Website of the Department of Health

Chief medical officer's annual report

Sustained action in five key areas highlighted by the country's chief medical officer will significantly improve health care in England.

In his latest annual report Professor Sir Liam Donaldson makes recommendations for GPs and other health professionals on smoking and skin ageing, the economic benefits of smoke-free public places, better blood transfusion, academic medicine and earlier detection of HIV.

On the State of Public Health also reviews progress on five topics from previous annual reports including obesity.

Sir Liam makes the economic case for smoke-free work and public places and looks at how the NHS can make smokers and non-smokers more aware of the risks of cigarette smoke for skin ageing.

The report also focuses on academic medicine and recommends that throughout the NHS a culture of research and innovation should be developed to continuously improve patient care.

Sir Liam also promotes the need for the NHS to expand HIV testing services in primary and community care settings in addition to traditional genito-urinary medicine clinics.

The full report can be found at:

• On the state of the public health: Annual report of the Chief Medical Officer 2003

New childhood immunisation programme

GPs and other health professionals can get the latest information on a new immunisation programme on the web.

A new five-in-one vaccine will be offered to infants to ward against diphtheria, tetanus, whooping cough, polio and hib (haemophilus influenza).

The change has been introduced so that inactivated polio vaccine can now be used instead of a live oral polio vaccine for all ages. This eliminates the risk, albeit extremely small, of paralysis.

A new vaccine is also being introduced for whooping cough which causes fewer minor reactions in children compared to the previous vaccine.

The new vaccines are thiomersal free, so meet the internationally agreed aim of reducing children's exposure to mercury. 

All these vaccines are now combined so that children will receive just one injection. The new vaccines will be introduced from late September.

Professor Elizabeth Miller, head of immunisation at the Health Protection Agency, which monitors responses to vaccines, said: 'There is no need for parents to be concerned about their children being vaccinated against five diseases at once - the number of vaccines being offered has not changed - only the way they are given. A child's immune system is more than able to cope with being exposed to many more viruses and bacteria at one time.'

The website, which is also aimed for parents, can be reached at:

• NHS Immunisation Information (opens new window)

New sexual health guidance

GPs and fellow clinicians have been issued with revised guidance on what approach to take when asked for contraception by someone under 16 years old.

They should develop a rapport with the teenager concerned by discussing the emotional and physical implications of sexual activity, including sexually transmitted infections (STI) and pregnancy.

The guidance, jointly issued by the Department of Health and Department for Education and Skills' teenage pregnancy unit, says the discussions should also establish the nature of the patient's relationship with a partner. Healthcare professionals can then determine whether sexual activity is mutually agreed or whether there is some coercion or abuse involved.

It comes as the Health Protection Agency (HPA) revealed that the number of STI cases in England, Wales and Northern Ireland rose by four per cent last year to more than 708,000.

The HPA's first annual report showed marked variations in diagnoses nationwide, reflecting the impact of local outbreaks and indicating high-risk areas. New cases of chlamydia - the most common STI - rose by nine per cent to nearly 90,000.

The guidance also stresses the benefits of encouraging under-16s to discuss the issues of sexual health and contraception with a parent or carer, but any refusal should be respected.

The guidance can be found at:

• Contraception

The latest SPI figures and  HPA Annual Report can be found at

• Sexually transmitted infections continue to increase during 2003 (opens new window)

Managing complaints and improving services

The imminent release of the final Shipman Inquiry recommendations will lead to a further review of complaints management in the health service.

GP attitudes to complaints must be seen to be patient-centred, accessible and responsive as highlighted in the 2004 Health Ombudsman's report.

NHSU has developed the managing complaints for service improvement programme to help ensure all healthcare staff, involved with complaints or service improvement, are equipped to cope with these changes.

By influencing service improvement, the programme:

The programme will roll out to trusts throughout England from October.

New NHS complaints system

A new independent system for investigating patients' and carers' complaints about NHS services is being launched.

The Healthcare Commission has taken over responsibility for reviewing NHS complaints that have not been addressed at local level.

This new stage of the NHS complaints process is designed to produce a fairer, faster and more independent and consistent service.

The commission will assess the views of both the individual making the complaint and the individual or organisation about whom the complaint has been made.

Under the new system, complaints not satisfactorily resolved at a local level within six months will be passed to the commission.

Recommendations will then be made about service improvements.

More information at:

• Healthcare Commission (opens new window)

Payment by Results

Hospitals will be paid a national-set tariff for providing a clearly defined service under new Government plans.

Details of the Payment by Results (PbR) scheme, designed to change the way money flows within the NHS, were announced after a large consultation exercise.

Payment by Results Consultation: Preparing for 2005 invited views on the key policy and technical issues.

The feedback has been used to shape the scheme, which aims to deliver a transparent, rules-based system that will fairly reward hospitals for the work they do.

Measures include:

From 2005, trusts will have three full years to adjust to the new tariff and will be expected to make cost savings of up to eight per cent over this period if their current costs are above the tariff. If their costs are below it, they can use the savings to develop new services.

More information at:

• Payment by results

Tackling disability discrimination

The Department of Health and the Disability Rights Commission will jointly publish A Good Practice Guide For Primary Care Service Providers in September for those who own or run primary care health services, such as GP or dentistry surgeries, community clinics, walk-in centres, out-of-hours services, pharmacies or specialists such as podiatrists. 

The guide can help practices to understand the duties under the Disability Discrimination Act 1995 and what action you can take to meet the needs of disabled service users.

More information at:

• Equality and human rights

National diabetes audit

GP practices, PCTs, strategic health authorities and hospital trusts are being encouraged to participate in the newly launched National Diabetes Audit.

On 1 July, a national audit to collect diabetes information throughout England was launched. This will help NHS organisations raise standards of care and support the National Service Framework for Diabetes.

The audit, launched by the NHS Information Authority and commissioned by the Healthcare Commission, will provide the basis for national comparative audit of diabetes services.

The web-based application allows organisations to upload data via a secure connection. Participation will be monitored by the Healthcare Commission.

More information and registration at:

• Diabetes (opens new window)

Missed appointments guidance

Practice guidance on how to deal with and reduce missed appointments is now available.

Each year more than 17 million GP and practice nurse appointments are missed.

The guidance includes information about why patients do not attend and underlines the importance of patient education and communication.

It includes some useful messages for patients and ways to improve internal practice communications, reducing cancellations and developing better access to facilities.

The guidance also covers ways in which practices can improve attendance at hospital appointments.

GP practices have been consulted about the extent of the problem, and invited to supply examples of good practice that is helping to cut down the number of missed appointments.

A Guide to Managing Missed Appointments in General Practice was developed as a result,

The Developing Patient Partnerships Keep It Or Cancel It campaign was launched on 24 August and has Department of Health backing.

For more information about the campaign call 0207 383 6824 or e-mail:

• dpp@bma.org.uk (opens new window)

Practice leaflet

Best practice templates are now available to help practices to produce a leaflet on services for the local community.

The three templates, and a guidance document, are useful new resources to help practices inform patients and improve access to local services.

More information at:

• GP practice leaflet templates and guidance (opens new window)

What to do in a heatwave

A new national programme places GP practices at the heart of reducing public health risks during a heatwave.

The Heatwave Plan for England sets out the arrangements that will apply and precautions required in advance of and during a heatwave.

It identifies the roles and responsibilities of GPs, other health and social care colleagues, carers, organisations and patients at each stage of a Heat-Health watch system.

PCTs and social services will work with GP practices to identify at-risk groups, such as older people, babies, young children and those who live alone.

GPs and their practice teams are being urged to work together to identify at-risk groups and implement specific measures for those outlined in the plan.

The Department of Health has also produced a factsheet for health and social care staff with information and advice on caring for patients.

A patient leaflet A Guide To Looking After Yourself And Others During Hot Weather will be available in GP practices.

More information at:

• Heatwave: Plan for England - Protecting health and reducing harm from extreme heat and heatwaves (2004 edition)

Flu jabs campaign

The flu immunisation campaign will launch on 4 October this year with TV and press advertising.

This year there will be a new advertising campaign.

In addition to the national publicity campaign materials, there are other leaflets which form part of the routine immunisation information programme. They are:

Information about the advertising campaign, order form for the new support materials and downloadable artwork will be available shortly.

More information at:

• Flu key documents

Better local pharmacy services

Patients will find new pharmacies in the future will be easier to get to, open for longer and offer a wider range of services.

This is expected to be the result of new rules to control their locations.

All pharmacy applications to provide NHS pharmacy services must fall in to one of four categories and offer a full and prescribed range of services determined locally (or in the case of internet and mail order based pharmacies by the Department of Health). If they do their applications will automatically be accepted.

The four categories are that: pharmacies in shopping centres over 15,000 square metres must be away from town centres; pharmacies set up by consortia establishing new one-stop primary care centres must offer a wide range of primary and community based services in addition to usual GP services, to a population of 18,000 to 20,000 patients; internet or mail-order-based pharmacies must provide a fully professional service; and pharmacies that commit to opening more than 100 hours per week must maintain that.

PCTs will also be able to take account of the benefits that greater competition and choice for patients may bring when assessing new applications from pharmacies.

The current PCT assessment process will be streamlined to make it quicker, more transparent and promote more consistent decision-making.

The changes follow recommendations made in the Office of Fair Trading's report The control of entry regulations and retail pharmacy services in the UK, which was published last year.

More information at:

• Medicines, pharmacy and industry

Pharmacy contract - update

The Pharmaceutical Services Negotiating Committee (PSNC) has voted unanimously in favour of the Department of Health's £1.766 billion funding offer for the new community pharmacy contract.

The agreement is subject to a number of issues being addressed which will be negotiated over the coming weeks.

"PSNC believes that the new contract offers great opportunities for community pharmacy to increase the services it provides for the public and the NHS," said Sue Sharpe, chief executive of PSNC.

A Department of Health spokesman said: "We are pleased with such wholehearted support and will be working hard with the PSNC to work out the remaining details."

Choose and Book guidance

New guidance is available to help practices implement choice of hospital and booked appointments at GP referral.

By December 2005, all patients who need a referral to hospital for planned care  can expect to be offered a choice of four to five hospitals, or suitable alternative providers.

They will also be able to book their appointment with their preferred hospital or another provider.

Patient choice is at the heart of the Government's NHS modernisation agenda and key to offering a personalised health service to every patient.

The guidance has been developed following extensive consultation with the NHS, and sets out the policy for offering choice at referral and deals with many of the common questions about how choice should work.

PCTs will now produce plans for the implementation of Choose and Book with further guidance on its delivery due to be published shortly.

The guidance can be found at:

• Choose and book: Patient's choice of hospital and booked appointment - policy framework