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How pioneering pathfinder consortia are shaping up



Get the latest on the structure, partners and areas of focus for the Department of Health’s pioneering ‘pathfinder’ GP consortia

Interactive map: Click here to view our map showing the country’s first 141 pathfinder GP consortia

1. Nene Commissioning Community Interest Company (Northamptonshire)

Structure

An evolution of an existing PBC consortium. Currently consulting members on future governance arrangements but this will include new elections to the Board and a slightly different configuration of the locality structure.

Partners

Has its own dedicated management team and additional support deployed from the PCT. Not yet working with private sector, but is currently in the process of agreeing what additional support might look like.

Areas of focus

Has operated a Best Practice Scheme (of incentivised peer-to-peer referral review) for the last three years. This has been about reducing variation and improving the quality of referrals rather than targeting efficiency savings – however efficiency savings have resulted. Recently launched an incentivised GP-led Demand Management scheme (which will pay for itself when efficiency savings are generated).

2. County Durham and Darlington

Structure

Seven consortia moving forward as one pathfinder. The six consortia of Durham Dales, Derwentside, Durham and Chester le St, Darlington Sedgefield and Easington already established and longstanding former small PCTs, PCGs and localities. Intrahealth – private provider of primary care services have practices straddling 3 of the original consortia.

Partners

Not yet talking to private providers but is open to that option if its PCT is unable to resource the consortia through the transition.

Areas of focus

Looking at planned care initially. Delegated budgets, involvement in contracting and peer review of referrals will form part of that plan and will help to deliver QIPP. Also looking at prescribing savings and purchasing beds in nursing homes to help manage non elective care. Better management of long term conditions in the community especially COPD.

3. West Cheshire Health Consortium

Structure

An evolution of an existing PBC Consortium. All practices were involved in agreeing the competencies required of the GP chairman. The Consortium Board elected the GP Chair following an interview process held as part of a Board development session. The GP appointed as chair has the full support of the GP Board.

Partners

Has begun talking to independent providers to discuss support for areas such as referrals management, HR support, financial and accounting support, other back office functions.

Areas of focus

Has a referral management process in place that has reduced GP referrals by c.6% on last year. Is agreeing clinical commissioning policies and prescribing policies for use within primary and secondary care, targeted work to reduce statin prescribing, improved contracting around first to follow up ratios, consultant to consultant referrals and short stay admissions. Has started a piece of work to incentivise GPs to improve quality in primary care.

4. Newcastle Bridges GP Commissioning Consortia

Structure

Has developed from the fusion of 2 existing PBC groups.

Partners

Has looked at services provided by independent not for profit alternative providers and a commercial organization for triage and physio

Areas of focus

Referral management is a priority but sees acute admission avoidance as more important. Also doing case finding and treating to guidelines which reduces admissions for hip fracture COPD and heart failure, and blacklisting some drugs (enteric coated prednisolone and glucosamine so far)

5. Coastal West Sussex Federation

Structure

A federation of existing PBC consortia. Has an interim board and plans to hold elections in April.

Partners

Not working with private sector at present but it is likely especially for HR

Areas of focus

Has a peer review referral management scheme that will guide its planned care commissioning, has also commissioned a single point of access for non-elective referrals which will start in March.

Also has a very focused QIPP plan for 11/12, mostly aimed at reducing variability in performance at a practice level. All service redesign will be whole pathway and clinician led. Is taking a local health care economy approach to its plans and has set up a multiagency cabinet (commissioners, main providers and local authority) to oversee and drive the work.

6. Baywide GPCC Limited (Torbay)

Structure

Set up as a consortium 18 months ago and then agreed to form a company last November, which is Baywide – a company limited by shares not for profit.

Has a board of directives of seven GPs, a nurse practitioner and the chair of the practice managers group and several co-operative members, a patient representative, a community nurse, a director of public health and the deputy director of operations on the Torbay care trust. May change its organisational status in the future if deemed not acceptable legally, but has chosen to stick with the current board of directors and change if/when needed.

Partners

The company employs a business development manager, a performance finance manager and a corporate services manager. Uses resources such as finance team, HR team from Torbay Care Trust. Is open to accessing external help if needed.

Areas of focus

Clinical commissioning groups – Primary carer and a consultant equal voice on them along with the relevant commissioning support. Has about 20 of those for different specialities that are working on difference service re-design in line with QUIP. Is providing training for the GPs and Consultants on those PCT groups and trying to get them to work to a uniform method and work to set objectives bearing in mind NICE quality objectives as well. Is setting up a clinical cabinet which is going to give an over-arching look from the primary and secondary care consultants about how they feel service re-design should be shaped in the future and what is best for patients.

Is engaged with LINK and has set up a patient participation group. Has service re-design pilots running at the moment – including an obesity pilot, an alcohol admissions avoidance pilot, and a fit- for-referral pilot that is looking at how patients can be made more optimally fit for surgery.

7. Buckinghamshire

Structure

New structures will be based on three GP Collaboratives which have been in operation as statutory bodies for some time. 1) Buckinghamshire Primary Care Collaborative (BPCC) which covers 34 GP practices in the south of the county, 2) United Commissioning (UC) which covers 21 GP practices in the north of the county, and the Practice PLC, an independent company with three practices in Great Missenden and High Wycombe. The three consortia have established a transformation team, which also includes invited representatives from the PCT and Buckinghamshire County Council. The approach being taken is not the transfer of responsibilities from one body to another, but a review of every function to determine how best this should be delivered in future.

Partners

The review of each function is carried out in co-operation with the PCT team which is currently responsible. The review considers factors including value for money, productivity and reduction of duplication, sustainability, clinical outcomes & wellbeing benefits, timeliness of decision-making, responsiveness to local needs and promotion of partnership working. The reviews have already begun, with medicines management, shadow budgets and IM&T. Following each review, a joint recommendation is made about how the function should be provided in future. This might include purchasing services from independent providers, sharing responsibilities with other Collaboratives, building a bespoke version for Buckinghamshire, or discontinuing it.

Areas of focus

Is running an on-going referral management programme across Buckinghamshire, in response to a challenge from the PCT to reduce the number of clinically unjustified referrals as part of the plan to achieve financial balance and to meet waiting time targets. Academic detailing, i.e. referral management through sustained behavioural change, has been the theory upon which the programme has been developed. Provision of detailed practice information enabled the clinical team to generate dialogue which was based on current practice. A referral tool was created which generates a dashboard of information relative to each practice as well as enabling an overview of the collaborative performance. This programme has delivered a 15% reduction in referrals which has been sustained.

Delivery of QIPP Plan – 57% of the projected savings will be delivered by the ImPACT (urgent care project).

8. WyvernHealth.com (Somerset)

Stucture

Wyvern Health.com was set up to do PBC over 3.5 years ago. All 76 practices within Somerset are members. It currently has a board of 8, 7 GPs and 1 practice manager. It has put itself forward as a pathfinder primarily s a vehicle at this point, but won’t necessarily be the final consortium. Each practice has a membership agreement with Wyvern, and in that, they have identified a PBC lead within the practice that ranges from being a GP or practice manager. Somerset now has 9 federations which are effectively clusters of GP practices. Could develop as one large consortium but with empowered localities within that based around the 9 Federations.

Partners

Has hired an independent management consultant to work up governance arrangements, and has enlisted United Health’s risk-tool for managing high risk patients so they do that.

Areas of focus

Has been working for three years, initially on reducing inappropriate emergency admissions, and then subsequently moving on to looking at how to better manage elective referrals. Fully engaged in QIPP. Has had particular groups looking at particular groups of patients. For emergency admissions, has carried out specific work around nursing home admissions and working with the gold standards framework programme around end of life care. Has initiated work on improving medicines management for vulnerable patients to keep them at home. Is looking at developing interface services on elective care pathways for MSK and dermatology, and recently commissioned a paediatrics advice and guidance service.

Also doing loads of work around long-term conditions. Working with the PCT on developing an enhanced care co-ordination centre, which should result in patients having a more co-ordinated approach to their care, more work done on care plans and self-management plans.

9. Great West Commissioning Consortium (Hounslow)

Structure

Based around the previous Great West Commissioning Consortium PBC group. All 57 GP practices in Hounslow signed up.

Partners

Signed a deal with UnitedHealth UK to run a crackdown on GP referrals. The company won the contract following a competitive tender process, with the selection panel including local GPs and patients.

Areas of focus

The new Referral Facilitation Service would handle all referrals, including consultant-to-consultant referrals, from February 2011. It is designed to provide better information on how capacity is used, to help commissioners spend the budget wisely. The service will help patients book their appointment using Choose and Book.

10. South Gloucestershire Consortium Ltd

Structure

Has an executive, including 6 GPs and 4 practice managers and a PCT representation. Did have elections but not formal ones because of the lack of an elected mandate to take the government reforms forward and make permanent decisions. Priorities over the next couple of months are to try to develop a structure locally and engage with surrounding consortia. Talking to Bristol and North Somerset consortia to try to potentially join forces in some ways, e.g. commissioning from local hospitals, but does not want to become one big consortium. May decided to have a practice representative from all practices and then develop a new exec of the consortium. Yet to decided whether to have an appointment system through interviews or election.

Partners

They [Independent providers] are busy trying to talk to us. There are people who are private providers of various things knocking around e.g. providers of IT solutions and HR support. At the moment we’re keeping them at arms length.

Areas of focus

Working with the PCT and the QIPP programmes. Practices undertaking a peer review and really looking at referral pathways to make certain everyone gets referred to the right person first time and has developed a website with some criteria based questions to access secondary care. E.g. In order to access carpal tunnel syndrome surgery have they had some diagnostics done? Has an injection been considered? Have they had local therapy? This has reduced elective referrals by about between 3-5% below the previous year’s end point.

How pioneering pathfinder consortia are shaping up Map showing pathfinder GP consortia


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