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The Intelligent Practice

GPs need to receive timely and accurate information on which to base commissioning decisions, writes Dr Dennis Abadi

GPs need to receive timely and accurate information on which to base commissioning decisions, writes Dr Dennis Abadi.

The successful implementation of practice-based commissioning (PBC) is an essential prerequisite to the modernisation of the NHS. Equally, PBC cannot be done without real time accurate information on which GPs can base their commissioning decisions. In many areas this information is not currently available.

These are the unanimous views of a steering group of nine GPs, including myself, who have developed a new information framework outlining the minimum data requirements of doctors if they are to make a real success of PBC.

The recommendations of the group will be published in a report, The Intelligent Practice, due out on 22 February. The group was brought together by Dr Foster Intelligence, an independent research and analysis provider, and the report is available to download from its website, It is the final report in the Intelligent Board series, which has looked at the information requirements for boards of acute, mental health and ambulance trusts and PCTs and SHAs.

In The Intelligent Practice we propose a two-stage information framework. One sets out the minimum data needed by every GP for PBC, and the second is aimed at those more fully engaged in the process as lead commissioners or lead commissioning practices. These indicators focus on the information needs of commissioners, not providers of primary or community services.

This is not a ‘one size fits all' framework which we suggest all GPs should adopt. It should be a starting point that commissioners will adapt and develop in line with their needs and local circumstances as they gain experience from the practical impact of their commissioning decisions.

GPs are best placed to make decisions about the delivery of health services locally. But to commission those services successfully in line with the needs of their populations they need information that enables them to:

• understand current utilisation of resources and anticipate future trends

• design and deliver effective local services

• understand their budget

• manage demand for services.

This requires a consistent set of information across the local health economy. A number of organisations will be key to this information flow.

PCTs PCTs are obliged to provide information to GP commissioners. In order to develop effective commissioning GPs and PCTs (and indirectly, the strategic health authority) must work in partnership. There should be a mutual flow of information between the PCT and practices. PCTs in particular should provide practices with information about population health. GP practices need to feed back information about the needs, preferences and experiences of patients.

Providers Commissioners need access to real time information about the availability of local services, according to the patient pathway, from the NHS, independent and voluntary sectors. They also need comparative information on the cost and quality of those services.

Local authorities GP commissioners will need information about other local services, in particular, social services, education and housing – all of which have a significant impact on health needs. GPs will also need to provide local services with information about their populations.

Patients Commissioners need feedback from registered practice patients, information from patient groups, and information about the experience of patients treated by local providers.

In many cases, the challenge for GP commissioners is not the availability of information, but its presentation and interpretation. GPs lack real-time information about the care pathway of patients, often relying on paper-based discharge summaries. Information needs to be developed so that computerised online discharge summaries and information about patient outcomes are consistently available to all practices.

All information should be underpinned by a number of principles, which have featured consistently throughout the Intelligent Board report series.

All information should:

• be clearly and simply presented, including graphic overviews supported by a brief commentary

• be updated in a timely manner, working towards a ‘real-time' information culture

• direct attention to significant risks, issues and exceptions

• provide an appropriate level of detail.

The key tests of the success of any information resource should be the extent to which it:

• prompts relevant and constructive challenge

• enables performance improvement

• supports informed decision-making

• is effective in providing early warning of potential financial or other problems

• develops all commissioners' understanding of the organisation and its performance.

The steering group strongly recommends that a number of information framework pilots be set up in a representative cross-section of population profiles, with a view to arriving at a model which could be implemented more widely.

Next year the group intends to revisit the framework, to benefit from the experience gained in the start-up period of PBC.

Dr Dennis Abadi is a GP in Westminster, and PEC chair of Westminster PCT.

The steering group was chaired by Sir William Wells, chairman of the Appointments Commission.

The other GP members were: Dr Charles Alessi, GP in Kingston, and director of the Kingston Cooperative Initiative; Dr David Colin-Thome, GP in Runcorn and National Clinical Director Primary Care, Department of Health; Dr Michael Dixon, GP in Devon and chair of the NHS Alliance; Dr Steve Henderson, GP in Greater Manchester and NHS North West lead for Connecting for Health; Dr Mayur Lakhani, GP in Leicestershire and chair of the RCGP; Dr Naresh Rati, GP in Birmingham and PEC member of Heart of Birmingham PCT; Dr Lisa Silver, GP in Oxfordshire; and Dr Mark Williamson, GP in Hull, and senior medical adviser, Department of Health.

Minimum data all GPs should receive data that lead commissioning GPs should receive

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