty in registering
with a GP. This pilot has established a nurse-led primary care
service incorporating a salaried GP to provide personal medical
services to a practice population of approximately 1,800 patients.
The pilot has expanded an existing service provided by the
Trusts through the Help Team—a multi-agency, multi-disciplinary
team covering mental health, primary health and social care services.
The service is provided from a dedicated surgery site supported
by continued outreach nursing services within local homelessness
day centres and hostels. The nurse practitioner service incorporates
the development of nurse prescribing as a core component of the
service offered. Additional services developed at the site include
chiropody, counselling services and the Trust's dental service
for homeless people, as well as a wider range of social services.
Great Bridge, Tipton
This nurse-led pilot will see the two nurses in the practice
employing the single-handed GP as a salaried doctor and assuming
responsibility of his patients. The aim will be for significant
numbers of GP consultations to be more appropriately undertaken
by nurses, freeing up the GP to focus on more complex cases, as
well as helping to address the problem of GP recruitment and retention.
Finally, I would like to apologise for the time it has taken
for the Department to respond to the points raised by the Committee
members.
22 January 2001
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