This is one of the types of contract that Primary Care Organisations (PCOs) can have with any provider of primary care to increase capacity and offer more choice. It could be a contract to provide care for a specific population, or a different way of providing care. It can exclude some essential services. For example, a private provider could provide a walk-in centre service. See also GMS, PMS, PTMS and SPMS.

Academic Health Science Centre (AHSC). This is a partnership between a number of hospitals and universities initiated in the Healthcare for London report by Sir Ara Darzi (click here). The purpose is to bring together world-class research, teaching and patient care.

Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline. If the individual wishes, their family and friends may be included. It is recommended that, with the individual’s agreement, this discussion is documented, regularly reviewed and updated, and communicated to key persons involved in their care. Advance care planning discussions may lead to an advance statement (a statement of wishes and preferences), an advance decision to refuse treatment (link – covered below!) or the appointment of a Lasting power of Attoney (LPA). Guide for health and social care staff and RCP Advance Care Planning: concise evidence based guidelines. And also Advance Care Planning website

The Mental Capacity Act 2005 gives people in England and Wales a statutory right to refuse treatment, through an 'advance decision'. An advance decision allows a person to state what forms of treatment they would or would not like should they become unable to decide for themselves in the future. It is a binding decision. An advance decision cannot be used to:

refuse basic nursing care essential to keep a person comfortable, such as washing, bathing and mouth care refuse the offer of food or drink by mouth refuse the use of measures solely designed to maintain comfort, for example, painkillers demand treatment that a healthcare team considers inappropriate ask for anything that is against the law such as euthanasia or assisting someone in taking their own life An example from Alzheimer’s Society.

An ALMO is a company set up to manage and improve council housing stock. It is owned by the local authority but operates under a management agreement between it and the local authority.ALMOs are designed to encourage both the participation of the local community in the management of their homes and the continuous improvement of council housing services. Government funding is provided on the condition that local authorities separate their management and strategic functions. An ALMO must:

• deliver major repairs and improvements to bring homes up to the Decent Homes Standard
• collect rents, deal with arrears and debt counselling
• maintain properties
• manage lettings and deal with empty properties.

The local authority is still responsible for:

• the housing strategy
• housing benefit and rent rebate administration
• the overall policy on rents.

A number of organizations including the NHS Institute are looking to help commissioners predict who might be at risk of admission, and to find ways to divert that admission. Work by the Institute, Imperial College and Dr Foster’s has identified nineteen ACS conditions which account for 6%-13.2% of total hospital costs for which there is a community-based alternative to admission. The variation in that proportion gives scope for improvement. COPD, asthma, flu and pneumonia are significant in this list of nineteen. See here for how it can be used. The Kings Fund together with New York University and Health Dialog has also developed the Patients At Risk of Re-hospitalisation (PARR) Case Finding Tool and a later version called the Combined Model.

This is undertaken in England by the Healthcare Commission, which is the watchdog for England's healthcare - checking quality and safety provided by the NHS and independent organisations. The third annual health check performance ratings for NHS trusts in England were published on 17 October 2008. They show major improvements in performance with trusts improving the quality of services and managing money more effectively. One in five trusts were inspected, the rest of the ratings were derived from analysis of thousands of data items. To see how your trust has done, click here. For detailed reports, click here.

The only decision patients in England currently have to make about their non-urgent medical treatment is which hospital they want to use. But with the introduction of Any Qualified Provider in April 2012, any registered healthcare provider will potentially be able to offer services. Initially, this change will apply primarily to eight areas: back and neck pain; a range of diagnostic tests; wound healing; talking therapies; adult hearing; continence services; podiatry; and access to wheelchairs for children. Under AQP, organisations wishing to provide NHS-funded services register with the Care Quality Commission, and patients choose among them. Clinical Commissioning Group members could be sued for influencing patient choice - an “anti-competitive practice disadvantaging other potential providers”. Monitor will judge this. A key concern raised around AQP is that at a time when we are seeing a drive towards closer integration of services, this methodology could fragment them among a wider body of providers. For example, the IT systems and software chosen by providers to deliver the service may well differ and not be capable of being integrated, or at least make it more complex and costly. To address this, there will be a contractual duty on providers to cooperate to ensure that patient care is safe and any transfers are coordinated properly. How this contractual obligation to “cooperate” is enacted and enforced in practice, as well as Monitor’s role around promoting integration, will be key but at time of writing (NOvember 2011) were not known.

http://healthandcare.dh.gov.uk/any-qualified-provider-2/

Edited from guide to AQP by Beachcroft LLP partner Robert McGough

See also the AQP briefing document here.

Any product or service designed to enable patients to achieve greater independence and enhance their quality of life. The devices can be simple like a mobile phone or more complex dependent on the needs of the individual

The NHS Operating Framework for 2008/09 required PCTs to ‘create an internal separation of their operational provider services and agree service level agreements (SLAs), based on the same business and financial rules as applied to all other providers.’ Therefore by April 2009 all PCTs should have divested themselves of service provider functions* to focus entirely on commissioning and moved into a contractual relationship with their PCT provider function, using the national model contract for community services in 2009/10. This has meant ensuring sufficient separation of roles within the PCT to avoid direct conflicts of interests.

Transforming Community Services: Enabling new patterns of provision (Jan 2009 DH) required PCTs to develop a commissioning strategy and plan for transforming community services by October 2009 that introduced sufficient competition to drive up quality and value for money. In the context of this commissioning strategy, PCTs should also have developed a proposal for the most appropriate organisational form for existing PCT provided services that best suits local circumstances. Transforming Community Services suggests that there are several possible organisational models (such as PCT provider services, community foundation trusts and social enterprise companies, and services integrated with other organisations.

As of 2012, most community service providers have joined with either mental health trusts or acute providers.

Typically they provide community services such as health centres, community hospitals, community nursing including district nurses, health visitors and school nurses, continence, contraception and sexual health, dietetics and nutrition, intermediate care, minor injuries, occupational therapy, physiotherapy and speech and language therapy.

Related Words: Operating Framework; Service level agreement (SLA) ; Social enterprise