A BBI

General practitioner (GP) practices in the UK will directly commission care and services tailored to the specific needs of their patients as part of a new effort to "devolve" more decision-making to the front lines of the National Health Service (NHS). Beginning next April, GP practices will be able to receive an "indicative budget" from primary care trusts (PCTs) that they can use to improve the delivery of services.

PCTs themselves will continue to be legally responsible for the contracting process, but Health Minister John Hutton said any savings that result from managing referrals more efficiently will be shared between GP practices and PCTs, with all of those savings being reinvested into patient care. PCTs also will remain responsible for commissioning of specialists.

He said no targets will be set for the numbers of practices to become involved in the new program, known as "practice-led commissioning," since practices will be encouraged to respond to it at their own pace. Groups other than practices – such as community-based nursing teams – also could hold an indicative budget for groups such as vulnerable adults.

The Department of Health said the new effort means patients will be able to benefit from a greater variety of services from a larger number of providers in settings that are closer to home or more convenient for them.

Hutton said, "This will enable GP practices and other groups to play a bigger role in commissioning services for their patients and local populations. It will mean greater flexibility for GPs to deliver services tailored to their patients' needs."

He said PCTs and GP practices "should see practice-led commissioning as an opportunity to change the NHS from the bottom up. Money freed through practice-led commissioning will be ploughed back into the delivery of patient services, therefore increasing investment in primary care."

The proposals outlined this week will be tested within the NHS over the next few weeks. Some GP practices already are involved in practice-led commissioning, among them those in North Bradford Primary Care Trust. Dr. Ian Rutter, a GP in Bradford, said, "Our experience of offering practice-led commissioning has been immensely positive. It has achieved greater involvement of clinicians and practices with their patients in decisions about care."

Rutter added: "We have been able to deliver improved quality and better use of resources by empowering primary care to manage secondary care budgets."

Mike Dixon, chairman of the NHS Alliance, the main representative organization of primary care trusts in England, said practice-led commissioning "should re-ignite the enthusiasm of frontline GPs and practices who want to have a greater say in improving the range and quality of services available to their patients. It will support and strengthen PCT commissioning by making it more sensitive to individual patients and the decisions they make with their frontline clinicians."

Dr. James Kingsland, chairman of the National Association of Primary Care, called the new program "a significant landmark in the evolution of commissioning services within the NHS and reaffirms the government's wish to see primary care clinicians at the forefront of commissioning secondary care services."

Automation cuts hospital drug errors

A study presented at the British Pharmaceutical Conference in Manchester last month said that automating the distribution of drugs in hospitals can help to totally eliminate potentially serious drug errors. Research into the automated pharmacy systems (APSs) at West Wales General Hospital (Carmarthen, Wales) and Llandough Hospital (Penarth, Wales) showed that, pre-automation, there were problems with nearly 16 out of every 1,000 items issued as ward stock. Of those problems, there was a 1 in 5 chance of error occurring in both the strength and quantity of the item being issued. Following automation of the pharmacy systems, the incidences of the wrong quantities and strength of items being issued (covering those that were available in the automatic distribution service) were totally eliminated at both sites.

The research was carried out jointly by the Welsh School of Pharmacy (Cardiff, Wales); the University of Wales Swansea; the IT department of Health Solutions Wales (Cardiff) and the two hospitals.

Automation of shelf-stocking and picking processes within a self-contained machine, which then delivers the product via a system of conveyors to remote dispensing and distribution points, reduces the human element of pharmacy support staff picking stock for wards and departments. It is also possible, when using the machine for dispensing, to apply a label to the product before it leaves the machine.

Pharmacist Dr. Cate Whittlesea from Cardiff University said the study provides a template for other hospitals to benchmark the number and type of drug distribution incidents pre- and post-automation. "Hospital pharmacies are increasingly investing in innovative APS technology," she said.

"An APS facilitates better use of nurse and pharmacy staff resources," Whittlesea said. "Automation frees up pharmacy staff to spend more time on patient-focused activities [which] contributes to a reduction in prescribing and administration errors at ward level, as well as patients having an improved understanding of their medicines."

Noting that the cost of drug waste in Wales alone is estimated to be more than 15 million a year, she said such systems can reduce waste in the National Health Service, since drug packs don't have to be split for distribution.

West Wales General Hospital was automated in September 2003 and Llandough Hospital in November 2003.

Telemed firm starts European operations

Digital imaging and telemedicine applications supplier Trestle Holdings (Irvine, California) has reported beginning operations in Europe by retaining a Europe-based sales executive and signing a distribution agreement with SlidePath Ltd. (Dublin, Ireland), a provider of custom technical solutions for the scientific and medical communities. SlidePath, a provider of medical imaging and informatics solutions throughout Europe, will market Trestle's MedMicro, a dynamic telepathology and teleconsultation system. Used in clinical pathology, education and pharmaceutical development, MedMicro enables multiple physicians and scientists to remotely view, navigate and share high-fidelity microscope images at sub-micron resolution over the Internet.

Trestle said physicians using MedMicro have real-time control over physical slides, which they can examine online using a standard web browser. The company said that unlike standard "virtual microscopy" systems, that enable physicians to remotely view stored digital images, MedMicro gives physicians the ability to remotely navigate real slides, and even to adjust focus and lighting for more accurate diagnosis.

Maurizio Vecchione, Trestle's CEO, said, "With the growing worldwide trend toward dynamic teleconsultation, we are seeing an increasing demand in the European market for high-quality telepathology solutions. With Trestle's distribution partnership with SlidePath, we've taken a major step toward addressing that demand."

SlidePath's managing director, Dr. Donal O'Shea, said his company sees substantial opportunities for MedMicro throughout Europe, citing Scandinavia as an example of an area that features "a thriving life sciences market and a strong broadband infrastructure."

Trestle Holdings said its telemedicine products use proprietary software and standard computer and medical hardware "to facilitate remote examination, diagnosis and treatment of patients through real-time integration of voice, video, medical devices and patient data."

Pap test firms add to market positions

Cytyc (Boxborough, Massachusetts) followed with its fellow U.S. producer of Pap tests for cervical cancer screening, TriPath Imaging (Burlington, North Carolina), in reporting success in adoption of its tests in the UK. Cytyc said the London Region of the National Health Service (NHS) intends to convert all cervical screening to the company's ThinPrep Pap Test. That region is comprised of five sectors, which together process about 650,000 Pap tests annually.

That announcement came a few days after TriPath reported that it has been awarded a five-year contract to supply Cheshire and Merseyside Strategic Health Authority with its SurePath liquid-based Pap test. The SurePath test is expected to be used in more than 90% of the authority's total annual cervical cancer screening requirements.

Cytyc said its exclusive arrangement with the London Region of the NHS represents a potential use of some 3.3 million ThinPrep Pap tests over the five-year term of the contract. Daniel Levangie, executive vice president, said the London region is one of the largest regions in the UK and combined with previously announced agreements in Scotland, the South West Region and the South East (East) Region represent a total potential use of more than 1.75 million ThinPrep tests annually.

In its earlier announcement, TriPath said the SurePath solution would be supplied to the Cheshire and Merseyside SHA by Medical Solutions plc, the company's licensed distributor in the UK. "We anticipate that the adoption of this technology will result in significant improvements to cervical screening in this area," said Lesley Turnbull, MD, regional director of quality assurance in the NHS's North West Cervical Screening Region.

UK pushes to grow organ donor registry

A new report published in mid-October indicates that the UK recorded the largest number of organ transplants in the nation's history in 2003-2004. The accomplishment was attributed to greater investment in publicity campaigns and hospital-based initiatives aimed at encouraging more people to join the NHS Organ Donor Register or agree to donation.

The organization UK Transplant spent 3.6 million on raising the profile of organ donation with a view to increasing transplantation rates, resulting in 2,867 transplants being carried out. That represents a 3% increase over the previous year's figures.

The report, Saving Lives, Valuing Donors: One Year On, details the progress made by the Department of Health and UK Transplant in meeting the commitments published in July 2003 in Saving Lives, Valuing Donors-A Transplant Framework for England.

During a celebrating of the success of organ transplantation with Prime Minister Tony Blair and organ transplant patients at Downing Street, Health Minister Rosie Winterton said,"Thanks to the generosity of donors and their families, the dedication of staff in the NHS, the voluntary sector and UK Transplant coupled with continuing investment, 2003-04 has been a record year."

Noting, however, that "there is still a shortage of organs available and nearly 6,000 people are currently on the national list for a kidney transplant," she urged British residents to join the NHS Organ Donor Register "and to tell their family and friends that they would like to help others to live after their death."

The launch of the progress report coincides with the 10th anniversary of the NHS Organ Donor Register. Some 11.6 million people are on the register and UK Transplant aims to add 1 million more during the coming year. The UK government has a goal of increasing the number on the Organ Donor Registry to 16 million by 2010.

bioMerieux, Gen-Probe in accords

bioMerieux (Paris), its affiliates and Gen-Probe (San Diego) signed licensing agreements granting access to Gen-Probe's ribosomal RNA technologies and, in turn, providing Gen-Probe admittance to bioMerieux's intellectual property related to genetic mutation detection, specifically in blood clotting disorders. Terms include a payment to Gen-Probe of up to $250,000 for a limited nonexclusive research license and options to develop diagnostic products for certain targets using its technology. Options if exercised could be worth an aggregate $4.5 million. bioMerieux also could acquire development rights for extra targets, paying up to $3 million by the end of 2006, and Gen-Probe is entitled to sales-based royalties.

Gen-Probe will pay bioMerieux $1 million plus potential royalties for a nonexclusive worldwide license to its intellectual property to develop mutation detection kits focusing on genes coding for Factor V and prothrombin. The French company ended agreements to develop assays for its VIDAS instrument with Gen-Probe, which expects to record the remaining $500,000 in the third quarter. The companies agreed that Gen-Probe could negotiate rights to develop certain transcription-mediated amplification assays to run on bioMerieux's Easy Q platform.

UK, Medicon Valley collaborating

The Medicon Valley Academy (MVA) and the UK government have established a collaboration, the MVA-UK Challenge Program, to foster cooperation in biotechnology research between the UK and the Medicon Valley region, which spans the Greater Copenhagen, Denmark, area and the Sk ne region of southwest Sweden. Lord Sainsbury, the UK trade and industry minister, unveiled the initiative at the BioTech Forum in Copenhagen last month.