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At the heart of general practice since 1960

Cumbria – invested £6m into PBC

The DH survey suggests practices in Cumbria have a much higher than average level of satisfaction with the relationship they have with their PCT and the quality of managerial support provided by it.

The DH survey suggests practices in Cumbria have a much higher than average level of satisfaction with the relationship they have with their PCT and the quality of managerial support provided by it.



Dr Ian Mitchell, a GP in Penrith and PEC chair of NHS Cumbria Teaching PCT, thinks this is because of the unusual way PBC is set up in Cumbria. The county is divided up into six localities that fit with the county council footprint.

The areas are all very different in terms of both geography and demography – Barrow, for example, has some of the worst health statistics in the country, whereas Eden Valley has some of the best.

Six GPs head up these locality groups, which also have a representative from each of the constituent practices. These six GPs effectively make up the PEC – which has been created as the commissioning body – along with, among others, a nurse member and an NAHP member.

The more usual approach of having separate PEC and commissioning consortiums does, admits Dr Mitchell, give an extra layer of governance that helps ensure probity, but where it loses out is that the PBC groups are not always commissioning within the strategic frameworks.

‘We've cut out the step where you have a handful of GPs who decide to pursue a project, then have to come back to the PCT for approval. We say, what are the big things we want to go with strategically? For example, let's agree a plan for reorganising unscheduled care, then ask the localities to implement that plan locally,' he says.

The PCT has devolved core PBC staff, who previously worked within the PCT, out into the localities so each one has a commissioning manager and a team.

The GP lead in each locality works at least one day a week for the PCT, and there are lead clinicians from primary care for most of the major commissioning areas.

Dr Mitchell says: ‘We set up PBC in this way because the geography of Cumbria meant we had to protect services in the larger hospitals that are all some way from each other. We couldn't allow market forces to destabilise this so we had to work within a strategic framework and commission on a locality footprint to ensure stability for all services in the county.

‘The financial facts are all out on the table, and if clinicians are aware of them they will be responsible in the way in which they make decisions.'

He adds: ‘This has really turned things around for us. When the new PCT started in 2006 we had a £32m historic debt and £18m recurring debt. Last year we broke even. This year we've given the six localities their first £6m of new money to invest in projects at a local practice level.'

Support is not universal across the county, says Dr Mitchell, but by and large there is very good engagement.

In Westmorland General Hospital in Kendal, GPs have been running a primary care access centre since August. They've taken over the running of 50 beds from the acute trust and, says Dr Mitchell: ‘GPs who are interested are recognising there's a real opportunity for change and are beginning to embrace it.'

Cumbria - invested £6m into PBC

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