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Healthcare for London: A framework for action

21 August 2007

Dear Colleague

The Framework for Action for the NHS in London – a wide-ranging review announced by Lord Darzi in July - is something all those interested in healthcare in London should be aware of and concerned with.

Many of you will have seen a lot of service reviews come and go and coping with change or plans for change, has just become part of the background to your working lives.

Lord Darzi asserts that this will be the review that succeeds in radically re-shaping the London NHS landscape. Whether or not you believe that, it’s our duty as your union to keep you informed and to supply you with any guidance you might need.

The review is the planned implementation, for the capital, of ideas that have been around for some time now and which were given a major impetus by the Government’s Your Health, Your Care, Your Say exercise in 2005; the concentration of GP and other services in single convenient locations, the shifting of more work out of hospitals and into the community, the active promotion of healthy lifestyles, the concentration of specialist services in large hospitals and the strengthening of the commissioning function.

Many doctors are suspicious of this agenda, coupled as it is with national policies which many see as driving fragmentation; competition and privatisation; the single national tariff (payment by results), the establishment of treatment centres and referral management systems and the involvement of the independent sector in provision and commissioning.

The BMA agrees that it is absolutely necessary to tackle health inequalities and to promote both prevention and high-quality care. However, rushed implementation of bad or poorly-developed ideas, notably in North-West England last year with the introduction of independent Clinical Assessment Treatment and Support services, has shown doctors’ suspicions to be well-founded.

We are encouraged, but not beguiled by the fact, that the new Ministerial team at the Department of Health has signalled a greater willingness to listen to the profession before embarking on changes and to involve it more in discussing and planning change.

Lord Darzi’s review has the potential to alter radically the working arrangements of many London doctors. For those of you involved in discussions about London’s services, we have put together this initial, web-based resource pack to help guide you through it and to encourage collaboration between different sectors.

This resource will be updated as the direction of the review becomes clearer and as the need for new guidance emerges, but for the time being it contains:

• A summary of the review document
• Guidance on hospital reconfiguration
• Guidance on the process of commissioning, and specific guidance on the framework for procuring support for external commissioners. Read BMA principles for effective and successful commissioning and Framework for procuring external support for commissioners.
• Guidance on joint working between local bodies representing hospital doctors and GPs

We would encourage every doctor, whatever your branch of practice, to draw on these documents in discussions with PCTs and SHAs and at meetings of LNCs, RCSCs, LMCs and MSCs. We also strongly encourage joint working and meetings between these bodies to help forge a common professional approach, firmly rooted in collaboration, to any service changes in your part of London.

The BMA will also provide dedicated support through its London regional services network for any local problems (contact Ask BMA on 0870 6060828) bring to national attention any serious problems arising from this review through its press office and its national branch of practice committees help out with any local press work arising from the review provide any assistance in lobbying London MPs in service changes that are felt not to be in the best interests of doctors and patients.

The BMA is responding to the review and this will be available in due course. You can read the full text of the review at the link below, or the summary provided on these web pages.

http://www.healthcareforlondon.nhs.uk/framework_for_action.asp

I hope this is helpful. We will continue to support you in every way we can.

If you have any comments then please email info.ccsc@bma.org.uk

Yours sincerely

Hamish Meldrum
Chairman of Council
British Medical Association

For further information read the briefing note – Lord Ara Darzi's Healthcare for London Review