Focus on… Tackling clinical variation
GP commissioning consultant Gerry McLean explains how the latest NHS reforms will put the focus on clinical variation like never before
GP commissioning consultant Gerry McLean explains how the latest NHS reforms will put the focus on clinical variation like never before.
There is a fundamental difference between what is happening now with GP commissioning under the coalition government and fundholding or practice-based commissioning.
The latter two were optional, while the changes taking place now are both compulsory and universal.
Under PBC you could get away with being an ‘outlier' – but not any more.
Traditionally creatures of independence, GPs now have to grapple with working within a corporation – and this is a new sensation for GPs and one many will not feel comfortable with at first.
The analogy I use to describe what's happening with practices is corner shops.
Until now, as independent contractors, GPs have effectively been like corner shops opening at different times and charging different prices.
The new model GPs will have to move towards is to become a SPAR or a LONDIS – with uniformity in opening times, pricing and products.
If your ‘shop' is not a success, you won't survive. And it won't necessarily be the private sector that comes in to take over if you underperform, but another practice.
As Dr James Kingsland points out in the Engaging with the outliers feature, not all practices will survive this policy. Obviously the starting point for tackling variation is to share information.
Consortia I'm working with are approaching this by getting a single GP to take on a particular area – say medicines management – and to share this information with the rest of the group.
This is effective because the PCT only has to deal with one person at a time and the nominated GP can share the information with the others.
And GPs shouldn't shy away from presenting such information to all consortium members in easy-to-understand formats that draw them in, as Dr John Havard's Bentley dashboard initiative illustrates very well.
There is also a realisation that consortia will have to have an element of internal policing and ask themselves how they will ensure practices do not start to underperform.
The example of peer visits to practices on page 18 shows this facilitation does not have to be punitive and how the exec needs to create its own awareness of factors that individual practices are up against.
Finally, on the ground I am seeing consortia realise they will need to scale up with other consortia for certain commissioning functions to enhance economies of scale and avoid duplication.
Forming such federations will be another challenge, with GPs having to learn to work together even though they might have radically different agendas – and more variation.
Gerry McLean is co-owner of Consulting Associates UK
The latest NHS reforms willl put the focus on clinical variation like never before The latest NHS reforms willl put the focus on clinical variation like never before