Select Committee on Health Minutes of Evidence

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



EU average health
care expenditure as a
percentage of GDP

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.


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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