A report by the King's Fund says that filling the "democratic deficit", which is likely to be a central theme in Lord Darzi's review of the NHS, expected next month, could involve councillors gaining control over primary care trust budgets. But extended political control over primary care would not necessarily improve services. Here the report asks for an incremental approach using citizens' juries or enhanced versions of patient and public involvement forums, focused on specific PCT functions.
The Local Government Association has stepped up its lobbying in favour of more councillor involvement in primary care, and the thinktanks are weighing in. We will pick up the argument in June's edition.
The King's Fund also looked at choice in the health service. It found that 44% of patients referred for treatment in May 2007 remembered being offered a choice by their GP. That's a rise from 30% the previous year, when monitoring began, but falls well short of the expected level of 80%.
Most people were satisfied with the process; the main negative comments were about difficulties accessing the appointments phone line and appointments taking a long time to come through - issues not likely to be solved soon, as technical problems with the electronic appointments system Choose and Book meant an upgrade had to be postponed and resulted in some patients being given the wrong appointment times.
Also on a technical front, PCTs and strategic health authorities were warned by the Department of Health that most existing GP IT systems will not meet the department's new data security requirements for storing and transferring data. These requirements were brought in following the loss of confidential data by HM Revenue & Customs at the end of 2007. Authorities and PCTs have been told they will have to meet the costs of extra software to encrypt personal data.
There has also been a rise in the use of practice-based commissioning, according to the health department: 62% of GP practices now support the policy, a rise of 5%. The department also announced the launch of three more independent sector treatment centres, two in Greater Manchester and one in Hampshire and the Isle of Wight. There are now 10 such centres. Future centres will be procured locally, rather than centrally - a move welcomed by private providers.
But who are private providers? GPs are, as a matter of fact, but not in terms of their self-perception. They take profits from their own practices but the British Medical Association led opposition to the proposal that doctors working in Sir Richard Branson's planned network of Virgin health centres would be given a percentage of the profits made by private dentists, therapists and laser eye surgeons working in the centres.
Whatever the Darzi recommendations on polyclinics, the private sector has got there first. The first such Virgin clinic opens in Swindon. Under General Medical Council rules, GPs working in private-sector primary care centres, who will be paid an NHS salary, will only be allowed to refer patients to the private clinics in the same building if they make it clear they have a financial stake in the profits - they will get 10% of the profits of the whole polyclinic.
More staff are now receiving appraisals and have a personal development plan according to the Healthcare Commission's annual survey and job satisfaction is high, something not borne out by external research. Poll firm Ipsos-Mori consistently registers NHS job dissatisfaction.
The public health minister, Dawn Primarolo, announced 12 new biomedical research units, which will investigate ways to translate medical research into diseases such as asthma, obesity and heart disease into effective treatments.
Meanwhile, heavy lobbying on all sides continues as politicians head towards a free vote on the human fertilisation and embryos bill, with embryo research support by a wide range of scientific and medical bodies and most strongly opposed by the Catholic church.
