Commissioning articles

Dr Ollie Hart and Dr Andy Hilton explain how they were asked to use their skills as GPSIs to reshape local care for back pain

Following the news that GP commissioners are to be ranked on compliance with NICE using a scorecard, Dr Charles Alessi explains the implications for CCGs awaiting authorisation.

Paul Zollinger-Read discusses how GP commissioners can start the process to plan urgent care services across the community

Dr Penny Newman and Dr Ed Garratt explain how GP commissioners can ease the load on partners – by involving salaried GPs and locums.

Jamie Foster of Hempsons discusses the challenges GPs will face as providers and commissioners, working with Foundation Trusts.

Jonathan Hayden of Browne Jacobson gives a short guide to the who, what, when, where, how and why of registers of interest.

Dr Michael Dixon takes on ten big fears about the future of the NHS, and the reasons why change is key to the sustainability of the health service.

GP Dr David McMaster spent a shift in A&E to find out first hand what the priorities were for reshaping urgent care services.

Sir John Oldham lays out the clinical, organisational and systemic reasons to commission more self-care and co-management schemes.

The NHS Alliance's Julie Wood explains how CCGs should avoid ‘Hobson’s choice’ when securing commissioning support

Dr Sharad Pandit and Dr Aman Mann explain how their CCG set up a community clinic that improved patient satisfaction and reduced DNAs.

Dr Mike Dixon on the need for collaboration between groups and the NHS Commissioning Board

Dr Penny Newman and Dr Ed Garratt give ten reasons to share the load when it comes to GP commissioning.

Dr Ruth Cooper and Wendy Sunney explain how internal referral management helped their CCG reduce costs per patient while improving care

The supply and demand within our NHS needs reforming with a restructured management support system and more proficient transactions, writes Dr James Kingsland.

Dr Adrian Baker describes how case management in NHS Highland has reduced hospital admissions and improved end-of-life care for thousands

Dr Richard Dawson and Dr Duncan Petty make five suggestions for better medicines management, based on National Audit Office recommendations and case studies from around the country

Dr Niti Pall and Debra Sprague describe how they used a technique called experience-led commissioning to reshape local services

It is surprising how many colleagues, in both clinical practice and NHS management, consistently tell me that they could have easily enacted the necessary changes for commissioning without primary legislation, writes Dr James Kingsland

Three examples for GP commissioners, provided by the Joint Commissioning Panel on Mental Health.

Dr Richard Blakey describes how his heart failure service – as part of a new quality improvement programme – reduced admissions and boosted diagnoses

The Independent reported me 'despondent' over the progress of the health bill, Dr Kingsland writes, but I'm still enthused by the reforms

Professor David Peters discusses the options available to GP commissioners as they aim to ease pressures on the NHS

With sickness absence an increasingly expensive problem for the NHS, Dr James Cowling gives three examples of patients his service helped back to work and health

We still need to move to a new paradigm within these geographies and create something remarkably different to PCTs, Dr Kingsland writes - to do otherwise would be unthinkable.

Dr Raza Toosy discusses his experiences of using blood pressure monitors to reduce admissions

Dr Judith Smith and Dr Sara Shaw from the Nuffield Trust look at schemes of integrated care from around the country.

Dr Dominique Thompson‘s service for eating disorders at her campus practice has now been rolled out across Bristol and Bath

Dr Sarabjit Singh Bawa and Dr Sandeep Bawa describe how they set up a community-based clinic that reduces waiting times and saves the NHS money

Dr James Kingsland explains why GPs should not 'wait for permission' to develop commissioning.

Pulse editor Richard Hoey sat down with some of the leading figures in general practice last week to discuss the new world of GP commissioning and ask what it means for the future of the profession. Here are the highlights from a vigorous debate

Pulse’s new campaign – A right to refer – is opposing crude restrictions on referrals and promoting peer-led schemes. Here, GPs present two case studies of how they are working together to control their referral rates – without the need to resort to blanket bans or referral management centres

This week, Dr James Kingsland asks if we are at risk of losing clinical engagement.

Dr Stephanie Lamb explains how she set up a teen-friendly service in the community aimed at confidentially dealing with sexual or psychological problems.

Dr Ruth Livingstone explains how GPs are using the new NHS 111 number to redesign urgent care services.

Dr Carl Ellson has focused on creating a bottom-up culture at his CCG. Here he answers questions on engaging with fellow practices

GPs need an overview of how PCT finances work to ensure a smooth handover to CCGs. Helen Northall provides her guide

You have an investment in a local private provider, which you made because of your high regard for the quality of care it delivers. You want to continue to referring your patients to the provider, but are concerned new GPC guidance might make it more difficult to do so. Dr Michael Dixon advises GPs on what to do.

Dr James Kingsland introduces the second element of his new column, where he will provide commissioning dispatches from his own practice in Wallasey, Merseyside. This week, he explains why his practice chose to join a small CCG.

Dr James Kingsland, Merseyside GP and national lead for clinical commissioning, introduces his new column - exclusive to Pulse -where he will chronicle his commissioning experiences from around the country, and provide dispatches from the practice coalface.

As part of moves for your CCG to take on a real prescribing budget, the PCT has set an incentive scheme modelling on the quality premium, including money for quality improvements, but which is only...

Your clinical senate has set out a strategy for your clinical commissioning group that seems focused on high-quality specialist care, but at the expense of allowing any investment to be redirected to the community. You are unhappy about this direction – is there anything you can do? Dr Stewart Findlay tackles this dilemma.

Dr Sam Everington talks about how GPs in Tower Hamlets have managed to span the gaps between primary and secondary care, and between the NHS and the local authority

Practices are increasingly taking on notional commissioning budgets as they involve themselves in the reforms. Dr Peter Weaving gives six tips on what you should know first

The only consultant who volunteers to sit on your board is a retired eccentric, with a good reputation among his specialist colleagues, but no understanding of primary care. You know attempting to block his appointment would cause ill feeling among your hospital colleagues. Should you attempt to do so? Dr Stewart Findlay advises.

Dr Steve Kell sets out how GPs can assess local needs and focus on where they can have greatest impact

Your health and wellbeing board challenges a decision you have taken to close a hospital dermatology department after a row blows up in the media. You firmly support the decision, but are unwilling to see yourself become a media scapegoat. What should you do?

Half the board members at your CCG have financial links with local private providers, although none at director level. You don’t doubt your colleagues’ integrity, but are concerned about the message it could send out. Dr Tony Grewal explains the practicalities of dealing with a conflict of interest.

Dr James Findlay describes how his commissioning group has developed an IT system that supports GPs in keeping their own referrals in check – without the need for referral management centres

Half of the board members at your clinical commissioning group have some financial links with local private providers, although none are at director level. You have no reason to mistrust your colleagues’ integrity, but are concerned about the message it could send out. What should you do? Dr Tony Grewal advises GPs on the best course of action.

You have been elected to serve on your LMC, but are also keen to get involved with your clinical commissioning group, and have been invited to stand for election to its board. Would it be appropriate for you to do so?

Legal expert Ross Clark discusses the pitfalls presented by issues such as TUPE and inherited debt.

Dr Neil Paul explains how GPs implemented a system of secure record sharing with urgent care clinicians

The Government’s NHS reforms lay GPs open to the risk of serious conflicts of interest. The GPC’s Dr Simon Poole provides his guide to steering clear of controversy

Good information is critical to good commissioning. Kevin Hudson & Dr Nick Matthews describe the work that has taken place in Somerset to firmly get to grips with these challenges.

Philip Hewiston explains how an evaluation of an early Commissioning pilot in Bradford offers GPs lessons for today.

Only a root-and-branch overhaul of care and long term conditions can save the NHS, argues Sir John Oldham. Here, he sets out how GPs can play their part.

You are expected to review local outpatient referrals with local practices under the QOF, but you have a difficult working relationship with your nearest neighbour, whose clinical judgment you don’t trust. What do you do if your PCT insists you work together to collect your QOF points? Dr Gary Calver advises

The third and final part of our serialisation of Dr Sunil Gupta’s Effective GP Commissioning looks at how GPs can successfully put together business plans

Your consortium has plans to shift work from hospital to the community, but you are not convinced the clinical governance is in place to do this safely. Dr Trish Edney advises

The second instalment in our three-part serialisation of Dr Sunil Gupta’s new book Effective GP commissioning provides a checklist for GPs to refer to when commissioning a new service

Your local Primary Care Organistion is insisting on savings you believe are inappropriate under the new quality and productivity indicators, including end use of several branded medicines you think are important. Dr Trish Edney advises GPs on what to do.

The first instalment of our three-part serialisation of Dr Sunil Gupta’s new book Effective GP Commissioning looks at the importance of recruiting the right staff

Your practice and all those around you have been signed up as part of a pathfinder without your knowledge. You’re convinced there has not been proper consultation about its structure and which practices should be included? Dr Brian Balmer advises GPs on what action to take.

Concerned about how to manage your dual roles as a provider and a commissioner? Dr Clare Gerada and Dr Dennis Cox give their tips on avoiding any problems

GP commissioners are likely to face increased media scrutiny. Andrew Harvey offers some tips on dealing with the media storm

Dr Martin Whiting and Simon Wootton explain how a radical referrals scheme will help GPs achieve the new QOF indicators

Your shadow consortium is struggling to make decisions and you are unconvinced by its leadership. How can you raise your concerns? Dr Michael Dixon advises.

Struggling with the contracting process? David Marcer advises GP commissioners on how to manage contracts robustly

The commissioning group has decided that it will no longer fund vasectomies – in your view, a very short sighted approach. Do you decide to accept the decision, argue your case with the commissioning group or consider training up to provide a personal and private service to your patients? Dr Helena McKeown advises

Your practice has historically always worked together with its neighbours in a deprived area of town, but has now been offered the chance to work with a more affluent and successful group next door. Dr Helena McKeown offers GPs advice on what to do.

You have a special interest in dermatology and your partners are keen for you to provide a service for the commissioning group, seeing it as a way of maintaining income. This will seriously impact on your time available for your routine patient care – and your colleagues are not keen on taking on any extra manpower. Dr Michael Dixon advises GPs on how to resolve this.

Your neighbouring practice has a high referral rate, and while it protests that this is a product of its patient population, you know its GPs have a low threshold for referral. Should you take this up with your consortium? Dr Charles Alessi advises

Dr Matthew Davies talks through the process of developing a service plan, designing specifications and going out to tender

Dr Peter Weaving explains how GPs in Cumbria created a new patient pathway for COPD care

In the new world, GPs will need to know how to procure services as well as provide them. Hannah Chapelhow explains how it’s done

Your practice is anxious about making commissioning decisions with practices they have previously been in competition with, one of which you suspect of trying to poach your patients in the past. How can you reconcile any potential conflicts of interest? Anne Crofts explores this dilemma.

GPs need to watch hospital activity like a hawk to prevent miscoding and overpayment. Here, Dr Charles Alessi explains how his commissioning group is doing it

A significant minority of your referrals are returned to you via the commissioning groups referral management process – even after appeal that, for example, the patient was significantly distressed or insisting on referral. You feel the process is starting to impact on your duty, as a doctor, to refer when appropriate. What action do you take?

Your consortium has decided to bar access to a number of new drugs, but you have an interest in these clinical areas and feel the decisions are flawed. Should you accept them? Dr Jo Galvin advises

See where your local pathfinder is, who is running it and what population it will cover.

Good referral management doesn’t opt for blanket restrictions on access to hospital, but instead relies on good communication and data analysis. Helen Northall describes three successful approaches

See the locations of practices that have not yet joined a GP consortium.

Your patient has asked for a treatment that my consortium has decided not to provide, but you believe it is clinically appropriate. What options are available to you? Dr Nick Clements offers GPs his expert advice

Dr Brian Fisher explains how co-production could create full patient and public engagement in commissioning decisions.

A dermatology GPSI works at your practice and has always provided services to your practice and several neighbours. Can you continue this arrangement under the commissioning plans, or does do you need to declare a market under any willing provider? Dr Shane Gordon advises.

Practices will need to deliver major prescribing savings for consortia. Pharmaceutical adviser Kym Lowder provides a guide to cutting bills

Your practice has had an unexpectedly high referral rate in the last quarter, and you are worried you are likely to come under scrutiny. A patient consults you who needs hospital treatment, but they could wait a couple of months until the next financial year. Should you delay their treatment? Dr Shane Gordon tackles this dilemma

The amount of time your nominated clinician is spending on commissioning duties is way above the time he’s reimbursed for via the management allowance. Do you accept this is an inevitable consequence of commissioning, go to the group requesting extra funds or insist that he keeps his work within the hours for which he’s reimbursed? Dr Simon Poole advises

Dr Charles Alessi sets out his top tips to ensure your commissioning decisions are helping reduce costs in your consortium

Overwhelmed at the prospect of taking on commissioning? Dr Joe McGilligan gives you the information you need to get started

Your consortium has agreed a LES which contains a component for paying for making your referrals more cost-effective, but you are concerned that this is code for reducing your number of referrals. Should you agree to it? Dr Helena McKeown advises.

Your patient has gone to the local paper to complain that they have been denied access to a treatment by your consortium. You are sympathetic to their cause. What should you say if the journalist asks you for comment? Dr Helena McKeown advises

In the rush to set up consortia, it’s easy to miss key details. The GPC’s Dr Chaand Nagpaul provides a simple checklist

Get the latest on the structure, partners and areas of focus for the Department of Health's pioneering 'pathfinder' GP consortia

Paul Bearman, General Manager at Wyvern Health, discusses how his consortium is advancing as a commissioning pathfinder, and some of the challenges it is facing to ensure it is set up to succeed in ‘the new world’.

Recently-elected chair of the Primary Care Cardiovascular Society, Dr Kathryn Griffith, gives her views on NICE's recent chest pain guidance, GP commissioning and moves to downgrade the use of statins in diabetes

Dr Lucy Wictome explains how her practice conducts daily review meetings to assess referrals, get specialist opinion and find ways of treating patients in general practice

PBC leader Dr Luke Twelves suggests a to-do list for GPs looking to take on commissioning

Judith Smith looks at non-UK commissioners' experience of balancing patient and population health needs.

NICE does some superb work when it comes to recognising excellence in medicines, writes Dr Donal Hynes, but complying with its guidance must not become a tick-box assessment for local commissioning groups.

Dr Krishna Korlipara started one of the first GP co-operatives for out-of-hours care, and argues they represent a far better model than failing out-of-hours companies.