Health CommitteeWritten evidence from Assura Medical Limited (ETWP 78)

About Assura Medical Limited

Assura Medical Limited (AML) improves health outcomes for patients by enabling a greater range of services to be delivered in primary care and community settings. We achieve this by partnering with groups of GPs to develop provider companies (GPCos). We have now formed 25 GPCos with GPs representing over three million patients and these are providing a wide range of services including diagnostics and out-patient day care services, GP surgeries, walk-in and urgent care centres as well as providing convenient high quality services for patients. Our services have also generated significant savings for PCTs.

Our GPCos are working closely with a wide range of providers from across the NHS, social care and independent sectors. We have formed a range of innovative models to provide integrated services that span primary and intermediate care which we see as essential to developing joined up and cost effective services.

1. Ensuring providers and commissioners play an appropriate part in developing the future workforce

1.1 The report of the Future Forum on education and training, Chaired by Julia Moore of University Hospitals Birmingham NHS FT, made some very helpful recommendations about ensuring that the training and education system for staff reflects the changing needs of healthcare and the Government’s proposed market-based reforms to the NHS. AML fully supports attempts to modernise the training system so that it better meets the needs of a reformed health service and ensures that all providers have access to high quality staff.

1.2 The Government’s proposal to levy a charge on all providers to cover the costs of training is important and we believe requires widespread consultation prior to implementation. AML understands the intention behind the proposal but is concerned to ensure that there is a level playing field applicable to all providers and that the sums involved are transparent and are not so large as to act as a major barrier to entry. Managing the levy via Monitor’s licensing system would seem to be the most practical way of handling the levy and keeping the costs down with subsequent cost savings focused on keeping the levy to a minimum rather than going back into the central pot. In addition, we believe that the levy must already take account of work done by the independent sector, which the NHS has often found difficult to track.

1.3 In developing a training levy AML believes that it will be important to provide clarity about who needs training to ensure that the fees reflect the training requirement. Current requirements on training are too often vague and it is difficult to set a budget for the costs of training. The new system must be far more robust in determining who needs training, the numbers of staff involved and the level of training required, being more comprehensive than the current arrangements. In addition, the ongoing training needs of locum staff who are not aligned to an employing organisation such as an agency must be considered to support both professional development and professional regulatory requirements.

1.4 Transparency of costs is going to be critical in ensuring that providers understand what their contribution to training and education will be. As part of its consultation into provider licensing Monitor has made clear that the cost setting process for registration will be transparent and as noted in section 1.2 AML believe that the Department of Health should consider aligning the training levy to the wider provider licensing process, thereby ensuring that training requirements are explicitly written in to the commissioning process, both in the bidding stage and the contracts themselves.

2. Leadership and accountability

2.1 Effective clinical leadership within the NHS and its partners is going to be vital in meeting the Government’s Reforms, including the Outcomes Framework and the QIPP scores on efficiency. The quality of the current arrangements for clinical leadership are mixed which is why AML has developed its own approach to mentoring senior clinicians and supporting them develop a range of skills associated with running provider organisations and operating within the wider NHS marketplace. This includes elements of clinical management and clinical governance supported by “on the job” mentoring, more formalised face to face training and processes and procedures.

2.2 High quality leadership will be needed from the various education and training organisations being established by the Government, particularly Health Education England and the Provider Skills Network. The current fragmentation of training and education organisations and the lack of clarity around their roles can be difficult to navigate and we would hope that greater coordination can be introduced.

2.3 Leadership within the NHS and ensuring there is a constant stream of high quality graduates coming into the system will be crucial and AML believes that much more could be done to reach out beyond the traditional routes. In particular, we would like to see the NHS adopt commercial best practice by pursuing a policy which reaches out to schools and colleges to explain careers in healthcare and enthuses young people about their opportunities and potential career paths, as is done by other large-scale public sector recruiters such as the armed forces.

3. Training curricula and Continuing Professional Development

3.1 Julia Moore’s Future Forum report raised some particular concerns with the Post-graduate Deanery system and AML supports many of the points made, in particular the fact that Deaneries often operate differently across the country, have very different systems and practices and implement their own policies. With staff leaving the Deaneries and the workforce planning functions of SHAs closing down there is a potential training vacuum and the Government need to come forward with specific proposals for eradicating the existing fragmentation and making Deaneries far more outward facing and inclusive in the way they do business.

3.2 In both initial graduate training and postgraduate education we believe that much more emphasis should be placed on patient communication and customer service. Clinical skills are rightly the main priority of the training system but there is currently very little in the system which helps staff understand how to talk to patients, explain issues that have arisen or just to ensure that their experience is a positive one. Patient satisfaction is not just about the treatment that is provided by the clinician, it is also includes engagement and respect, access, choice, convenience and safety, and the NHS should recognise that much can be learned from the independent sector. Aligned to the Government’s plans for a Duty of Candour, our position is that staff are not always going to have the communication skills required to manage delicate situations or stressed patients and putting a more commercial focus on training could lead to patients having a far better experience of the NHS.

3.3 Continuing Professional Development is a vitally important way of improving individual clinicians’ skills and keeping up to date with changes to medical practice and technology. AML also believes that training can be a helpful way of integrating care provision by running modules across organisational boundaries and structured in such a way that the package mirrors the integration required under Monitor’s licensing regime. This could be a very helpful lever for improved integration across the service and developing innovative packages of care delivered by different entities.

December 2011

Prepared 22nd May 2012