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Step into my shoes

Our protagonist gets to grips with the theory of advanced commissioning – life’s just simpler without it

Our protagonist gets to grips with the theory of advanced commissioning – life's just simpler without it

The story so far

Dr Peter Weaving, a full-time GP in north Cumbria, was previously chair of a consortium but now works for the PCT and regularly finds himself sandwiched between GPs and managers. He is now preparing to leave for a three-month sabbatical that will include a trip to the US to see how they provide healthcare there. Now for the handover…

‘Peter, you're wrong. What you're doing is wrong and the way you're going about it is completely wrong.'

That's Charlotte, a local GP and the deputy clinical lead for our locality who will fill in for me while I'm on sabbatical. What is wrong is that she's been sent on a course; not just any old course but a Foundation for Health Improvement course that leads to an MSc in Advanced Commissioning. Which means that in practice-based commissioning terms, and certainly in locality terms, she is now an expert.

‘You need to base every commissioning decision on a health needs assessment. You need to follow the eight-point commissioning cycle.'

I feel like I'm at a meeting of Alcoholics Anonymous but with more fervour. That probably puts me at pre-contemplation – the stage before you feel the need to change.

I put down my whiteboard pen (the most useful commissioning tool I possess) and look across the locality office at Charlotte. ‘It's a question of balance,' I reply. ‘Look at the bone densitometry service we're commissioning.'

This is a good example of the gaping chasm between very detailed commissioning informed by epidemiology based on population demographics and morbidity data, and the ‘finger in the air to test the wind' approach. The latter relies on a commonsense view that a frail and elderly population with moderate deprivation quite simply should not be expected to travel 80 miles for a screening X-ray to diagnose their osteoporosis.

Clearly the service should be sited bang in the middle of the locality's centre of elderly population. So the solution is to commission that service locally. And that is what we are going to do. A victory for the whiteboard school of commissioning.

Where it gets more complicated is looking at how that locality-commissioned service fits into the rest of Cumbria and its population and their needs. Only a proportion of them would be in easy reach of the new stand-alone service in our northern locality.

What we have to do next is that complex assessment of need, population density, travelling times and the cost of the current service throughout the county and consider the alternative models of provision available. What that may throw up is that the solution outside the large urban areas is a mobile service providing fixed sessions at a number of different sites, the cost of which is partially offset by a reduction in the out-of-county spend.

But of course to make that decision accurately enough to satisfy your director of finance, you will need your advanced commissioning qualification. Hmm... I may need to retrain.

Enjoy the advanced commissioning course, Charlotte – you'll be in my shoes before you know it.

The PBC diaries - step into my shoes

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