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Teaching and Learning Consultation skills 

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Teaching and Learning Consultation skills 

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To register for an account on our website, follow these steps:

Click on the "Sign Up" button on our homepage and provide your personal details, including your name and NHS email address.

Tell us about yourself and your role.

Pick the tags that represent the areas you want to learn more about. This will help us tailor the resources we recommend to you.

Watch our brief onboarding animations, which will provide you with an overview of our website and its features. This animation will help you get the most out of our resources and ensure that you can navigate the website with ease.

Once you have completed these steps, you will be able to access our full range of resources and take advantage of additional features, such as personalised recommendations and progress tracking.

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Consultation Skills - for Healthcare Professionals

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To register for an account on our website, follow these steps: Click on the "Sign Up" button on our homepage and provide your personal details, including your name and NHS email address. Tell us about yourself and your role. Pick the tags that represent the areas you want to learn more about.

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Consultation skills : TALC and Healthy English

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Consultation skills : TALC and Healthy English

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Clinical Evidence from NICE

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NHS OpenAthens

You can access a range of bibliographical databases with your NHS OpenAthens account. Sign in to see what you can access.

You can access bibliographic databases from the providers' websites. For example:

Health Education England provides links to these databases and materials to help you search effectively.

You will need to sign in to the databases with your NHS OpenAthens account.

NHS Knowledge and Library Hub

Visit Health Education England's NHS Knowledge and Library Hub for:

A single search of all the knowledge and library resources available to you, whether purchased nationally or locally.

Links to database provider websites for advanced literature searching.

A browsable list of all the journals you can access.

A list of all resources purchased nationally for the NHS in England.

You'll need to sign in with your NHS OpenAthens account to access the resources.

Help and support

For help and support using the resources listed here, or for further information, contact your local healthcare library. You can find details in the Health Library and Information Service Directory.

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Evidence search service closure information

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You can access a range of bibliographical databases with your NHS OpenAthens account. Sign in to see what you can access. You can access bibliographic databases from the providers' websites. For example: Health Education England provides links to these databases and materials to help you search effectively.

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Clinical Knowledge Summaries

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.

CKS content is produced by Clarity Informatics Limited. It is available to users outside the UK via subscription from the Prodigy website.

If you believe you are seeing this page in error please contact us.

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories. CKS content is produced by Clarity Informatics Limited. It is available to users outside the UK via subscription from the Prodigy website. If you believe you are seeing this page in error please contact us.

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EARS, NOSE, THROAT AND MOUTH

Thousands of people in Britain use British Sign Language (BSL) as their primary method of communication. However, their language is not currently recognised by law. This can make accessing public services, especially healthcare, and daily life extremely challenging.

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Symptom Checker, Health Information and Medicines Guide

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EARS, NOSE, THROAT AND MOUTH Thousands of people in Britain use British Sign Language (BSL) as their primary method of communication. However, their language is not currently recognised by law. This can make accessing public services, especially healthcare, and daily life extremely challenging.

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Headspace for Mindfulness and Resilience 

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Headspace for Mindfulness and Resilience 

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DermNet NZ is the world's free resource and authority on all things skin. We help thousands of people make informed, evidence-based decisions on how to care for skin conditions, by providing reliable information at the click of a button.
Supported by and contributed to by New Zealand Dermatologists on behalf of the New Zealand Dermatological Society Incorporated

Guidelines for authors

Are you interested in writing for us? DermNet New Zealand is always looking for potential authors to write on new topics or to update existing ones. Potential authors interested in writing a new page are generally asked to write a topic page about a disease or condition, or a treatment, product or procedure.

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DermNet NZ - All about the skin | DermNet NZ

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Supported by and contributed to by New Zealand Dermatologists on behalf of the New Zealand Dermatological Society Incorporated Are you interested in writing for us? DermNet New Zealand is always looking for potential authors to write on new topics or to update existing ones.

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The RCGP is the professional membership body for family doctors in the UK and overseas. We are committed to improving patient care, clinical standards and GP training..

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Skip Intended for UK Health Care Professionals Only

Welcome to GP SelfTest the RCGP's learning needs assessment tool for GPs at all career stages, from those preparing for the MRCGP AKT to those preparing for their annual appraisals.
FREE unlimited access for all RCGP Members and AiTs
Non-members click here to subscribe

Over 2000 questions

All questions written by practising GPs

Detailed clinical scenarios

Question feedback and links to further resources

Certificates for CPD portfolio

Peer comparison scores

Eight different types of test including:

Curriculum wide learning assessments

MRCGP AKT style revision tests

Topic specific assessments

Short lucky dip quizzes

TEST - Thousands of quality assured questions will support your MRCGP exam revision and learning-assessment. Practise with AKT style questions and mock exams.

REVIEW - Fit your AKT preparation and medical revision around your busy schedule with short quizzes and topic specific tests. Analyse your performance and access further resources.

ACHIEVE - An extensive question bank complemented by up-to-date resources that enable GPs to identify areas for improvement and build their all-round knowledge for CPD and appraisals.

Dr Kofo Jegede, a GP in North East London, explains how she sees GPST benefiting her everyday practice and CPD needs.

Have a query?

Please visit our frequently asked questions page.

For help with logging in please see our user guide.

For all content or technical queries, please email gpselftest@rcgp.org.uk.

If you have a question regarding GP Self-Assessments International Induction or Return to Practice Programmes please email IGPR@rcgp.org.uk.

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Skip Intended for UK Health Care Professionals Only Welcome to GP SelfTest the RCGP's learning needs assessment tool for GPs at all career stages, from those preparing for the MRCGP AKT to those preparing for their annual appraisals.

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Am I on track to pass? How do I compare to others?

PassMedicine constructs a histogram based on other candidates scores which is updated on a daily basis. This not only allows you to see where you are in the pecking order but also helps predict whether you're ready to take the exam.

All the features you'd expect. And more.

Revision mode, timed tests, extensive performance analysis and powerful question review functions. Not only are PassMedicine questions accompanied by answers there are also revision notes under each question. Flag questions, add your own revision notes and much more...

Introducing the knowledge tutor. Harness the power of spaced repetition learning.

As well as our established, conventional question banks PassMedicine has developed the knowledge tutor. We've taken the results of the latest trials in memory science and applied them to medical revision. What this means in practice is a powerful system that drills key, high-yield, exam-relevant facts into you.

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Online revision for the MRCP Part 1, MRCGP Applied Knowledge Test (AKT), GP ST Stage 2 - Specialty Recruitment Assessment, Medical student finals, MRCP Part 2, Situational Judgement Test, PLAB, DRCOG. Revision questions in the current format to help you pass.

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Leadership Academy – Learning hub: Easy to access learning materials for all NHS staff

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Welcome to our NHS Leadership Academy learning hub. This site hosts a range of short learning solutions designed by experts for the development of NHS staff of all levels to work though at their own pace. The content of many of these learning materials is taken from elements of our Leadership Academ…

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Online mental health support for youth 10-25 years 

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Online mental health support for youth 10-25 years 

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Diabetes UK - Know diabetes. Fight diabetes. | Diabetes UK

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We are Diabetes UK, the leading charity for people living with diabetes in the UK. Our vision is a world where diabetes can do no harm.

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Providing health advice and guidance on some common conditions, informed by physiotherapists.

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This programme is in partnership with...

About the Tackling Loneliness and Social Isolation programme

There is now substantial evidence that having a lack of social connections significantly increases the risk of premature mortality. The risk to health that chronic loneliness can bring is greater than those associated with many factors that currently receive substantial public health attention and resources.

This elearning course is focussed on highlighting the impact of chronic loneliness as a serious health concern and how we can all help to tackle loneliness with the interactions we have with patients and the public. It support s the call to action from the Jo Cox Commission to 'equip people with information about the potential triggers for loneliness and ensure they know where to go for support'.

The course highlights how health and social care staff and the wider public health workforce can recognise risk factors, risk groups and apply simple interventions that will that can make a positive impact.

The learner will:

Understand the importance of loneliness and social isolation (LSI) as a risk factor for negative health outcomes.

Be able to recognise people within their practice at risk of LSI through an understanding of the risk factors and key risk groups.

Be able to have conversations with people, in order to identify if an individual is likely to be at risk of, or experiencing, LSI.

Have knowledge of the available range of evidence-based interventions for loneliness, and know how to refer or signpost those identified at risk of LSI.

Where it is relevant to their role, be able to have ongoing interactions with clients with LSI to ensure ongoing care.

How to Access

In order to access the Tackling Loneliness and Social Isolation  programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.
Register >
To view the Tackling Loneliness and Social Isolation  programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.
View >
Gain CPD points and continue your personalised care learning experience.

This programme forms part of the Personalised Care Institute's library of personalised care training for all healthcare professions. If you would like to obtain a certificate and CPD points for your ongoing CPD records, and learn a lot more about personalised care, then please visit the Personalised Care Institute website to register and access.

Not an NHS organisation?

If you are not an NHS health or care organisation and therefore do not qualify for free access elfh Hub, you may be able to access the service by creating an OpenAthens account.

To check whether or not you qualify for free access via OpenAthens, you can view the eligibility criteria and register on the ' OpenAthens ' portal.

Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Tackling Loneliness and Social Isolation programme, please contact elfh directly.

Organisations wishing to use their own LMS

For HR departments wanting to know more about gaining access to courses using an existing Learning Management System please contact elfh directly to express interest.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a Health Education England programme in partnership with the NHS and professional bodies

© elearning for healthcare 2022

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Tackling Loneliness and Social Isolation - elearning for healthcare

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This programme is in partnership with... There is now substantial evidence that having a lack of social connections significantly increases the risk of premature mortality. The risk to health that chronic loneliness can bring is greater than those associated with many factors that currently receive substantial public health attention and resources.

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This GP trainer hub aims to help GP trainers deliver on cancer prevention, screening and detection elements of the RCGP curriculum August 2019.

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Foundation Curriculum and Resources

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All things General Practice! Join doctors Sara and Lisa as they interview specialists from around Greater Manchester with the aim of improving the confidence and knowledge of local primary care clinicians. The podcast has been made possible due to the supp...

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We've developed a series of videos that will take you through all aspects of the exam, including how to...

Improve your exam technique

Assess your learning needs

Focus your revision

Maximise your score on the day

You will have access to the FourteenFish Library which is full of important relevant clinical updates that are likely to come up in the exam.

You may want to use this package in conjunction with your deanery educators as it will enable them to provide additional support.

The cost is £95 (inc VAT) for 12 months access, this can be extended for only £50 (inc VAT) per year.

Videos covering how to prepare for the AKT and proven exam techniques

Over 80 clinical update video modules on key topics

Watch videos in your own time, as many times as you like

Mock AKT exam with randomised questions covering all areas

Detailed report highlighting your weak and strong areas to help optimise your revision

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We've developed a series of videos that will take you through all aspects of the exam, including how to... Improve your exam technique Assess your learning needs Focus your revision Maximise your score on the day You will have access to the FourteenFish Library which is full of important relevant clinical updates that are likely to come up in the exam.

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Site created by Dr Ramesh Mehay (Bradford, UK), rameshmehay@googlemail.com

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We have a vision to support and empower women and girls from all backgrounds, facing any personal issues, to live equal and fulfilled lives. If you need support and want to make positive changes in your life, Tomorrow’s Women can help!

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We have a vision to support and empower women and girls from all backgrounds, facing any personal issues, to live equal and fulfilled lives. If you need support and want to make positive changes in your life, Tomorrow’s Women can help!

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You need to understand medical ethics and be ready to answer ethics questions or tackle MMI stations that focus on this topic. This guide outlines the four pillars of medical ethics and introduces three ethical frameworks that you should know about.

Ethics in Medicine

Medical ethics describes the moral principles by which a Doctor must conduct themselves. You need to understand the concept of medical ethics when you're applying for Medical School, but you aren't expected to be an expert.

It's worth being aware that medical ethics is a changing ideal. Something that might have been considered ethical 30 years ago may not be today - and what we think is ethical right now may change in the future.

Why Is Medical Ethics Important?

Medical professionals frequently find themselves facing moral questions and ethical dilemmas in their line of work. Medical ethics provide a framework to help them make judgement calls which are morally sound and right for the patient in question.

It's essential for aspiring Doctors to have a good moral compass and a solid grasp of medical ethics so they can consistently do what is best for their patients.

Four Pillars of Medical Ethics

The four pillars of medical ethics are:

1. Beneficence (doing good)

2. Non-maleficence (to do no harm)

3. Autonomy (giving the patient the freedom to choose freely, where they are able)

4. Justice (ensuring fairness)

These four principles represent a framework for analysing the best action to take in a given situation. To use this approach, you must consider whether your actions are in compliance with each of the four pillars.

Example Ethical Dilemma

A good example of an ethical dilemma relating to Medicine is that of surgery.
Imagine that a patient has appendicitis and the surgeons believe that surgery is necessary. Technically, making an incision into the patient's skin is causing "harm" to the patient; however, this is done with good intent as removing the inflamed appendix eliminates the risk of progression to rupture and peritonitis.
Surgery would be offered to the patient based on their clinical need and they will have the right to make an informed decision. The four principles would, therefore, support performing this surgery.

Medical Ethics Concept: Consequentialism

Consequentialism is an ethical ideology that states the morality of an action is dependent purely on its consequences. A simpler way to phrase this would be that the "ends justify the means". If your action has an overall benefit, then it does not matter about the action itself.

Example: Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetised, she asks you: "Doctor, will I be okay?" A consequentialist ideology supports that lying in this circumstance is acceptable, even though lying itself is not a moral action.

Medical Ethics Concept: Utilitarianism

Utilitarianism says the best action is that one that brings about the best increase in utility (benefit). Utility is generally considered on a broad scale, often taking into consideration wider society and not just the patient in question. It's a form of consequentialism.

Example: You have a sum of money to either fund a very expensive treatment for one patient with a rare disease or five patients with a very common and easy-to-treat disease. Utilitarian ethics dictates that treating the five patients is morally superior as a greater overall benefit is achieved.

Medical Ethics Concept: Deontology

Deontology is also known as "duty-based ethics". This ideology states that the correct course of action is dependent on what your duties and obligations are. It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.

This is in direct contrast with consequentialism.

Example: If your terminally ill patient asks if they'll be ok after a surgery they're unlikely to survive, a deontological approach would suggest you don't lie to comfort them. That's because according to this concept, lying isn't morally acceptable because it's our obligation not to lie - no matter the consequences.

Generally speaking, consequentialism may be the most relevant guide to thinking about the broad aims of healthcare - and deontology-based guidance is the one most commonly seen in Medicine.

How To Develop Medical Ethics Knowledge

One of the best ways to develop your understanding of medical ethics is to practice analysing situations using ethical frameworks and ideologies. You can do this on your own, with a teacher, or with a fellow Medical School applicant who could give you their perspective and share ideas. Try to compare the outcomes given by different frameworks and consider the implications of this.

Make sure you stay up-to-date with the latest health news - and see how these ethical frameworks apply to what's currently in the news.

Medical Ethics Examples

At Medical School interviews, medical ethics is a big part of the selection process. It's highly likely that you'll be asked ethics questions or face an MMI station designed to test your understanding of these concepts.

Some key medical ethics examples that you should be aware of for your interview are:

When you answer ethics questions, you don't have to list each of the four principles of ethics and outline these concepts - instead, pick a couple that are really relevant to show the interviewer that you're aware of medical ethics in general.

And remember - you may not be expected to make decisions yet. The key thing to do in your interview is to show you understand the issues by discussing how the key ethical principles relate to the question. If the interviewer pushes you for an opinion, make sure you can back up what you choose with some ethical reasoning.

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Medical Ethics - The Four Pillars Explained - The Medic Portal

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Swot up on medical ethics with this simple guide that outlines the four pillars of ethics and explains three ethical frameworks that apply to Medicine

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0208 1234 684 | Email us patientvoices@pilgrimprojects.co.uk

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The webinars aim to support the emotional and psychological health of staff by supporting you in finding your own strategies, tools, and coping mechanisms. These 40-minute interactive webinars are packed with take-home applications. Each webinar is followed by a 20-minute Q&A/discussion session. The webinars are led by Dr Amrita Sen Mukherjee who is a GP, [...]

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The webinars aim to support the emotional and psychological health of staff by supporting you in finding your own strategies, tools, and coping mechanisms. These 40-minute interactive webinars are packed with take-home applications. Each webinar is followed by a 20-minute Q&A/discussion session. The webinars are led by Dr Amrita Sen Mukherjee who is a GP, [...]

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Health and high quality care for all, now and for future generations

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Coaching about you and your team

If you lead, manage, or organise teams, groups or services in primary care you can access this offer of coaching with a highly skilled and experienced coach.

Your coach will help you think about and plan how you work with the people you lead and manage, using approaches centred in compassionate and collaborative team leadership.

The aim is to encourage resilience in teams while supporting them to continue to deliver projects, services and high-quality care to patients. Your coach can help you to develop practical tools and methods to work with your team in whatever way is important to you.
Register and book a coaching session
What might you talk about?

The coaching is designed to be bespoke to your individual needs.

To give you an idea, the sorts of things people often talk about include:

thinking through how a team is working together

how to best set up a new team

building an environment of trust and safety

coping with the pressure of meeting the demands of the system

creating a more resilient and compassionate team culture

developing ways to improve team relationships

helping teams and groups move forward after a set back.

Who is it for?

Staff working in the delivery of frontline primary care services who lead, manage, or organise a team, group or service. You will be either employed by the NHS or working with an NHS funded employer delivering an NHS funded primary care contract.

How does it work?

Simply register and book a coaching session.

Sessions are available Monday to Friday between 8am and 8.15pm and on Saturday between 10am and 1.30pm.

The first session will last up to 60 minutes.

The sessions will be delivered virtually, preferably via a video platform, but telephone appointments are also available.

Subsequent sessions will be dependent on the conversation between you and your coach.

Your coach might signpost you on to further support if they think this might be helpful.

You may receive follow-up emails to support you and your team once your coaching sessions have finished.

What others have said

"Really sensible, practical advice. These sessions have really supported me and given me ideas and inspiration over the last few months". Partner

"The coaching sessions have really supported me and allowed me to be honest with myself and workplace. It's definitely made a difference and I am so glad I signed up to them, they are saving me". Practice Manager

"It feels really good to have someone looking in, seeing things a little different, giving an alternative perspective. Listening with no judgement, giving some ideas and tips in relation to resolving and moving things forward. It has given me confidence to make decisions".
Social Prescribing Link Worker

What happens to my information?

The Institute for Employment Studies has been commissioned to conduct an evaluation of this work. All data collected will be anonymised and aggregated so that individual respondents cannot be identified. Participation in evaluation activities is voluntary and will not affect the level of support you receive. This service is run by a consortium of partners - please see the service-specific privacy policy for more details about what happens to your data and how you can help us research and evaluate this offer.

Spread the word

You can download this poster to display in your workspace and send to colleagues.
Register and book a coaching session
Other coaching offers

Looking after you too - coaching about you and your wellbeing Looking after your career - coaching about you and your career

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If you lead, manage, or organise teams, groups or services in primary care you can access this offer of coaching with a highly skilled and experienced coach. Your coach will help you think about and plan how you work with the people you lead and manage, using approaches centred in compassionate and collaborative team leadership.

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Population Health Management - short summary

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Population Health Management - short summary

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The proposals represent a marked shift away from the focus on competition that underpinned the coalition government's 2012 reforms, towards a new model of collaboration, partnership and integration. At the same time, removing some of the competition and procurement rules could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing number of people who rely on multiple services.

Unlike previous reforms, the proposed legislation aims to avoid a one-size-fits-all approach and leaves many decisions to local systems and leaders. This is appropriate given the great variation across England in terms of history, demography and local health challenges.

It is also important to recognise the limitations of what legislation can achieve. It is not possible to legislate for collaboration and co-ordination of local services. This requires changes to the behaviours, attitudes and relationships of staff and leaders right across the health and care system, including within the national bodies. This makes the implementation plan very important, especially as the legislation leaves so much to local (and national) discretion.

Some of the proposals seek to give ministers far greater powers over NHS England and other arm's length bodies. While it is right to clarify who is accountable for the health service, the government should protect the day-to-day clinical and operational independence of the NHS. Similarly, the proposal to give ministers the power to intervene earlier in local decisions about the opening and closing of NHS services risks politicising local service decisions.

While legislative changes are needed to progress the integration agenda further and faster in the interests of improving care for patients, these proposals come at a time when the NHS, local authorities and voluntary sector organisations are still battling Covid-19. In implementing these proposals, health and care services must not be distracted from dealing with the crisis at hand.

Finally, while there is much to welcome in the White Paper, the health and care system faces many challenges that will not be addressed by these proposals, including chronic staff shortages, deep health inequalities and an urgent need for long-term reform of social care. There is a pressing need for the government to chart a way out of these deep-seated challenges.

At the heart of the changes set out in this section is the proposal to establish integrated care systems (ICSs) as statutory bodies in all parts of England. ICSs will be made up of two parts - an 'ICS NHS body' and an 'ICS health and care partnership'. The dual structure is a new development and recognises the two forms of integration that are needed to adopt a population health approach aimed at improving the health and wellbeing of local populations: integration within the NHS (between different NHS organisations) and integration between the NHS and local government (and wider partners).

The ICS NHS body will be responsible for NHS strategic planning and allocation decisions. It will be set a financial allocation by NHS England to cover the majority of NHS care for its population and will be accountable to it for NHS spending and other financial objectives at a system level. It will be required to develop a plan to meet the health needs of its population and develop a capital plan for the NHS providers within its footprint. To enable it to fulfil these requirements, it will merge some of the strategic planning functions currently being fulfilled by non-statutory ICSs or sustainability and transformation partnerships (STPs) with the functions of clinical commissioning groups (CCGs), which will be abolished, with their staff transferring over to the ICS NHS body. The ICS NHS body will not have any powers to direct NHS trusts or foundation trusts - these will remain separate statutory bodies. The ICS NHS board will be made up of, as a minimum, a chair, a chief executive and representatives from NHS trusts, general practice and local authorities. Other members can be determined locally.

The ICS health and care partnership will be responsible for developing a plan to address the system's health, public health and social care needs, which the ICS NHS body and local authorities will be required to 'have regard to' when making decisions. The membership of the partnership and its functions will not be set out in legislation - instead, local areas will be given the flexibility to appoint members (likely to be from the wider system - eg, Healthwatch, voluntary and independent sector providers, and social care providers).

The document also recognises the importance of 'place', which is a smaller footprint than that of an ICS, often that of a local authority. Experience suggests that much of the heavy lifting of integration and improving population health is driven by organisations collaborating at this level, and successful ICSs have therefore often concentrated their efforts on developing the places within their footprint. The Department states that it has decided against giving place a statutory underpinning although it is explicit that there will be an expectation that ICS NHS bodies delegate 'significantly' to place level as well as to provider collaboratives. The development of place-based partnerships will therefore be left to local determination, building on existing arrangements where these work well. ICSs will be expected to work closely with health and wellbeing boards and required to 'have regard to' the joint strategic needs assessments and joint health and wellbeing strategies produced by health and wellbeing boards.

These forms of collaboration and integration will be supported by a range of other measures, including: a duty to collaborate across the NHS and local government; a shared duty on all NHS bodies to pursue the 'triple aims' of the NHS Long Term Plan (better health and wellbeing, better quality health care and ensuring the financial sustainability of the NHS); and a duty on NHS trusts and foundation trusts to 'have regard to' the system's financial objectives. The legislation will also be amended to assist organisations by enabling decisions to be taken by joint committees and to facilitate increased 'collaborative commissioning' across different footprints, for example, by enabling NHS England to share some of its direct commissioning functions with ICSs.

Finally, the government will be given a new 'reserve' power to impose capital spending limits on individual, named foundation trusts that are not working to prioritise capital spending within their ICS. There are also a number of proposals aimed at preserving patient choice rights and protections, including bolstering the process for any qualified provider (AQP) arrangements.

Reducing bureaucracy

This section of the White Paper contains a number of proposals aimed at changing how competition law applies to the NHS, how procurement works and how the payment system operates.

First, there are a number of changes that would remove competition as an organising principle in NHS clinical care. These include removing the Competition and Markets Authority's (CMA) role in reviewing mergers involving NHS foundation trusts and allowing NHS England to oversee these instead, alongside removing NHS Improvement's competition functions.

Similarly, the proposed changes to procurement seek to reduce transaction costs and give NHS and public health commissioners greater flexibility over when to use competitive procurement processes when purchasing health care services. These include removing the commissioning of NHS and public health services from the scope of the Public Contracts Regulations 2015, to be replaced by a bespoke NHS provider selection regime and a new duty on commissioners to act in the best interests of patients, taxpayers and their local populations. The procurement of non-clinical services (eg, professional services such as consultancy) will remain subject to public procurement rules.

Continuing recent trends, there are a number of changes proposed to how the national tariff payment system works, aimed at streamlining the pricing process and supporting a shift away from activity-based payments towards a model that facilitates greater collaboration and a focus on population health. The changes include removing the requirement on providers to apply to NHS Improvement where they wish to make local modifications to tariff prices.

This section includes a proposal to give the Secretary of State the power to create new NHS trusts 'to provide integrated care' and potentially in other circumstances subject to appropriate consultation.

There is also a proposal to remove local education and training boards (currently statutory sub-committees of Health Education England) from statute, with the aim of giving Health Education England more flexibility to adapt its regional operating model over time.

This section of the White Paper sets out a range of legislative proposals aimed at formalising the merger of NHS England and NHS Improvement and strengthening ministerial control over national bodies and service reconfigurations.

First, it recognises the work already undertaken to bring together NHS England and NHS Improvement into a single organisation and places it on a statutory footing by abolishing Monitor and the NHS Trust Development Authority (the two bodies who work together under the name NHS Improvement) and transferring their functions to NHS England. This body will now be formally considered to be responsible for providing 'unified, national leadership for the NHS'.

In recognition of the increased range of functions this newly merged body will have, the White Paper proposes changes to ensure the Secretary of State has 'appropriate' and 'structured' intervention powers over NHS England. Little detail is provided on how these powers will work, although it is suggested that they will continue to maintain the clinical and day-to-day operational independence of the NHS and that under the new arrangements, ministers would remain unable to direct local NHS organisations or intervene in individual clinical decisions.

Linked to the above, this section includes a proposal to change the frequency with which the Secretary of State is required to publish the NHS Mandate - the document that sets out the objectives that NHS England is expected to achieve. Instead of needing to publish the Mandate on an annual basis (as is currently the case), the requirement would be to always have one in place, creating the flexibility for ministers to update it more frequently or leave it in place for multiple years as they consider appropriate.

In response to concerns that local service reconfigurations can be complex and protracted, the Department proposes legislating to give the Secretary of State the power to intervene in reconfigurations at any point with a view to speeding up decision-making. The current process for contested reconfigurations, including the Independent Reconfiguration Panel, would be removed and replaced with a new process underpinned by statutory guidance. When using this power, the Secretary of State would be required to seek appropriate advice before intervening, and to publish it subsequently.

To 'allow the system to adapt and shift to changes in priorities and focus over time' this section proposes to establish a new power in primary legislation that would allow the Secretary of State to transfer functions to and from specified arm's length bodies and to abolish arm's length bodies where they become redundant as a result of any such transfers. It is suggested that there are no immediate plans to use this power and that before any use in the future, formal consultation would be required.

There is also a proposal to remove from the legislation the three-year time limit for any special health authority established after 2012. Under the current arrangements, the Secretary of State is required to review and formally extend the existence of any such special health authorities every three years.

The final proposal in this section would place a new duty on the Secretary of State to publish a report every parliament that sets out the roles and responsibilities for workforce planning and supply and would cover the NHS (including primary, secondary, and community care) as well as sections of the workforce that are shared between health and social care (eg, registered nurses).

Additional measures

The final section of the White Paper sets out a range of specific and targeted proposals relating to social care, public health, and quality and safety, described as 'appropriate... in light of the experience of the pandemic, and the desire to support the health and care system to recover and reform'.

Social care

In recognition of the increasing numbers of people who need adult social care and the consequent need for greater oversight of the provision and commissioning of services, the White Paper proposes introducing a new duty for the Care Quality Commission (CQC) to assess how local authorities are meeting their adult social care duties, and a new power for the Secretary of State to intervene where CQC considers a local authority to be failing to meet these duties. To support this increased oversight, the Department is also proposing changes to the types of data it collects centrally from the sector and the frequency with which it collects it.

Learning from the experience of the pandemic, when it was necessary to provide support to the social care provider sector at speed, the Secretary of State's current power to make direct payments to not-for-profit social care providers will be expanded to include any type of provider.
Other proposed changes include introducing a legal framework for the 'discharge to assess' model so that assessments can take place after an individual has been discharged from acute care (replacing the current requirement to assess before discharge) and a small technical change to the Better Care Fund to separate it from the process for setting the NHS Mandate (which will no longer be set on an annual basis).

Public health

The White Paper proposes giving the Secretary of State the power to direct NHS England as to the public health services it commissions (which range from national immunisation programmes to sexual assault services).

There are also several proposals to legislate for commitments made in the government's obesity strategy, aimed at enabling it to achieve its commitment to halve childhood obesity by 2030. The first is to give ministers the power to introduce new labelling requirements to support more informed consumer choice. The other proposed changes seek to increase restrictions both on the advertising of foods high in fat, sugar or salt on TV before 9pm and on the advertising of these products online.

The White Paper also proposes changes that would move the responsibilities for initiating schemes for water fluoridation from local authorities to the Secretary of State.

Safety and quality

There are a number of proposals aimed at improving the quality and safety of services, including placing the Health Services Safety Investigations Body on a statutory footing; establishing a statutory medical examiner system to scrutinise all deaths not involving a coroner; enabling the Secretary of State to set minimum statutory standards for food and drink provided in hospital settings; and giving powers to the Secretary of State that would enable them to reform the system of professional regulation. Further regulatory change will enable the MHRA to set a national medicines registries, and legislation will be put in place to enable the implementation of comprehensive reciprocal health care agreements with other countries.

Reflecting on the proposals

Overall, there is much to welcome in the ambition of the White Paper. The proposals represent a shift in emphasis towards more integrated working, seeking to enable local collaboration and removing some of the main barriers to partnership-working. Many of the proposals are widely supported within the NHS and by stakeholders. To ensure widespread public support, it will also be important to develop a strong narrative around the benefits the reforms will bring to patient care.

At the same time, however, in addition to the specific points raised in the sections above there are a number of general issues that should be considered at this point, before the legislation enters parliament and during its passage.

Timing of the legislation

These proposals amount to a significant reform package and come at a time when the NHS, local authorities and voluntary sector organisations are still battling Covid-19. The legislation will mean a lot of change for commissioning bodies and their staff in particular, with CCGs coming to an end and their functions being folded into ICSs. Given that previous attempts at reorganisations have tended to overstate the benefits and understate the cost and disruption of change, a careful approach to implementation will be needed in order to avoid these recurring pitfalls.

The limitations of what legislation can achieve

It is important to recognise the limitations of what legislative change can achieve. The proposals represent a welcome shift in emphasis towards more integrated working, but this will be critically dependent on new collaborative ways of working between organisations, leaders and teams across health and care. While legislation can remove some barriers to collaboration and co-ordination of local services, it will not deliver the changes in behaviour that are needed to fully harness the benefits of the integration agenda. Instead, behaviours and relationships that support collaboration will need to be developed, nurtured and modelled right across the health and care system, including within national bodies. Consideration should be given to how this cultural change will be supported, and how staff at all levels will be supported to genuinely collaborate across organisational and professional boundaries.

Nature of the legislation

Throughout the White Paper, there is a tendency towards creating broad enabling powers for the Secretary of State, for example, over arm's length bodies. It is suggested that these are needed to enable the Secretary of State to respond more flexibly to rapidly changing circumstances, such as those seen during the pandemic. However, it does not make clear why such powers would be needed outside of a pandemic, nor why reducing parliamentary involvement in this way is merited.

These proposals will change the nature and extent of parliamentary scrutiny of the NHS, with a significant shift from primary to secondary legislation. More power is being moved from previously independent arm's length bodies to the Secretary of State while at the same time, the Secretary of State will be subject to less parliamentary scrutiny of their actions. It will be important to debate these issues as the Bill progresses through parliament.

Health and care system reform in totality

While the White Paper includes some limited, targeted changes to public health and social care, the proposals predominantly amount to reforms of the NHS - with a focus on integrating services, collaborating better with other partners and the relative balance of power between national players. The Department of Health and Social Care is clear that the White Paper is not intended to be the place to set out reforms to the structure of national, regional and local public health systems in light of Public Health England's abolition, or to commit to the long-promised and much overdue plans to reform the adult social care system.

The NHS doesn't work in isolation - public health, social care and the NHS are closely connected. There is clearly a risk that in setting out fixed plans for the NHS, the options for public health and social care reform become limited. A clear overall vision for all three arms of the health and care system at national, regional and local levels would help position the NHS reforms within the wider picture, and ensure that the NHS reforms do not inadvertently limit positive change in public health and social care.

With thanks to

The authors extend their thanks to colleagues across The King's Fund who have contributed to shaping this long read, including: Anna Charles, Alex Baylis, Siva Anandaciva, Simon Bottery, Dave Buck.

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The health and social care White Paper explained

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In February 2021, the Department of Health and Social Care published a White Paper setting out legislative proposals for a health and care Bill. Here, we consider the proposals and what they might mean for the health and care system in England.

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Professional medical indemnity for clinical negligence claims - The MDU

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The MDU is the leading medical defence organisation in the UK. We provide professional medical indemnity to doctors, dentists and other healthcare professionals. We also provide medico-legal advice

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A brilliant language site for medical communication , local idioms and phrase and how to explain things in lay terms

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Doctor to doctor
Dr Ben Sinclair, with nearly two decades' experience as a British GP and Founder of Dr Finlay's Private Practice, interviews a range of extraordinary people from all walks of life and recently he spoke with our very own Dr Heather Currie MBE about menopause, her career and life.
" Listen here

Have you experienced memory issues in menopause?
Lexi is a PhD researcher at University College London (UCL). She is looking for research participants who have experienced memory issues during menopause for a focus group study. If you have experienced memory or concentration problems during your menopause, she would like to hear from you! Please contact her by email if you are interested.
" Email Lexi here

Episode 4 of our Let's Talk Podcast: The psychological & emotional symptoms
Thankfully there has been increased awareness about these symptoms in relation to the menopause in recent years. They are incredibly common and can be some of the most debilitating symptoms that people will experience...but don't forget, not everyone will experience these symptoms. It can be challenging for some people to identify the cause of these symptoms, as it's not always related to hormones - there can be many contributory factors. We discuss the range of options which can help to manage these symptoms. Is it right to take antidepressants, should you take HRT, is a combination acceptable? We go through alternative options for you to consider, either on their own or in combination with the above, but remember taking an individualised approach is always important. We also continue the conversation about HRT.

A new weekly podcast will be available from 6pm every Tuesday or you can listen now via the link below and catch up with those you may have missed.

Menopause Matters information is available via Amazon Alexa
Menopause Matters will be providing answers to some of the most commonly asked questions around menopause via Amazon's cloud-based voice service, Alexa.
" Read more

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Menopause Matters, menopausal symptoms, remedies, advice

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Menopause and treatment options. An independent, clinician-led site aiming to provide accurate information about the menopause.

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to www.bladdermatters.co.uk, the sister site of the extremely popular, award winning www.menopausematters.co.uk and of the site which brings together organisations offering support for various aspects of Women's Health: www.wematter.co.uk because Women Everywhere matter!
Bladdermatters.co.uk is an independent, clinician-led website. Our aim is to provide easily accessible, up-to-date, accurate information about Bladder problems and treatment options so that women and health professionals can make informed choices about Bladder management.

Introduction

Bladder problems can affect women, and men, of all ages However if you are approaching or experiencing the menopause you are particularly at risk. One of the most distressing bladder problems is incontinence. Incontinence affects personal hygiene and overall health. It is not just the physical side of incontinence that is distressing, incontinence can also have psychological and social effects, with many women often having their lives ruled by their bladders! For some women the problem becomes so distressing that they do not want to leave their homes.

Despite the consequences of incontinence, many women put up with these problems for many years before seeking help for a variety of reasons including embarrassment, being unaware that treatments are available, believing that it is a normal part of ageing and fear of surgery. Have no fear, for many women simple changes can make big differences and there are treatments which can also make life bearable again. Learn more from this website, from our links to other useful resources, and join our forum where you can discuss the problems with other women; remember you are not alone!

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Assessing fitness to drive – a guide for medical professionals

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How to develop a Multidisciplinary Learning Environment