Clinical academics must be included in partnerships to ensure quality in the future NHS, writes Michael Powell
Abolition of general practitioner fund-holding and the internal market have been at the centre of debate on the government's plans for the National Health Service.
Ministers have announced a bill to give statutory backing to the government's policy commitments from last year's white paper, The New NHS: Modern and Dependable.
This said that the government would establish a statutory duty for NHS trusts to work in partnership with other organisations. It is important that this includes universities.
The "new" NHS will be characterised by partnership and an emphasis on quality, backed up by statutory duties. Universities and medical schools will need to be alert to the implications of the legislation for the development of their partnerships with the NHS, while being prepared for innovation and adjustment to new structures and approaches to the delivery of care.
Two bodies are to be set up. The National Institute for Clinical Excellence is expected to be established under existing legislation allowing the creation of special health authorities. Frank Dobson, secretary of state for health, has announced its chairman-designate as Michael Rawlins, professor of clinical pharmacology at the University of Newcastle upon Tyne.
Both Nice and the second new body, the Commission for Health Improvement (Chimp), will include academics in their membership.
Nice will promote clinical and cost effectiveness in the NHS, by advising on best practice in the use of existing treatments, appraising new health interventions and producing authoritative national guidance based on evidence and research findings. Clinical academic units in universities will play a key role in providing both clinical and research expertise and leadership.
Chimp will be a statutory body responsible for assessing clinical performance. It will ensure that mechanisms are in place to identify clinical problems at local level, to provide national leadership in clinical governance and to scrutinise local clinical governance arrangements for promoting the delivery of high-quality patient care services. Academics will have a significant role in its programme of visits to every NHS trust and primary care trust over a period of years.
Clinical academics, mostly in medical schools, are employed by universities to teach and do research. Clinical teaching and research is practice-based. Academics therefore require access to patients and on average about half of their time is spent providing patient care. While paid by universities, they have honorary (unpaid) contracts with NHS employers, to whom they are responsible for clinical performance. It is vital that trusts and universities, which are the primary employers, maintain close liaison so that any problems and necessary remedial action can be addressed jointly.
Recent Department of Health statistics indicate that of the 20,000 hospital medical staff at consultant level in England, 7.4 per cent (nearly 1,500) have honorary contracts. Most of these are academics employed and funded by universities to teach and do research. While these clinical academics also treat patients, many of the consultant clinicians employed by the NHS contribute to clinical teaching. There is therefore a close and symbiotic partnership between universities and the NHS. It cannot work effectively without formal and informal liaison arrangements and joint planning.
The boards of NHS trusts and health authorities that have significant teaching responsibilities in association with university medical schools include university-nominated members.
As more clinical teaching takes place in general practices and other primary care settings, universities will be challenged to develop links with the new primary care groups and trusts that are to be set up, initially as sub-committees of health authorities. There is expected to be one primary care group for roughly every 100,000 of population throughout the country, responsible for purchasing both primary and secondary health care for patients registered in their areas from general practitioners and hospitals.
Medical schools are at present bedding in substantial changes in undergraduate curricula and responding positively to the government's decision to increase the annual student intakes to medicine by nearly 1,000 by 2005.
It is essential that the internationally recognised quality of the research base in the medical and other life sciences is sustained and strengthened as a foundation for excellence in medical education and for future innovation in clinical services and evidence-based health care.
Michael Powell is executive officer of the Council of Heads of Medical Schools.
Medicine, pages 26-31