Our diarist anticipates how a COPD scheme will be received by his peers. And finds a response as unpredictable as the British weather.
The story so far
Dr Peter Weaving is a GP and locality lead for Cumbria PCT, an area regarded as something of a health bill pioneer for its innovative integrated care plans and ability of GP commissioners to steer the PCT out of a £50m overspend. But even with its impressive track record, the focus remains on the everyday GP commissioner challenges like managing demand and reducing admissions…
Each year in my little locality, we spend about £2.3m on respiratory emergency admissions – the biggest single group of which are people with exacerbations of their COPD. It's a miserable condition which, as well as guaranteeing you a limited life expectancy, promises to make your last decade a particularly unpleasant one.
There are a number of ways we focus on this condition, ranging from public health and practice measures around smoking cessation to funding community-based specialist respiratory nurse teams. It's targeted by QoF and locally we're even QIPP-ing it.
Because we have such high levels of hospital admissions with COPD, we blew the dust off an initiative started 10 years ago by, of all people, the Met Office. It's a scheme called Health Forecasting and uses simple known facts and observations about the weather and prevailing viral respiratory infections in communities to produce for your COPD patients a warm and friendly, if robotic, support service. Since a cold snap will trigger a peak of COPD exacerbations (and admissions) 10 days later, there is ample time to call these patients, check their wellbeing and the supply status of standby meds.
Initially I was extremely sceptical of the scheme, as was my chief exec who said she would provide the service by looking out of the window and making a few calls. But when we drilled the data of those PCTs who had already implemented it, to our surprise, their emergency admission rate for patients suffering from an exacerbation of COPD fell by between 20-50%. A fag packet calculation showed that a reduction of only 5% would cover the implementation costs of the scheme.
So far, so good. Now, dear reader, as an experienced GP commissioner, would you expect problems implementing a scheme with a proven track record of helping patients avoid inappropriate admissions and bringing financial benefit to those practices' commissioning budgets? What? You do expect trouble? Well, I wish you'd spoken up sooner.
Even after debate and agreement by the practices' commissioning lead docs to approve the funding of the scheme, the response from individual practices has covered the full spectrum of what I can only describe as GP-ness.
I can look on the screen in the locality office and see practice X with its signed-up patients chomping at the bit for the scheme to go live. At the same time I hold in one hand a request from practice Y, asking me to pay for everything including the stamps, and in the other, from practice Z, a formal letter of complaint to my chief executive about the scheme.
I don't know why I love this job but I do.
There's a storm coming