The results of the government’s national consultation on patient choice have been revealed in the strategy paper Building on the best: choice, responsiveness and equity in the NHS.

Feedback from the public has helped create the following proposals:

• enabling people to record their own treatment preferences on their electronic health record
• extending GP surgery opening times beyond normal working hours
• allowing private contractors to provide free open day surgeries
• extending the right of pharmacists to issue repeat prescriptions without GPs’ signatures
• increasing the levels of nurse prescribing
• allowing commuters to register with a GP near their workplace
• making more medicines available without prescriptions
• ensuring that the planned electronic patient record enables patients to access care throughout the UK
• encouraging women to see a midwife without having to go through a GP and deciding on their own birth plans
• giving all adults the right to palliative care
• creating living wills to predetermine a patient’s right to whether they wanted to be kept alive
• allowing sufferers of progressive diseases to appoint healthcare proxies to be consulted by doctors about treatmen
• expanding NHS Direct to provide more digital TV services

Tony Blair described the exercise as the ‘biggest response back on virtually anything we have done in the health service’. The three-month consultation led to meetings of voluntary organisations representing over 110,000 people and 30,000 patients and professionals. The Department of Health received 2,500 completed questionnaires and 750 written submissions. The consultation was led by ‘patient tsar’ Harry Cayton, the Department of Health’s director for patients and the public.

The Royal Pharmaceutical Society of Great Britain welcomed the report. The society's president, Dr Gill Hawksworth, said:

‘There are plenty of excellent new ideas being tried and we think that patients deserve to have the benefit of them. If you are suffering from a minor ailment, getting your treatment on the NHS from a pharmacy saves you having to go to the GP. Millions of people are on long-term medication and could have their repeat prescriptions, monitoring, routine care and advice provided by the pharmacist near to where they live, work or shop. It all adds up to a much more flexible, user-friendly service for patients and better use of resources by the NHS.’

The latest report into the state of the NHS suggests that the service is performing well and that it is making good progress in meeting key waiting time targets.

The NHS chief executive Sir Nigel Crisp’s report examines the work and performance of the NHS over the last six months and the progress made in the three years since the NHS Plan’s publication. The increased use of day case surgery and a fall in hospital waiting times is highlighted in the report, but critics say more should be achieved from the extra money made available to the NHS.

• outpatient clinic procedures between March and September 2003 increased by 14.9 per cent
• GP surgery procedures between March and September 2003 increased by 1.4 per cent
• value of drugs prescribed to NHS patients reached £7.18bn in April 2003 (an increase of £2.3bn since 2000)
• number of patients waiting more than a year for operations between September 2002 and September 2003 fell by 99.3 per cent
• number of patients waiting longer than 21 weeks for a first outpatient appointment between September 2002 and September 2003 fell by 99 per cent
• non-urgent hospital admissions between April and September 2003 increased by 2.4 per cent

On publishing his report, Sir Nigel Crisp said:

‘Too often, people try to judge value for money in the NHS by looking only at acute hospital admissions. In fact the vast majority of patient care is provided outside hospital settings. Today's report shows that we're beginning to see operations which used to need a stay in hospital move to take place outside hospitals, in the community, by different groups of staff.’

‘These are important findings’, Health Secretary John Reid said in welcoming the report. ‘The NHS is far from perfect, but these figures show clearly why those who work in it deserve our thanks.’

MPs have voted to pass the government’s legislation for creating foundation trusts and the Commission for Healthcare Audit and Inspection (CHAI). Despite opposition from the Conservative party, Liberal Democrats and the House of Lords, the Health and Social Care (Community Health and Standards) Bill has been approved.

The bill will also see the creation of the Commission for Social Care Inspection and the handing of new powers for PCTs to commission dentistry locally.

The Medicines and Healthcare products Regulatory Agency (MHRA) are seeking views on the reclassification of the simvastatin Zocor Heart Pro from a POM (prescription only medicine (POM) to a P (pharmacy medicine).

Following the consultation the statin could become the first of many to be made available over the counter in pharmacies. (It is proposed that Zocor Heart Pro would be made available in doses of 10mg a day to combat coronary heart disease.)

The NHS currently spends £700m a year on statin drugs. One in every 50 people in Britain is currently receiving statin therapy, which saves around 6,700 lives a year.

Comments from the industry, NHS and the public are required to reach MHRA by January 2004. The Committee on Safety of Medicines will review the results and then advise the Department of Health.

The Healthcare Industries Task Force (HITF) brings together government and industry leaders in healthcare with the aim of:

• identifying steps to develop and stimulate the growth and performance of the UK healthcare industry
• maximising the benefit to patients from healthcare products

HITF will run for one year and is jointly chaired by health minister Lord Warner [use pic from Structure] and Sir Christopher O’Donnell (chief executive of medical devices company Smith & Nephew).

Four working groups will support HITF:

1) Market access working group — will look at factors around the UK market for products from the healthcare industries
2) R&D and industrial base working group — will consider and make recommendations on how to strengthen the UK as an attractive location for R&D and manufacturing investment in the healthcare sector
3) Regulatory issues working group — will consider the regulatory environment for medical devices and public health, identifying issues which would benefit from government and industry joint working
4) International and export business working group — will look at how government and British healthcare can assist the healthcare manufacturing industry to improve its international trade performance and to submit recommendations for possible inclusion in the operational plan

John Reid has published Maintaining the momentum, a progress report on the NHS cancer plan that highlights the achievements of the last three years and the challenges for the future.

The report highlights a number of achievements:

• Cancer death rate for people under 75 has fallen by 10 per cent since1995.
• Over 300,000 people have quit smoking since 2000.
• 98 per cent of patients with suspected cancer are seen by a specialist within two weeks of being urgently referred by their GP.
• 940 more cancer consultants are working now than in 1997.
• Over 850 pieces of equipment for diagnosing and treating cancer delivered to hospitals since 2000.
• Patient numbers entering clinical trials have doubled in the last three years.

Mr Reid has also asked the national cancer director, Professor Mike Richards, to ‘look at the NHS in every region and ensure the drugs and treatments which have been approved nationally are available. Where they are not, [he] will be seeking rapid action to redress the situation.’

Joanne Rule, chief executive of national cancer information service CancerBACUP, said:

‘The NHS cancer plan continues to engage the entire cancer community. It was based on consensus about the evidence base and real engagement with people affected by cancer. A great deal has been achieved in a short time. But in highlighting progress, it's important to recognise there's a lot to do between now and 2010.’

The Commission for Health Improvement (CHI) has produced the first independent national report on NHS Direct and has given the service a clean bill of health.

What CHI has found in: NHS Direct services praised the nurses that NHS Direct employ for providing ‘good quality advice and reassurance’ and for being ‘professional and compassionate when providing basic healthcare advice’. Ninety per cent of users were either ‘completely satisfied’ or ‘satisfied to some extent’ with the service.

The report also discovered that:

• On a monthly basis the service receives 500,000 telephone enquiries and the same number of internet enquiries.
• The majority of calls are made outside GP surgery working hours.
• 25 per cent of enquiries relate to children under the age of 5.

Common questions fielded by NHS Direct are:

• How should I feed my baby?
• What is the male pill?
• Do I need vitamin supplements?
• Can I get impotence drugs on the NHS?
• How do I find an NHS dentist?
• What happens if I miss a dose of medicine?

However, it was discovered that some of the NHS Direct call centres are missing the national target to answer 90 per cent of all telephone calls within half a minute. Acting chief executive of CHI, Jocelyn Cornwell, said:

‘Success, however, has meant increasing demand for the service and capacity problems for some call centres. There are also complex management arrangements, which can create confusion over the development of policy, practice and performance and a lack of clarity over roles and responsibilities. For NHS Direct to build on its success and popularity, these issues need to be resolved.’

CHI and NHS Direct will be working together to meet some of the issues that the report raised.

On the same day of the publication, John Reid celebrated the volume of calls made by NHS Direct, which has exceeded 20 million.

Dr Roger Boyle, the national director of coronary heart disease has launched the Coronary heart disease national workforce competence framework guide.

Specifying the standard of performance required of workers and identifying the knowledge and skills they require, the framework covers all activities involved in:

• the prevention of coronary heart disease (CHD)
• heart failure
• rehabilitation

The framework is divided into nine key areas — the first four areas are generic and apply to anyone working to improve people’s health and wellbeing:

1. Develop, implement and review policies, strategies and plans to improve health and wellbeing
2. Obtain, manage and account for the use of resources
3. Research, monitor, evaluate and improve the efficiency, effectiveness, equity and quality of CHD services
4. Work collaboratively with individuals, families, communities and other professionals.

The remaining areas relate to practitioners working with individuals with, or at risk of, heart failure or CHD:

5. Reduce the risk of people developing CHD
6. Carry out clinical tests for CHD
7. Diagnose CHD and assess individuals’ needs
8. Manage care for individuals with CHD
9. Deliver CHD services

The second wave of NHS foundation trusts has been announced. The 32 hospitals that make up wave 1A will now make formal applications to become working foundation trusts from October 2004.

• Airedale NHS Trust
• Barnsley District Hospital NHS Trust
• Birmingham Heartlands & Solihull NHS Trust
• Birmingham Women's Healthcare NHS Trust
• Burton Hospitals NHS Trust
• Chelsea & Westminster NHS Trust
• Chesterfield & North Derbyshire NHS Trust
• East Somerset NHS Trust
• Gateshead Health NHS Trust
• George Eliot Hospitals
• Harrogate Healthcare NHS Trust
• James Paget Healthcare NHS Trust
• Lancashire Teaching Hospital NHS Trust
• The Lewisham Hospital NHS Trust
• Liverpool Women's Hospital NHS Trust
• Luton & Dunstable Hospital NHS Trust
• Mid-Staffordshire General Hospitals NHS Trust
• Morecambe Bay NHS Trust
• North Hampshire Hospitals NHS Trust
• Nottingham City Hospital NHS Trust
• The Royal Bournemouth & Christchurch NHS Trust
• Sandwell & West Birmingham Hospitals NHS Trust
• Southampton University Hospitals NHS Trust
• South Devon Hospitals NHS Trust
• Southend Hospital NHS Trust
• South Tyneside Healthcare NHS Trust
• Taunton & Somerset NHS Trust
• West Dorset General Hospitals NHS Trust
• West Suffolk Hospitals NHS Trust
• Winchester & Eastleigh Healthcare NHS Trust
• Wrightington, Wigan & Leigh NHS Trust
• York Health Services NHS Trust

An additional £28m is being made available over the next two years to assist PCTs in providing out-of-hours (OOH) services. As part of the new general medical services contract, GPs will be able to opt out of providing OOH care from December 2004.

In announcing the extra funding, health minister John Hutton said:

‘We are fully committed to delivering the new GP contract on time so that all GPs, who wish to, can opt out of their out-of-hours responsibility from December 2004. This is an opportunity for PCTs to rethink the provision of out-of-hours services across their area and to coordinate this with other services including A&E, social care and NHS walk-in centres.’

Strategic health authorities will be working with the Department of Health in deciding how to distribute the money. John Hutton stated that PCT funding will be based on local populations — not GP numbers.

Church Road primary care centre in east London has become the first local improvement finance trust (LIFT) project to begin construction. By August 2004 the building should be finished with the first patients expected to be seen in the following month.

The £4.9m care centre will provide primary care services to an area that traditionally had failed to attract investment.

An extra £15m has been made available for genito-urinary medicine (GUM) services. The money will help sexual health clinics expand their services, increase capacity and reduce waiting times. In announcing the extra funding, John Reid said:

‘This government is committed to tackling increasing rates of HIV and other sexually transmitted infections (STIs). Today's investment will enable the NHS to make the necessary improvements so that patients are treated in higher quality premises.’

GUM service providers will work with the DoH and strategic health authorities to ensure that the areas in most need receive a share of the extra funding.