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This article was published in March 2013. The information may be out of date. Please check our epilepsy information or our site A-Z.

Changes to the NHS in England from 1 April 2013

28 Mar 2013

Over the last couple of years you may have read a lot about the NHS changes in England. These changes can be quite confusing, particularly when it comes down to how it will affect you. Below we have set out a quick guide to the changes, and what it means for epilepsy.

Up to now

From 1 April 2013, the way the NHS in England is organised will change. This is because of the Health and Social Care Act (2012).

Up until April, the NHS has been organised through:

  • Strategic health authorities (SHAs). These covered a region and oversaw the NHS in that area on behalf of the Department of Health.
  • Primary care trusts (PCTs) covering a smaller area, such as a city. PCTs were responsible for providing some services in the community, and for planning and buying other services for people in their catchment area.
  • NHS trusts providing direct care in hospitals or in the community.

GPs (General practitioners) are private contractors to the NHS, and had contracts to provide services with PCTs.

There have been local groups called LINks (Local Involvement Networks), which hold local services to account and have had some rights to inspect NHS services.

From April

From April 2013, the NHS will be organised through:

  • The NHS England organisation and its local area teams. These boards will plan specialist services and hold contracts for these services (this will also include GPs).
  • Clinical commissioning groups (CCGs). These are made up of GP practices and cover a smaller area, such as a city. CCGs do not provide services, but they do plan and monitor them.
  • NHS trusts providing direct care in hospitals or in the community.
  • And ‘qualified providers of care’ who will be given contracts by CCGs

GPs will be leading CCGs, and it is hoped that having doctors in charge of these groups will improve services and bring them closer to what patients want. CCGs have a legal responsibility to inolve patients in the planning of their services. It is also hoped that members of the public will have a bigger role, influencing the delivery of services and the type of services that exist.

Doctors will also be able to buy services for their NHS patients from a wider range of approved providers. It is hoped that having a wider choice of services will lead to services competing on quality and being smarter about how they treat patients.

GP practices will have patient reference groups to involve patients in improving local services.

Local councils will also be given a bigger role in deciding what health (and public health) issues should be the local priorities. This will be through their new Health and Wellbeing Boards. Local councillors will sit on the Health and Wellbeing Board.

And new local organisations, funded by the council, called ‘Healthwatch’ are being set up. Each council will have a Healthwatch, and these will replace LINks. They will represent local peoples’ views to the Council and CCGs provide information to the public and help advise them what to do if something goes wrong. They will also have the power to inspect the NHS services to make sure they are clean, safe and providing the services they say they are.

What will this mean for people with epilepsy?

Some services, that up till now have been planned and funded by PCTs, will now be planned and funded by NHS England. Epilepsy surgery for children has already been changed to be funded and monitored in this way. Epilepsy Action believes this can potentially be great news. For children’s surgery, a fully funded service that we believe will increase the quality of surgery (and the care before and after surgery), and will increase the number of operations each year. Other services that NHS England might take over include:

  • All adult’s specialist epilepsy services (based at specialist centres).
  • Adult epilepsy surgery.
  • All children’s specialist epilepsy services.

Epilepsy Action is still waiting for further developments.

The NHS changes can be difficult to understand. A lot of new documents have been produced, mainly to help CCGs to commission, and providers to deliver, high quality services. They look at how the NHS organisations will work out the needs of local people, decide what a good quality service should deliver and how patients will have their say on this. These documents include the Clinical Commissioning Group Outcomes Indicator Set and the NHS Commissioning Framework.

Many of these set the NHS a standard of care and ‘outcomes’ that should be received by patients. So for example, one outcome might be an increase in the number of people who are seizure-free. It is then down to the CCGs to work out how to make this happen.

However in order to commission new services, or improve current services, some services may be ‘decommissioned’ when they are reviewed. Health and wellbeing boards and CCGs are new and will set new local priorities for services that should be developed/improved. The people making decisions will not know everything; they will bring new ideas and may take more of an interest in one particular condition. That means it is all of our responsibility to make sure that the GPs and the patient representatives know that epilepsy is an important condition requiring specialist services. This is why Epilepsy Action launched it’s A Critical Time: for epilepsy in England report earlier this year.

What will this mean for you?

At first you shouldn’t notice much change to your care. It is likely that the care and services you receive will stay the same.

Over time it may be that your doctors and specialists give you more or different options about your care. They may offer you a referral to a different hospital, or may ask if you would like to try a new service. As always, you should consider what is right for you. Your doctor or nurse will help you with this. The Epilepsy Action helpline is here if you would like information to help you make these decisions.

You will be able to find out if your GP practice has a patient reference group. As the name suggests, this is a group of local patients who are routinely consulted. You may be able to go along and be a voice for people with epilepsy.

There could also be opportunities to join in with your local HealthWatch meetings. If you are a patient at an NHS foundation trust you could become a member. Your CCG may have a patient group or keep a list of people they consult when planning services.

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