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«Cm 9013 February 2015 Treasury Minutes Government responses on the Eighteenth, the Twenty First to the Twenty Fourth, and the Thirty Third reports ...»

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NHS England should do more to understand the reasons for the significant variations in cost and patient satisfaction.


NHS England should take responsibility for developing an understanding of the significant variations across England in the cost of out-of-hours GP services and in the level of patient satisfaction with these services.

2.1 The Government agrees with the Committee’s recommendation.

Target implementation date: March 2016.

2.2 NHS England will further strengthen assurance arrangements in the cost of out-of-hours GP services, making the benchmarked costs of out-of-hours GP services a standard aspect of future data returns. The GP Patient Survey includes data on patient experience of out-of-hours GP services.

Geographical variation will be identified and acted upon by local commissioners.

3: Committee of Public Accounts conclusion:

Clinical commissioning groups are not presently managing conflicts of interest when commissioning out-of-hours GP services. They should be able to demonstrate that they are.


NHS England should test whether its guidance on conflicts of interest is being followed and assess whether it offers enough safeguards. Where contracts for out-of-hours GP services have been awarded since 1 April 2013, it should seek documentary evidence that no one with an interest in the successful provider organisation was involved in the procurement process.

3.1 The Government agrees with the Committee’s recommendation.

Recommendation implemented.

3.2 NHS England has sought and obtained assurance that all 211 clinical commissioning groups (CCGs) have appropriately managed conflicts of interest in the award of contracts in line with the NHS England guidance to CCGs for 2013-14.

3.3 NHS England published statutory guidance for CCGs on the management of conflicts of interest in December 2014. This statutory guidance builds on and supersedes previous guidance, and offers a number of new and strengthened safeguards, especially for CCGs looking to undertake commissioning of primary medical services under co-commissioning arrangements. Assurance of how well the guidance is being followed will be sought through CCG assurance.

4: Committee of Public Accounts conclusion:

The urgent and emergency care system is complex and fragmented and the present financial incentives run the risk of undermining effective integration of the different elements.


Given the pressures on the NHS budget it is important that NHS England should expedite the redesign of urgent and emergency care services. NHS England, working with Monitor, should urgently identify solutions for paying for urgent and emergency care that address the current misaligned incentives and promote the treatment of patients in the most appropriate setting and the most effective use of NHS resources.

4.1 The Government agrees with the Committee’s recommendation.

Target implementation date: April 2016.

4.2 NHS England continues to support the local redesign of urgent and emergency care services.

‘The Forward View into Action: Planning for 2015-16’ states that commissioners and providers should prioritise the major strategic and operational task of how they will implement the urgent and emergency care review. This will be reinforced in 2015-16 by incentives in the CCG quality premium and the Commissioning for Quality and Innovation (CQUIN) framework for providers aimed at increasing the number of patients with urgent and emergency care needs who are managed closer to home, rather than in a hospital setting.

4.3 Urgent and emergency care networks, which will build upon existing System Resilience Groups, should be established by April 2015, and oversee the planning and delivery of a regional or sub-regional urgent care system, including designating and assuring the quality of urgent care facilities, in line with guidance planned for summer 2015.

4.4 In August 2014, NHS England and Monitor published a discussion document setting out their thinking on options for reforming the approach to paying for urgent and emergency care, in support of NHS England’s review of urgent and emergency care led by Professor Sir Bruce Keogh.

4.5 To facilitate system-wide co-ordination of the delivery of care, a new payment approach would seek to be consistent across as many components of care delivery as possible, and enable individual providers to share in the benefits (or costs) of their actions to the system as a whole. This approach could combine a proportion of fixed core funding, a proportion of volume-based funding and an element to reflect incentives that could be aligned across the entire local health economy, to support service change and promote quality improvement.

4.6 NHS England and Monitor will be working with local health economies during 2015-16 to test possible future payment approaches, including the impact of new models of care such as Multispecialty Community Providers. Assuming the test sites demonstrate positive results, they hope to start transition to the new payment approach in 2016-17.

5: Committee of Public Accounts conclusion:

Too many people are unaware of the different urgent care options and of how to contact them, meaning they may not receive care in the most appropriate setting.


NHS England should set targets to increase public awareness of out-of-hours GP services and NHS 111, and collect data to monitor progress. As well as general public awareness, it should focus particularly on those groups with the lowest levels of awareness.

5.1 The Government agrees with the Committee’s recommendation.

Target implementation date: March 2016.

5.2 NHS England proposes, subject to further consideration of affordability, to deliver a national campaign to raise awareness of NHS 111, working collaboratively with CCGs. The promotion of NHS 111 is intended to help the public to understand the purpose of the service, how to use it and when to use it.

More patients will be triaged and signposted to the most appropriate service, including out-of-hours GP services.

5.3 NHS England has gathered feedback from the general public and a range of specific patient groups, including seldom heard and vulnerable audiences, to ensure that communications and marketing can be tailored accordingly. The NHS 111 Programme Team is also delivering a patient engagement programme. It has held engagement events with the deaf and hard of hearing community and with people with learning disabilities. It has also held specific events around mental health focused on addictions, anxiety, depression and suicide, older people, dementia, and severe mental health disorders. These will help shape future communications and marketing. Ongoing engagement with these groups will also raise awareness and support of NHS 111 including out-of-hours GP services.

6: Committee of Public Accounts conclusion:

NHS England cannot at present assess how many GPs will be needed over the coming years.


The Department and NHS England should develop a model for the GP workforce now, and use the results to inform discussions about the budget the NHS needs and decisions about the number of GP training places required.

6.1 The Government agrees with the Committee’s recommendation.

Target implementation date: July 2015.

6.2 The model for the future primary care workforce including GPs will be informed by new models of care arising from the NHS Five Year Forward View. Health Education England (HEE) will undertake planning to determine what sort of workforce is required to deliver these care models. HEE has established an independent Primary Care Workforce commission chaired by Professor Martin Roland.

This will consider how HEE develops the wider workforce for primary care requirements and what innovative practices will be defined to support the future models of primary care. HEE will report by the end of July 2015 and will inform commissions for 2016-17. The review will consider the impact of any shift from secondary to primary and community care; better integration of services; new ways of working in urgent and emergency care; and seven day services.

6.3 HEE is already working to increase the number of GP training places to 3,250 by 2016. The figure of 10,000 additional GPs quoted in evidence during the Committee’s hearing reflects the extra staff expected to be available in primary care by 2020 (of which 5,000 will be GPs), as set out in the departmental publication: Transforming Primary Care. To tackle immediate pressures, NHS England and HEE have published a plan alongside the Royal College of General Practitioners and the British Medical Association, to attract more training doctors into general practice, make better use of the wider clinical workforce in primary care, target measures to support retention, and support the return of clinicians who have left general practice.

Twenty Third Report of Session 2014-15 Cabinet Office (Crown Commercial Service) Transforming Contract Management The private sector delivers complex services on behalf of the public sector, to the value of around £90 billion, which represents half of public sector expenditure on goods and services. The public needs to have confidence that contracts are managed well by both Government Departments and the contractors themselves. The case of G4S and Serco overcharging the Ministry of Justice for years on electronic tagging contracts was the starkest illustration of both contractors' failure to work in the public interest and Government failure to safeguard taxpayers' money. In the course of the Committee’s work, similar cases have been identified and examined where there are allegations of the misuse of taxpayers' money. Led by the Cabinet Office, the Government is now working to improve the way it manages its suppliers and contracted-out providers of public services.

On the basis of a report by the NAO, the Committee took evidence, on 8 September and 10 September 2014, from the Cabinet Office; Ministry of Justice; Home Office; Serco; G4S and CBI on contract management. The Committee published its report on 10 December 2014. This is the Government response to the Committee’s report.

Background resources

–  –  –

Committee of Public Accounts conclusions 1-5:

The Government will not achieve value for money from its contracts until it pays much more attention to contract management

Recommendation 2:

The Cabinet Office must lead efforts to make sure that the current emphasis on improving contract management is embedded across all departments and that tendering processes did not discriminate against small and medium sized enterprises. It must not lose focus and should report back to this Committee by the end of 2015 on the progress made in implementing reforms across Government.

2.1 The Government agrees with the Committee’s recommendation.

Target implementation date: Late 2015.

2.2 Since 2010, the Cabinet Office has led a cross-Government programme to address long-standing weaknesses in commercial and contract management skills. As part of reforms to procurement, the Government aims to ensure that there is a level playing field for suppliers of all sizes. The Government acted swiftly and decisively when problems emerged with G4S and Serco in 2013, and is continuing to strengthen contract management following the Cross-Government Review of Major Contracts. All departments are implementing improvement plans, which include strengthening their audit and governance of contracts. The Crown Commercial Service (CCS) has published supporting materials alongside these plans, and has updated its standard operating procedures to ensure contract management is mobilised effectively.

2.3 The Treasury is increasing its scrutiny of contract management plans within the Treasury Approval Process for major projects. The Government will develop further standards including earlier mobilisation of contract management in due course.

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