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Cambridgshire - a typical tale

Cambridgeshire could be viewed as representative of the region, both demographically and also in terms of how PBC has developed.

Cambridgeshire could be viewed as representative of the region, both demographically and also in terms of how PBC has developed.

The county and the region as a whole are characterised by a large rural area with a few modest urban areas. The county has shown some progress on PBC despite a £52.4m deficit last year, with 86% of GPs saying that they have an indicative budget.

But there is also scepticism, with 84% having no confidence that plans will free up resources – compared with a national average of 58%.

Cambridge GP Dr Pauline Brimblecombe of CATCH, the Cambridge Association To Commission Health, says that as with many areas, demand management dominated the commissioning scene in the early phase.

This was in part due to the strength of Addenbrooke's, which became a Foundation Trust early on, and which Dr Brimblecombe says was offering ‘world-class tertiary care to a DGH catchment area'.

She adds: ‘PBC has given us data from the PCT so we know what we're spending. Had we carried on referring as we were, there was going to be no money left for community services. And most GPs recognised that.

‘Last year the PBC savings were over £13m so we have that to invest in patient care. One of the schemes we're looking at is for the frail elderly – we're going to be employing a community geriatrician for six months and hoping to get that as a substantive post. It's been very successful as a pilot and we're now rolling that out.'

Savings will also be used by CATCH to fund an enhanced service for diabetes.

Dr Brimblecombe says: ‘I'm really keen to develop that as general practice is not going to get more money at the present time, and the only way to get money back is through enhanced services.

‘With diabetes – the majority of patients ultimately need to be supported to manage themselves, but the first stage of that is to ensure GPs and primary care staff are also supported. A lot of it is education – using our community specialist nurses and diabetologist – to support the practices rather than seeing the patients themselves.'

Elsewhere in the county, Tony Medwell is the PBC ‘business partner' for the 600-square-mile East Cambridgeshire and Fenland region. He is employed by the PCT to act as a broker between the PCT and commissioning groups.

With no large urban areas, it is a patchwork of five clusters covering vast areas but few people. Each has a different population and they use different providers – from Cambridge to King's Lynn.

In such a rural area, health challenges include isolation among the elderly, distance from hospital and large numbers of migrant agricultural workers.

Mr Medwell says: ‘In south Fenland, one of the GPs has worked with the PCT provider service to commission bladder scanning. They've used the established nurses who the consultant used to do the scans – they now do a direct access service that has been commissioned between the GP provider group and the PCT provider group.

Mr Medwell also highlights a mobile ultrasound service that has been commissioned from a group of ultrasonographers from one of the local hospitals, meaning patients no longer have to travel to Peterborough for diagnostics.

He says: ‘That's complete innovation – where GPs are saying we don't want it in hospital and the local market comes out of that. There's no conflict of interest in it as well, which is good.

‘And once you've got the diagnostics you can also then do the treatment – so it gives you the opportunity to redesign services around access to diagnostics,' he adds.


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