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Surviving a breakaway

Dr John Havard describes how a split in his PBC consortium galvanised the residual members into trying to achieve something significant

Dr John Havard describes how a split in his PBC consortium galvanised the residual members into trying to achieve something significant

Nobody likes not being picked for the team or left uninvited to the party but this is just what happened to half of our

Suffolk Coastal Commissioning Group. At the group's last meeting, the chair and his deputy announced they were both part of a new private company that planned to commission and provide healthcare in our area. It was a bit of a shock to discover that invited practices had been meeting and planning this departure for five months.

The commissioning group had formed in November 2005 from the constituent 14 practices of the original PCT. Neighbouring PBC groups followed the same lines so the bonds locally were geographical, not ideological.

News of the breakaway left the remaining practices considering whether they should carry on alone or join another neighbouring PBC group. The departing practices were largely a central cluster, leaving Felixstowe in the south, one small central practice and a few coastal practices in the north. One possibility was the Felixstowe group commissioning together and the small northern group opting out.

After some reflection and discussions, we realised that despite our disparate geography, we had some crucial commonality. Suffolk is a rural county and within our group there are two cottage hospitals. We favour a step-down care model, going right back to the basic role of secondary care, to provide a specialised and often technical service as well as immediate post-treatment care.

I remember Dr David Colin-Thomé [Runcorn GP and the Department of Health's primary care ‘tsar' ] telling me that when they were fundholders they secured their district nursing service from a distant trust on the other side of the Pennines.

With this in mind, we have now formed a new group covering about 60,000 patients, named the Commissioning Ideals Alliance (CIA), to demonstrate that our ideology is more important than geography.

Our alliance plans to ‘unbundle' the tariff, starting with routine elective joint replacements. Why shouldn't patients be discharged to a local cottage hospital at three or four days instead of going home at day six? We have physios and OTs available who could be persuaded to accommodate additional work, and there are clear possibilities for using community matrons.

Despite step-down care being frowned upon by ministers espousing ‘care closer to home', we believe our plans would deliver an enhanced patient experience by moving the step-down barrier along so it encroaches into the acute sector. Money could be released for better local care, since patients will recover quicker if they are fed and looked after well while being closer to their families. The long-term security of cottage hospital beds would also be enhanced.

Initial discussions with the acute sector are positive, as they want to concentrate on high-value expert interventions and freeing up capacity to meet the 18-week referral-to-treatment target. Any potential obstruction is most likely from our PCT leaders. Already, a new DVT protocol has been delayed for more than three months, and the PCT has also refused to back a health and social care one-stop service for various reasons.

If PBC is to work then it will require honest and open engagement because unmotivated GPs have the capacity to drop goodwill and bankrupt the NHS.

GPs who share the same philosophy should be enabled to make great progress in improving patient care while allowing our colleagues in secondary care to be empowered to do what they do best – and freed of what they do worst!

Dr John Havard is a GP in Saxmundham, Suffolk

Ideology is more important than geography

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