Podcasts about clinical commissioning groups

Dame Barbara Hakin's immense personal contribution to the NHS has spanned four decades – as a clinician, manager and national leader.During her long career she has worked as a GP for 20 years before taking up her first management role in the NHS, first as a Primary Care Trust Chief Executive in Bradford and then as a Strategic Health Authority Chief Executive in the East Midlands. She went on to become National Director of Commissioning Operations and Deputy Chief Executive at NHS England, where she helped oversee the establishment of CCGs. Described as Sir David Nicholson's right-hand woman and a forthright and skilled operator, she has often been depicted as the most influential woman in the NHS during her time there. In this conversation Barbara provides a fascinating overview of how primary care has evolved over time, as well as advice on leading effectively as the shortest person in most rooms, whether clinical credibility matters, and influencing politicians.Side note: Given the number of three letter acronyms mentioned, you might find this historical overview and this one useful to look at alongside the conversation. The King's Fund also has some great animations and explainers which might help. Please see a summary of the terms she mentions below too in case it's helpful. *Highlights:Her early journey (3 mins)Work life balance (6 mins)Remaining a doctor and being in management roles (10 mins)Her first experiences of NHS management (16 mins)Being an influencer (21 mins)Having presence and making your voice heard (24 mins)Journey to helping to set up NHS England (28 mins)Imposter syndrome (33 mins)The Health and Social Care Act, and Andrew Lansley (34 mins)Advice on working with politicians (38 mins)Her favourite health minister (41 mins)Her view on integrated care systems and the trajectory of primary care (42.5 mins)Future challenges for primary care post-Covid (48 mins)Final 3 questions - a leader, a book, and top tips (51 mins)*Social media:@NextGGP/@nishmanek*Subscribe to the Next Gen GP monthly bulletin to keep in the loop about future webinars, podcast episodes, and our virtual programmes:bit.ly/NGGPbulletin*EXTRAS========Here are some explanations of the terms Dame Hakin uses:Commissioning: the process by which health and care services are planned, purchased and monitored.Fundholding: In 1991, the Conservatives introduced the purchaser/provider split. Health authorities began to commission (buy) care, and GP fundholding was introduced. Under GP fundholding, GPs held real budgets with which they purchased primarily non-urgent elective and community care for patients; they had the right to keep any savings and had the freedom to deliver new services. Fundholding was not compulsory and applicants initially had to meet a number of criteria to enter into the scheme. Smaller practices could group together to form fundholding consortia. PCGs and PCTs: Fundholding and family health authorities were replaced in 1999 with 481 primary care groups (PCGs). In 2000 the government announced that PCGs would become primary care trusts (PCTs). PCTs were managed by a team of executive directors headed by a chief executive.PEC: Other board members of the PCT included the chair of the professional executive committee (PEC). This was elected from local GPs, community nurses, pharmacists. Broadly speaking, PECs provided a clinical viewpoint on the strategy and operations of the PCT. SHA: In 2002, groups of health authorities were formed called Strategic Health Authorities (SHAs). These were responsible for developing and improving health services in their local area, ensuring quality, measuring performance, and making sure that national priorities were integrated into local plans.2012 Health and Social Care Act: In 2012, the 10 SHAs and the 152 Primary Care Trusts which looked after services at a local level, were replaced by NHS England and more than 200 Clinical Commissioning Groups. The proposals were primarily the result of policies of the then Secretary of State for Health, Andrew LansleyICS: These Integrated care systems (ICSs) are a key part of the NHS long-term plan, and are intended to bring about major changes in how health and care services are planned, paid for and delivered. ICSs are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners, to collectively plan and integrate care to meet the needs of their population. In November 2020, NHS England and NHS Improvement published Integrating care: next steps to building strong and effective integrated care systems across England, which Barbara references towards the end of the podcast. Hosted on Acast. See acast.com/privacy for more information.

She is passionate about helping organisations harness the sometimes-latent potential of their employees using bespoke coaching, mentoring approaches to address workforce challenges such as Mental and Physical Health.  Marteka has over 15 years experience improving emotional wellbeing through coaching, consulting and mentoring. She is an expert in mental health and is curating health & wellbeing programmes for individuals, teams and organisations. She has worked in one of the UK's largest NHS Mental Health Trusts.  And practices as a Psychotherapist, specialising in compulsive & emotional eating disorders. Marteka is a Mental Health Innovator through her company Benevolent Health specialise in providing expertise in mental health to NHS Trusts, Clinical Commissioning Groups, Local Authorities and Third Sector both in the public and private sector. Connect with Marteka https://benevolenthealth.co.uk/consulting/  

This week, we have a special episode to join in with the events being held for World Benzodiazepine Awareness Day. World Benzodiazepine Awareness Day seeks to raise global awareness of iatrogenic benzodiazepine dependence, the dangers of its adverse effects and the associated withdrawal syndrome, which can last for years. To give some context around the issues with Benzodiazepines, we have three interviews in this episode. Firstly we talk to Professor Malcolm Lader who is Emeritus Professor of Psychiatry from Kings College London and is globally recognised as an expert on Benzodiazepines. Following that we talk with Jocelyn Pedersen. Jocelyn is a US based campaigner who shares her own experiences with Benzodiazepines and talks also about her views of the medical response to the issues of dependance and iatrogenic harm. Finally, we talk to Barry Haslam. Barry is a veteran UK campaigner who shares his experiences and also what we should be doing to help those dependant or damaged from use of these medications. Barry has been instrumental in raising awareness and taking action for last 30 years and is well known in political and medical circles. Interview 1, Professor Malcolm Lader In this interview we discuss: ▪Professor Lader’s training in medicine and how he specialised in psychopharmacology and psychiatry ▪That he went on to become involved in research, particularly around tranquilliser dependance and adverse effects ▪How Benzodiazepines were created in the 1950s, replacing Barbiturates because they were generally safer in overdose ▪That the first Benzodiazepine created was Librium (Chlordiazepoxide) soon followed by Valium (Diazepam) ▪That for a time, Valium was the most widely prescribed drug on the planet ▪That the advantages are that Benzodiazepines are relatively safe in overdose but they can result in dependance (likely a 1 in three chance) at therapeutic doses ▪That by 1975, Professor Lader’s Addiction Research Unit at the Maudsley hospital in London were becoming increasingly concerned by the number of people who were being referred to them for specialist help ▪How this led to Professor Lader’s famous quote on a BBC Radio 4 interview that it was “easier to withdraw people from Heroin than from Benzodiazepines” ▪That Opioid withdrawal caused an acute, very unpleasant withdrawal experience but Benzodiazepines caused a protracted withdrawal that was actually more difficult for many people to deal with ▪How they were left with patients who had successfully withdrawn from Opioids like Heroin but were still having trouble with the Benzodiazepines like Ativan ▪How the British Medical Association have only recently become engaged in the issues of dependance and withdrawal to give advice to their members (General Practitioners) ▪That the regulators don’t have sufficient influence to get doctors to prescribe Benzodiazepines in a more responsible way ▪That much of the long term use of psychiatric medications comes down to lack of monitoring of patients by doctors ▪That there have been cases where long term prescribing of Benzodiazepines has been seen to be negligent on the doctors part and that this has led to some out of court settlements ▪That the treatment of dependance is not simple or straight forward so it is much better to educate GPs upfront to intervene before people have the chance to become dependant ▪How we are now repeating some of the same mistakes made with Benzodiazepine prescribing with Opioid analgesics and antidepressants too ▪That the increase in prescribing of psychiatric drugs is partly down to greater recognition of mental health difficulties but also that we do not have enough people trained in non pharmacological interventions ▪That Pharmacists can play a pivotal role in monitoring, advising and supporting patients ▪How Professor Lader became involved in the educational resource the Lader-Ashton organisation ▪That Professor Lader welcomes this second Benzodiazepine Awareness Day because knowledge and education about the related issues is important ▪That people who are currently taking a Benzodiazepine should make themselves aware of the risks and benefits and talk to their prescriber if they are concerned ▪The concerns around the lack of research in this area and that we need ring fenced money to better understand how best to help and support dependant patients ▪That the prediction of the efficacy of psychiatric drugs from biochemistry to animal experiments to human treatment is very poor, so the Pharmaceutical industry is losing interest in psychotropic drugs ▪That psychiatric drugs largely offer symptomatic relief and so their usefulness is limited and we also need to focus on the safety issues Interview 2, Jocelyn Pedersen In this interview we discuss: ▪How Jocelyn first came into contact with benzodiazepines, having had family illness difficulties and finding that she suffered with insomnia but wanting something that was safe to take while pregnant ▪How her doctor recommended the nonbenzodiazepine tranquilliser Ambien (Zolpiden) which Jocelyn used for less than a week because she felt that it was affecting the baby ▪How Jocelyn, after stopping the Ambien even after such a short usage period, found that she couldn’t sleep, couldn’t eat or even do basic things like reading or watching TV ▪That Jocelyn, in trying to explain the wide range of symptoms she was experiencing had a range of physical examinations and tests that all came back negative ▪That doctors explained away her constellation of symptoms as postpartum depression ▪How doctors then prescribed the Benzodiazepine Ativan at 1mg and Effexor, telling her to only take the Ativan until the Effexor ‘kicked in’ ▪That, for Jocelyn, the Effexor never did ‘kick in’ because she was suffering Benzodiazepine withdrawal ▪That upon doubling the dose of Ativan, Jocelyn felt better but she knew that it was only meant for short term use ▪How she found that every time she tried to reduce, even by a small amount like 0.25mg, she was unable to function ▪How three years later, Jocelyn decided it was time to get off the Ativan because she was suffering other health issues ▪How Jocelyn realised that Benzodiazepines like Ativan are teratogens and dangerous in the first months of pregnancy and that being pregnant, Jocelyn had no option but to withdraw ▪That on starting her tapering, Jocelyn was unable to do much else but writhe on the floor in agony, describing even a small reduction as “descending into hell” ▪How Jocelyn’s husband, having found online support groups like Benzo.org.uk realised that what was happening was Benzo withdrawal ▪That Jocelyn, then suffering a miscarriage, ended up in the ER, begging the ER doctor to switch her over to Valium ▪That Jocelyn then spent the next year and a half tapering from Valium ▪How Jocelyn then started to join online support groups, learning how to do a proper taper like that recommended by Professor Heather Ashton ▪That it is very difficult to communicate to friends and family members what is happening, with many assuming it is merely depression or anxiety ▪That it is important to avoid the use of addiction terminology, because people struggling with withdrawal have more in common with those that have a traumatic brain injury or neurological damage ▪That often the only thing between someone and even more suffering is the Benzodiazepine, so it’s not as simple as just wanting to get off ▪That it has been just over two years since Jocelyn finished her taper and there has been considerable improvement but there are still lingering effects ▪That changing her diet made a significant difference to Jocelyn’s health and wellbeing ▪How Jocelyn became involved with campaigning and started her own YouTube channel BenzoBrains ▪How she wanted to be able to add some validity when approaching legislators and lawyers so she founded the Benzodiazepine Information Coalition, a non profit organisation ▪How these and other groups help to educate medical professionals, particularly in terms of avoiding addiction terminology but also to provide guidance on the right approach to take with someone who is dependant ▪How Jocelyn observes some mistakes in how doctors treat those who are iatrogenically harmed, particularly doctors who suddenly stop prescribing because they are worried about the legal aspects, this can leave a dependant person in a very difficult place ▪Secondly while doctors may be cautious about Benzodiazepines, they still readily prescribe other psychiatric medications and even recommend them to treat Benzodiazepine withdrawal effects ▪That a total ban or strict regulation and control of prescribing is an approach which would harm many people who are dependant ▪That what patients need is the proper information to help them successfully and safely get off the drugs ▪That people taking Benzodiazepines shouldn’t be scared by the horror stories but should take time to educate themselves and to accept that the path to being drug free might not be easy but healing is a journey and takes time ▪Jocelyn’s involvement with the forthcoming documentary film: As Prescribed directed by Holly Hardman ▪That much of the funding in this area of research goes to addiction services rather than specifically to help someone who is dependant ▪The difficulty that some people have in accepting that they may be dependant on a prescribed medication ▪The disempowering nature of the message that someone has to take a medication for life and that they have a chronic health condition ▪The message that Jocelyn has for people is that they are capable of more than they know and they can get through the experiences of withdrawal and be stronger for it Interview 3, Barry Haslam In this interview we discuss: ▪How Barry came into contact with Benzodiazepines in 1976 when he had a stress related breakdown due to the combined pressure of working full time  and studying ▪That Barry has no memory of the period 1976 to 1986 and he has had to piece together what happened from medical records and the recollections of family members ▪How a doctor put Barry firstly on Librium (Chlordiazepoxide), followed by a number of antidepressants and also Valium for a time ▪How Barry ended up on a huge dose of 30mg of Ativan (Lorazepam) per day ▪This happened because Barry was experiencing withdrawal effects because of tolerance to the drugs but the doctors didn’t recognise these effects so increased the dosage in response ▪That Barry suffered such powerful daily headaches that he ended up taking 12 opiate painkillers per day in addition to the Ativan ▪That in December 1985, Barry, suffering uncharacteristic aggression, felt that enough was enough and he had to quit the drugs ▪That he had some psychological support when he first started to withdraw but for the majority of the time he did it alone ▪How he dropped from 30mg to 2mg of Ativan in 9 months as well as stopping the opiate painkillers ▪For the last period he transferred to Valium (Diazepam) which took 5 months to come off ▪He did this with no guidance and very little support because the doctors had abandoned him ▪How he experienced many unpleasant physical symptoms including violent daily vomiting, hallucinations, feeling of things crawling under his skin and lost half of his bodyweight ▪How Barry feels that it was the love and support of his wife and family that got him through that 15 months of hell ▪That there is virtually nowhere for people struggling with withdrawal to go to get help and support ▪That these issues receive far less attention and funding than alcohol or nicotine dependance ▪That Barry feels that the health services are too frightened of litigation and that prevents them from directly addressing theses issues ▪How Barry joined an organisation called Oldham Tranx, a peer support group run by drug dependant patients and how Barry became chairman ▪How the local paper, the Oldham Chronicle supported Barry in his campaigning ▪How Addiction Dependency Solutions (now called One Recovery) started to help people in 2004 and is the first NHS funded facility in the UK ▪That we should get Government policy makers in the Department of Health to issue guidance to all local Clinical Commissioning Groups to ensure that similar services are set up across the country and in other parts of the world too ▪We should introduce peer support groups based on the model already in place in Oldham ▪How Professor Heather Ashton ran a withdrawal clinic in Newcastle for twelve years and learned a great deal from the patients experiences ▪That putting these services in place would save lives, Barry estimates that in the UK alone 20,000 lives have been lost since 1960 due to suicide, poisoning and road traffic accidents related to Benzodiazepine use ▪How Barry missed out on his daughters growing up because of the memory loss caused by the drugs up but now can enjoy seeing his three grandchildren grow into adults ▪How Barry has met so many good people in the community of those who needed help and support and that gives him the drive to continue campaigning ▪That even many years after the drugs have been stopped, they can continue to cause a range of health problems ▪That we need hard, clinical evidence of the damage cause by Benzodiazepine drugs as part of the evidence base for future legislative action ▪That this is national problem and needs to be tackled by national governments ▪That dependant patients should continue to put their experience back into the system and that will help society ▪Barry’s wish to have recognised the selfless and tireless work of Professor Heather Ashton including her withdrawal protocols that are used worldwide and that the British Government have never formally recognised her great service and the lives that she saved ▪That every doctors surgery should have a copy of Professor Asthon’s Benzodiazepine withdrawal manual ▪That Barry wants to pay tribute to all of those who have taken their own lives because of Benzodiazepines, either because the horrors of withdrawal or the increased suicidal thinking To listen on Mad in America: https://goo.gl/tyyLmt Podcast show notes: https://goo.gl/QU9XLU To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

A special debate on the current state of the NHS. Recorded in front of an audience at the BBC Radio Theatre London. The last few months have seen the service creaking under unprecedented demand, and there is likely to be worse to come. Something needs to give. Is it simply a matter of more resources, or do we also need to change our expectations of what the NHS provides? Is rationalisation and rationing the way forward? Dr Mark Porter discusses the issues with a panel including Clare Marx, president of the Royal College of Surgeons, Chris Hopson, chief executive of NHS Providers, David Haslam, chair of NICE, Prof Sir Nick Black, London School of Hygiene and Tropical Medicine and regular contributor Margaret McCartney GP. Issues discussed include whether the NHS should continue to be free at the point of use. Is there too much bureaucracy with too many bosses? Was the internal market evidence based, has it worked and was it fair? Rationing of treatments. And can the NHS be taken out of politics? Inside Health listeners set the agenda by emailing the programme - some of whom joined the audience - so thank you for all your input. Margaret McCartney writes: The NHS is never far from the headlines, but the last few months have depicted a service in crisis. It's been made clear that there will be no more money from central government - so what needs to give? Clare Marx, explained the angst of her members who wanted to operate on people but had been forbidden to. Nick Black, discussed the types of surgery that were now being placed off limits - like hip replacement surgery - even though they were very cost effective. Because of the way hospitals are funded, it is these useful operations that are being stopped rather than the much less cost effective prescription of some very expensive cancer drugs. Chris Hopson described tensions between the expectations being placed on the NHS to provide excellent care despite the funding gap to actually provide it. And David Haslam, chief executive of NICE, expressed his disquiet that patients could no longer expect a consistent service across the NHS. Instead, different Clinical Commissioning Groups decided themselves how many rounds of IVF to fund, for example. The result was a patchwork of provision, and was inherently unfair. Is rationing therefore the way forward? Some listeners had emailed in suggesting that the NHS shouldn't fund treatments for 'smokers, drinkers and the obese'. Others that people should pay for hospital meals, or there should be a charge made for GP consultations. We already have charges for some things - for example, prescriptions in England, or dental check ups for many people - but as Clare Marx pointed out, removal of teeth is the commonest childhood operation, so can we really say this policy has been successful? I don't believe that we have the evidence to show this is safe: the bureaucracy would be sizeable - I had to sign 12 bits of paper for a routine check when my kids and I last went to the dentist - and then there are unintended consequences. Paying for appointments turns us in to consumers - would doctors feel obliged to give us treatments that people want, even when they don't work well, aren't cost effective or do net harm? Listeners wanted to know if the NHS was over managed - and had strong opinions on how much could be saved if we got rid of middle managers in particular. But Chris Hopson pointed out that we spend less than the very efficient Germany on hospital managers, and Clare Marx said that hospitals are highly complex places needing a huge amount of organisation to run smoothly. For me it is a question of what managers are doing - is it of value to patients, or is it a waste of time? Nick Black argued that there was a great deal of waste still in the NHS - and suggested that the internal NHS market may have had some advantages to start off with, but now, the 4.5 billion a year estimated to be spent on it could be better used elsewhere. There is no doubt that the process of bidding and judging for commissioning costs time and money, but how to stop the problem of bad and wasteful policy in the first place? Could politics be taken out of the NHS? I was on my own, arguing that party politics had done avoidable harm to the NHS and that cross party working - as we see in the Health Select Committee and the National Audit Office - was possible. My fellow panellists argued that since the budget of the NHS was such a large amount of money it would be impossible to disentangle it from politics: but Chris Hopson pointed out that defence spending, for example, was ring fenced. The audience overwhelmingly voted to be taxed more to pay for the NHS. If we were sure that extra money would go on human level care, and not wasteful, non evidence based policy making, I would support it completely. But we are not, as a population, being given that option.

Prescriptions for over-the-counter items cost the NHS millions each year; in 2015 paracetamol prescriptions alone cost £87.6 million. Mark talks to Paula Cowen, medical director at Wirral CCG, one of a growing number of Clinical Commissioning Groups that are asking GPs to restrict prescribing of these items, and to Andrew Green, a GP and the prescribing policy lead at the BMA, who has reservations. Virtual Reality is being harnessed to help people recover from serious brain injury following accidents or strokes, and in conditions like Parkinson's disease and dementia. Mark visits a clinic in Salford where they're using virtual reality in neuro-rehabilitation. And treating sore throats with antibiotics. Sore throats are common accounting for 1.2 million GP consultations every year in England alone - and they affect many millions more who don't see their doctor. Most are viral and self-limiting, but around 1 in 10 are caused by a bacteria and may benefit from antibiotics. The tricky bit is telling the difference between the two but a new pharmacy-based test and treat initiative may help. Mark speaks to Peter Wilson, one of the authors of the pilot study, and Margaret McCartney is on hand to examine the evidence.

Is demand for long term nursing about to tip NHS finances over the edge? Under the system of "Continuing Healthcare" people with complex medical needs can claim the costs of nursing and medical help to keep them out of hospital. But the system has become mired in controversy with many people claiming they've been denied funding to which they are entitled. Now there's a deluge of backdated claims against Clinical Commissioning Groups. File on 4 finds the backlog is creating long delays in new assessments of patients. And it hears claims the assessments themselves are a postcode lottery, with the chances of being deemed eligible varying wildly between GP commissioning groups. The programme also hears evidence of NHS commissioners and councils fighting each other not to take responsibility for patients. Patients and their families are going to the health ombudsman in their hundreds. 18 clinical commissioning groups are already going to end the year in the red, with some threatened with being put in special measures over their finances. Now they owe millions of pounds in backdated claims, plus interest. Is this creating an incentive to squeeze spending on continuing care? GP commissioners are about to be asked to put £1.9 billion into the pot for new joined-up health and social care services. Do they have the money, or the will, to buy into joined-up care? Reporter: Jane Deith Producer: Nicola Dowling.