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Seven steps to making GP commissioning work

PBC leader Dr Luke Twelves suggests a to-do list for GPs looking to take on commissioning

PBC leader Dr Luke Twelves suggests a to-do list for GPs looking to take on commissioning

When I was a junior doctor, my training was focused on delivering the best care for the patient in front of me. Now, like it or not, the Government's plans for GP-led commissioning mean we will take responsibility for improving care for whole populations, not just the few thousand patients on our practice list.

The Government's reforms place our profession in the driving seat to improve the quality and efficiency of care for the NHS. But are we ready for it?

In one word – yes. In many areas of the country, practice-based commissioning has been a success and we need to build on this experience as a profession to ensure we deliver on this opportunity.

As a founder of a successful PBC group in Huntingdonshire, I have some idea about what GPs may have in store for them. In this article, I will attempt to outline the steps that, in my experience, GPs will need to take to make a success of commissioning.

1. Start with a vision

Your group has to have a shared understanding of the purpose for coming together, so spend the time to develop a shared mission or vision. This set of agreed principles, underpinned by a clear ethical framework, will enable you to develop and to go back to first principles when faced with a major challenge.

Engage your neighbouring GPs through small face-to-face meetings, in addition to larger area meetings, and use this time to pool together ideas and shape your vision.

Don't be afraid to seek out support or expertise from the PCT or GPs in other areas and use their help to assess the strengths and weaknesses of your consortium.

2. Crunch the data

To deliver the best outcomes you will need to be able to operate from an informed position – so having the right data and information is key.

If you are going to be managing the budget for a whole population, you have to understand its needs. Can you break down the data to identify the areas where activity is rising? What factors are driving costs in your health economy?

There are already a number of established technologies that can help you here. You can check NHS Comparators for data at the level of both GP practices and acute trusts. Ask your PCT what data it uses.

Monitoring this information will enable you to continually make improvements, and can inform your budgeting and forecasting capabilities. Later on, you can use this data to check the validity of invoices and the value of the spending decisions you are making.

3. Develop good relationships

Developing good relationships is crucial and will reap returns for many years. Make sure you reach out to your fellow practices in the consortium, patients, secondary care, PCTs, local authorities, community care and external organisations.

Relationships can be developed through formal agreements, but also by informal

co-working. Either way, it is often best to start with small and defined pieces of work and build a working relationship from there.

Involving patients is essential. They are, after all, the reason for doing all of this, so put them first. They are also a huge resource, and one that should be treasured.

Engage them and value them. Use existing patient-participation groups and consider public meetings with the local community. Web-based or paper surveys can also act as helpful tools to get their views.

4. Measure risk

An understanding of risk should underpin every decision you make – from commissioning a single pathway of care to fundamentals such as how large you want your consortium to be and how you will structure it to manage that risk.

There are several models of risk management that may allow you more flexibility than might otherwise be suggested.

Take a specific disease area, for example. There will be a range of factors that you won't be able to control when considering the clinical and financial risk over a certain period. But understanding care pathways and their optimum outcomes will mean you can manage risk by ensuring you focus on interventions that make the difference both in terms of quality and cost-effectiveness.

5. Analyse your finances

GPs are used to managing the finances of their practices, but the interdependencies and rules will differ at consortium level.

Investing in the right skills and tools in this area will help. Develop a baseline financial assessment of your cluster – for example a formal assessment of your true projected spend versus your current budget. This will help you plan, forecast and manage your budgets.

6. Implement good governance

Governance is a daunting subject, but ultimately it is about developing systems, processes and attitudes to ensure you can deliver defensible and sound decisions.

It incorporates information, clinical and corporate governance, and also certain principles, for example transparency.

A starting position would be an assessment of your consortium against the seven pillars of clinical governance – clinical effectiveness, risk-management effectiveness, patient experience, communication experience, resource effectiveness, strategic effectiveness and learning effectiveness. You could also use the governance toolkit – your PCT can give you access to this.

7. Forget about PBC

The white paper describes a step change, not a gradual progression from PBC. Many of the skills learned while doing PBC will be invaluable. But commissioning is not just PBC with a little more bite – and to consider it as such is underestimating both the challenge and the opportunity you face.

Don't get sidelined by the unknowns. Concentrate on what you do know and start building the foundations. Although 2013/14 may seem a long way off, the time will fly by. The transition period presents a major opportunity to build solid systems and give yourself the best chance of success. Use your partnerships and relationships to start putting your plans in place early.

Dr Luke Twelves is a GP in Huntingdon, Cambridgeshire, founder of HuntsComm and director of clinical commissioning for UnitedHealth UK

Useful resources

1. NHS Comparators. Tool to list and compare 200 parameters from primary and secondary care. www.nhscomparators.nhs.uk (registration is required)

2. Primary Care Commissioning. DH guidance on commissioning www.pcc.nhs.uk/commissioning

3. NHS Evidence. Collection of useful resources for commissioning. www.library.nhs.uk/commissioning

4. Practical Commissioning. Hundred of articles and case-studies on GP commissioning. practicalcommissioning.net

Seven steps to making GP commissioning work More on GP commissioning at the NAPC Annual Conference

A top line-up of expert speakers – including Andrew Lansley, Sir David Nicholson and Mark Britnell - will be addressing the latest developments in GP commissioning at the NAPC Annual Conference in Birmingham in October.

To find out more and book your place today please click here.

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