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Getting ICO-friendly

This month our diarist returns from sabbatical to find the PCT has been warming up to integrated care organisations

This month our diarist returns from sabbatical to find the PCT has been warming up to integrated care organisations

The story so far

Dr Peter Weaving is a GP in north Cumbria and locality lead for Cumbria PCT. A former chair of a large PBC consortium, he regularly finds himself sandwiched between the views of clinicians and PCT managers. He has just returned from a three-month sabbatical in South America.

‘Welcome back, boss,' says my deputy, Charlotte, regarding my peeling nose and unhealthy tan with disdain.

‘What's been happening?' I ask.

‘Well, Woolies has gone bust, your savings are worthless, as is your house, but you can now fill the car for less than £100.'

‘I meant in the locality, Charlotte.'

‘Right, well you'll be pleased to hear that the locality, in your absence and under my control, has been designated the only patch in the North-West to reduce both its overall mortality rate and health inequalities in line with departmental targets.'

‘That's excellent news,' I say, wondering if I have to clear my desk and slink back to full-time general practice.

‘The immediate concern for you, boss, is to get cracking on the ICO arrangements for Carlisle.' My heart sinks.

‘Eco?' I say hopefully.

‘ICO. Integrated care organisation. It looks as if pilot projects from both Allerdale and South Lakes are hitting the spot with the department and we need to keep our end up.'

Now that is interesting – in the last PCT reorganisation there had been a clear message for PCTs to divest themselves of their provider function. This order was almost immediately rescinded when it became apparent district nurses, health visitors and myriad other staff would no longer have an employing body. At that time the alternatives were few and unsophisticated.

Now, it seems, Cumbria is looking at two very different ICO models. In South Lakeland we will explore the potential of a not-for-profit, managed-care organisation, integrating the commissioning and provider (primary and community care) roles.

This draws heavily on the US Kaiser Permanente model we saw operating in Georgia on a PCT fact-finding trip at the end of last year. It will engage a wide range of clinicians (nurses, therapists, specialists, GPs) in the commissioning process to a much greater extent than occurs at present. Some 22 practices looking after 100,000 patients will form a single federation.

The other pilot is looking at integrated services at the small-town level with two populations of between 10,000 and 20,000 people.

The ICO headache for me is that the good GPs of our locality are lining up behind at least three different options.

These span the range from direct employment of community staff by practices through a socialist utopia of organisational status quo with enhanced communications, to a stand-alone community services foundation trust – or perhaps its services could be hosted by the local out-of-hours provider.

‘Are you listening to me?' says Charlotte, ‘I've left all the files on your desk and I think you should prepare an options appraisal for our next exec meeting.'

Welcome back, indeed, I think.

The PBC Diaries: Getting ICO friendly

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