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Have we become too hung up on the C word?

If we stop talking about commissioning the arguments for GP consortia start to make sense, says Dr Paul Zollinger-Read

If we stop talking about commissioning the arguments for GP consortia start to make sense, says Dr Paul Zollinger-Read



Commissioning is having a rather troubled adolescence.

I took on a joint clinical management role as I wanted quite simply, to make a difference to the care our patients receive. GPs, because they are so close to the patients can see the challenges they face and how to improve the quality of their care.

Through the development of pathfinder consortia we have seen many excellent examples of GPs working in local partnerships redesigning ,simplifying and improving care. This is what the C word is for me.

We have somehow managed to portray commissioning as one of the mystic arts of management, when in reality, isn't it just good medical practice? It's what happens in every consultation and is a central part of our daily work in our interaction with patients

So this leads me into a few observations about how we take forward the development of consortia to commission high quality care. Let's just intellectually park the 'pause' for a moment and ask what do we need to do to build upon this fundamental part of good medical care.

One of the most important issues that I'm increasingly hearing from pathfinders is the unwarranted variability in primary care. There is strong desire from many of the consortia I have met to be helped and also to be provided with the tools and incentives to manage this variability. This works best when it is based upon locally agreed data and on peer revie. In many areas this has had quite dramatic improvements on reducing variability and is an essential foundation for developing consortia

The next area of importance is the fundamental ability of consortia to develop a population-based approach to the management of disease. This has been exemplified already by the excellent work in such areas as Tower Hamlets who have driven up outcomes such as MMR vaccination rates in difficult to engage populations.

Interestingly one of their clear messages is that developing primary care yields significant results in improving population health care. Population-based approaches move us away from Individual approach of the patient in front of you, that we have focused on in previous years. There are many other excellent examples of this approach: its place in driving up outcomes is proven; its place as a fundamental value of consortia is clear.

Having started with the C word, we end with the all embracing 'I' word. I met with a group of pathfinder leaders last week and was fascinated by how many had already developed constructive relationships with secondary, community and local authority partners.

What's interesting is that most of these groups have been fairly successful in improving the local quality of care in a variety of different settings and the reason they have been successful is that they recognised the power of constructive relationships. I could waffle for England on integration of care and it's benefits - the evidence speaks for itself - those who go down this route succeed in effecting beneficial clinical change. Those that don't, struggle.

So pulling this all together perhaps it's time to move away from the C word and to start to look at the underlying principles: such as reducing variability; adopting a population-based approach and integrating care.

Dr Paul Zollinger-Read is a GP and director of GP commissioning at NHS East of England

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