Patients will continue to be guaranteed out-of-hours (OOH) access to GPs if they need one. This is the promise made by the Department of Health following the new GP contract’s stipulation that OOH care is to be provided by PCTs, rather than GPs.

National quality requirements in the delivery of out-of-hours services establishes what is expected of OOH care providers. From January 2005, PCTs will be legally required to commission services that meet these requirements.

The new quality requirements state that:

• patients will be treated by the clinician best equipped to meet their needs, in the most appropriate location
• if there is a clinical need, patients will be guaranteed a GP consultation, including a home visit
• services will be available on Saturday mornings
• services will be regularly audited to ensure that patients are receiving quality care

Announcing the requirements, health minister John Hutton said:

‘Patients are entitled to expect the NHS to provide high quality, accessible and comprehensive primary care services during the evenings and at weekends. I am determined that this will continue to be the case once the responsibility for organising out-of-hours services transfers from GPs to PCTs this year.

‘GPs will continue to play a leading role in helping to deliver out-of-hours services and working alongside nurses and other practitioners will help ensure patients get the right service at the right time from the right person.’

Primary care professionals have welcomed the pledges. Dr Michael Dixon, chairman of the NHS Alliance said:

‘OOH services now look different because patients may see someone other than a GP. But different does not mean worse. On the contrary, PCTs are providing a better, safer system than we have ever had.

‘I wouldn’t want to fly if the pilot had already been working 12 or 14 hours. If any of my family were ill, I wouldn’t want them to be treated by a doctor who was so tired after working all day and into the night as well that he might miss something vital.’

The NHS has appointed its first quality and human rights director — Surinder Sharma.

Already dubbed by the press as the ‘equality tsar’, Mr Sharma has taken up the £95,000 a year full-time post after leaving Ford Motor Company as diversity director.

The new post will involve:

• Promoting the government’s equality and human rights agenda across the NHS and social care system (including Sir Nigel Crisp's action plan on leadership and race equality)
• Delivering change at a national level
• Working in partnership with stakeholders in other government departments, equality and human rights organisations

In welcoming the appointment, Health Secretary John Reid said:

‘We have two aims with this appointment. Firstly, to make sure that appropriate services are available to anyone in the population, regardless of their background. Secondly, to ensure that we can draw on the talents, skills and passion of all parts of the community. Surinder is a very experienced professional who will enable us to do this.’

Surinder Sharma has over 25 years' experience working on equality and diversity issues in the public, private and voluntary sector. A qualified lawyer, his career began with the Commission for Racial Equality in 1983, and has since included chairmanship of the Leicester Racial Equality Council and commissioner at the Equal Opportunities Commission.

The NHS IT budget has been looping the loop this week, increasing from £30bn, decreasing to £16bn before soaring up to £40bn in the space of two days.

On Tuesday it was set at £30bn, followed by a decrease to £16bn according to health minister John Hutton and it went up again to £40bn on Thursday according to another report.

The NHS IT programme, which will provide e-prescribing, appointment booking and online patient records, was announced in 2002. At that time, the government allocated £2.3bn for procurement over the next three years. The figure later changed to £6.2bn over 10 years, and now further increases have been announced to allow for running costs.

On Monday the Department of Health said that the total costs for installing and running IT equipment over the next ten years would be between £15bn and £30bn.

This announcement was apparently made in response to a report in Computer Weekly saying that Department officials estimated the total costs of the national programme — including implementation — to be between £18.6bn and £31bn over ten years.

Much of the extra costs will have to be found locally and trusts fear that they will be left paying for the new kit. Gary Fereday, NHS Confederation policy manager, told The Guardian that there is 'real unease, particularly among directors of finance in the NHS, about how they will fund the programme.'

He continued: 'Over the next ten years we are looking at about 4 per cent of the average trust's turnover being spent on IT, compared with 1 per cent to 2 per cent now.'

The DH seems to have arrived at these figures using an IT industry rule of thumb — implementation costs tot up to three to five times the cost of procurement. A spokesman also described the running costs as being between 1.5 and 3 per cent of the expected NHS budget of £1,000bn over the next ten years. This adds up between £15bn and £30bn.

However, on Wednesday, health minister John Hutton told the BBC that running costs would be £1bn a year over ten years, putting the total at around £16bn (including the £6.2bn already spent on procurement).

On Thursday, The Guardian reported that when pressed about this, the DH said: 'We have always made it clear that we anticipate spending up to four per cent of the total NHS budget, in line with the recommendations of the Wanless report.' Calculators out again — it's £40bn total over the next ten years.

Naturally, this has caused consternation among trust IT and financial managers. Gary Fereday in The Guardian again: 'As yet there are no clear figures for the costs facing NHS organisations. Finance directors, as the people responsible for making the budgets balance, are concerned at this uncertainty.'

The National Audit Office announced in August that it has brought forward its value for money investigation of the project to summer 2005 — much earlier than expected.

Patients are spending less time in A&E according to a report from the National Audit Office (NAO).

• In 2002-03, 23 per cent of patients waited more than four hours.
• In April-June 2004, just over 5 per cent of patients waited more than four hours.

Since 2002 there has been a strong focus on ensuring no patient waits more than four hours in A&E. Better working practices are largely responsible for this improvement, according to the report, Improving emergency care in England.

Although there has been extra funding in A&E, most changes have been low cost. They include:

• See and treat, where the first practitioner who sees a patient can assess, treat and discharge that patient without referring to other clinicians.
• New roles, such as emergency care practitioners.
• Measures to speed access to other services.

Bottlenecks are caused by:

• Mismatches between admissions and discharges.
• Difficulties obtaining a specialist's opinion.
• Difficulties getting permission to admit patients to wards.

Staff shortages have also been redressed.

And the departments themselves have seen improvement. They are now decorated to create a more pleasant environment and patients enjoy better facilities. They are also laid out more flexibly to fit in with modern working practices.

Patients themselves are being encouraged to make fewer visits to A&E, using instead NHS Direct and minor injuries units.

But, says Sir John Bourn, head of the NAO, trusts should not sit back on their laurels. In August, nearly a quarter of patients needing admission to hospital spent more than four hours in A&E. Groups with complex needs, in particular older people and those with mental health needs, spend longer in A&E.

The report makes 16 recommendations, including:

• Trusts should monitor performance and use local benchmarking to ensure no patient spends longer than necessary in A&E
• Acute trusts should use simple bed management tools to identify avoidable peaks and troughs in inpatient flow
• Emergency care networks should look at care pathways of vulnerable patients
• Good practice care pathways for emergency medicine should be developed to measure and improve quality of care

Record numbers of transplants were carried out in the UK in 2003-04, mainly because people are being encouraged to join the NHS organ donor register.

A £3.6m campaign by UK transplant is behind the 3 per cent increase in transplants since the previous year, according to the Department of Health.

The good news was revealed in a new report — Saving lives, valuing donors: A transplant framework for England — one year on.

Meanwhile, in Scotland, a quarter of a million pounds has been made available for Glasgow and Edinburgh hospitals to increase the number of kidneys available for transplant.

Deputy Health Minister Rhona Brankin welcomed the funding, saying:

‘These new schemes will make an important contribution to improving organ donation rates in Scotland. Initially focusing on the donation of kidneys, they may later be extended to cover the donation of livers and lungs.

‘The programme will ensure that donation takes place in the controlled environment of the intensive care unit, after full discussion with patients' families, and after both clinicians and relatives are convinced that further treatment would be futile.

‘In addition, I am delighted that Scotland is to pilot the UK's first multi-organ retrieval team. Because the team will bring its own anaesthetist, it will now be able to retrieve organs in a wider range of cases, while at the same time allowing hospital staff to concentrate on the care of other patients.’

UK Transplant, NHS Lothian and NHS Greater Glasgow have provided the £261,016 funding.

The Welsh NHS will benefit from a £1.8bn budget increase over the next two years.

The draft budget for 2005-05 increases funding for health and social services in Wales to £4.9bn.

It will be invested in buildings and equipment, with plans for a spend of £309m. The Health Promotion and the Health Improvement programmes will benefit from an extra £45m. This includes £6m for research into cancer services.

But Health Minister Jane Hutt warned that increased investment would mean reform and renewal of the service. 'The Wanless review identified the need for a radical re-shaping of health and social care in Wales. The unprecedented level of capital funding that is now going into the NHS in Wales will ensure that this takes place.'

An extra £30m will help the NHS with a massive change in pay and conditions.

Health minister John Hutton has earmarked this sum for agenda for change. It will compensate NHS organisations for the time and manpower needed to negotiate and implement the shake-up.

Agenda for change affects about a million staff, including nurses, therapists and support workers. It includes a new top pay band with a maximum salary of £83,546 a year and at the other end of the scale, it has raised the NHS minimum wage to £5.69 an hour — an increase of 93p.

Another piece of good news for the agenda — it was approved by public service union Unison, which has 450,000 health members. At a meeting in London delegates agreed to recommend it to their members. The ballot results will be declared on 8 November. There have been wranglings over the agenda within the organisation because it was feared that the lowest paid workers might end up worse off.

The union's head of health, Karen Jennings, said: 'Agenda for change is crucial to the modernisation of the NHS. It’s an equal pay system that’s designed to cut out the inequalities and demarcations that are rife in the current antiquated pay system. It is simply not an option to carry on with a system that is failing to recognise or properly reward staff for the work they do.'

Finally, a booklet about the new pay system was published recently by the Department of Health. Titled Agenda for change — what will it mean to you? it is aimed at staff and includes new information following the review of pilot studies.

The number of diabetes sufferers in the UK is now equivalent to the combined populations of Liverpool, Birmingham and Manchester.

A report by Diabetes UK shows that 3 per cent of the population suffer from diabetes — 1.8m people. This is an increase of 400,000 in the last eight years. Five per cent of the NHS budget is spent on treating diabetes and its effects. The report warns that this could rise to 10 per cent by 2011.

The report, Diabetes in the UK 2004 predicts that the numbers will continue to rise as the population ages and more people become overweight.

It is thought that 250,000 people have type 1 diabetes and just over 1.5m people have type 2 diabetes. It is believed that there might be up to a million more with type 2 diabetes but they have not been diagnosed yet.

Sir Liam Donaldson, the chief medical officer has announced ambitious plans to eliminate tuberculosis (TB).

Stopping tuberculosis in England: an action plan from the chief medical officer establishes the steps which the government, health services and local communities need to take to reverse the rise in TB.

The action plan calls for:

• Providing multi-lingual and culturally relevant information
• Creating new TB clinical networks
• Screening high risk groups more effectively
• Assigning named case managers to every TB patient
• Increasing vaccination coverage of babies in high risk groups
• Utilising DNA bacterial fingerprinting to track TB spread in communities
• Strengthening TB surveillance in prisons
• Providing the wider use of digital X-ray
• Researching for better drugs and vaccines

Sir Liam Donaldson said:

‘In our battle against tuberculosis, the disease has regained the upper hand. We need to get back to public health basics. Identifying the high risk groups early, ensuring effective treatment for them and using modern laboratory techniques to track the disease are all vital control measures. Experience elsewhere has shown that the march of TB can be halted. Our long-term goal is to reduce, and ultimately eliminate, TB in this country.’