Paul Bearman, General Manager at Wyvern Health, discusses how his consortium is advancing as a commissioning pathfinder, and some of the challenges it is facing to ensure it is set up to succeed in ‘the new world’.
Wyvern Health put themselves forward as a potential pathfinder in Somerset. However, Wyvern Health.com was set up to do PBC, so we’re not going to be the new organisation that will be the GP commissioning consortium in the future, because it will be a different organisation. So we are working with the LMC and with member practices to think what the new world will be looking like. We’ve gone forward as a pathfinder as a vehicle at this point, but we aren’t necessarily the final solution.
We’ve been in place for over three and a half years now. We currently have a board of eight: seven GPs and one practice manager. We hold elections for those posts every year, and half of the board stand down one year and half stand down the following year, so there’s an opportunity to being in fresh blood and have a bit of rotation. We do that on an election process because the board of eight, we look for two representatives from four localities within the county.
So that’s Wyvern. In terms of the new GP commissioning consortia will look like, it is still too early to say definitely whether we are going to hold elections or whether we’ll have an appointment process. It’s likely to be a mix of the two. But no decisions have been made on that as yet. We’re working on that now. That’s the first big piece of work that needs to be done. We have an aspiration of having a shadow board in place from April 1, that might be a bit ambitious.
All 76 practices within Somerset are members of Wyvern Health. 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. So from the PBC perspective we have engagement by having nominated leads in each practice. In terms of how that will work, it’s still too early to define, but what we are very clear about is, originally in Somerset we have four localities, based around the old PCT areas prior to 2006. What we’ve now got is about nine federations which is effectively clusters of GP practices and we are looking in the new world, we haven’t definitely decided that we’re going to be one GP commissioning consortium, but it likely. What we would then want to have is empowered localities within that, and that’s likely to be based around the nine Federations and how those federations are engaged in the commissioning board is still to be decided.
The nine are primarily provider, but we’ve had a torturous time debating whether they are commissioner or provider, we’ve come to the conclusion that it doesn’t matter. If they want to provide things they need to be able to commission them first. So they’ve got to have both a commissioning and a provider role. But we’ve had some interesting discussions about this. yes, there will be conflicts of interests but we will have to manage those. Everybody has a conflict of interest really.
We’ve obviously got some practices that are not engaged, but they are still members of Wyvern. We’ve been very fortunate in that the LMC are incredibly supportive and recognise that this is the only game in town, so it is making the right noises to engage practices. Pratcices are starting to understand commissioning and think, what does all this mean and do I need to get more involved and engaged. People are starting to look at the PBC dashboard that we’ve got, to question the information, starting to challenge the budget that is being allocated to them, so we’re getting there.
We recognise patient public involvement is absolutely crucial and we are one of the pilots in the DH’s national pilot on patient engagement and involvement. So we will be doing more work around that. Our building block has been trying to invigorate practice Patient Participation Groups (PPGs). About 45 of our 76 practices have got PPGs. We recognise that’s a big workload and commitment from practices to each have them, and they quite often get interested in the more mundane day to day issues in practices. What we’re trying to do is get our federations to establish PPGs, or at least bring together some of the key players from individual practices PPGs to a bigger group. To address from a more strategic view.
Getting to grips with the management allowance
In the operating framework there was the £2 per head. We haven’t had a meeting yet to discuss how we were going to get that £1m for us or what it is going to be used for. It’s interesting that it’s moved to running costs rather than management allowance, we don’t know what are included and excluded from running costs. There hasn’t been a lot of guidance as yet. It’s a massive range from £25-£35 per head, which for us would mean we either het £12m or £18m. That is a big variation. That has proved difficult. It is difficult to plan what we provide, what we do or what we buy in.
Establishing a legal framework
From our perspective, we originally thought that Wyvern Health.com, which is a company limited by guarantee, would be wound up because we viewed the GPCC as a statutory body with an accountable officer and reportable to parliament, and we didn’t think that a company limited by guarantee could be that. That was the view of one source of legal advice that we sought, but informal discussions with another lawyer suggested we haven’t seen the bill yet, so we don’t really know what the status of GPCC will be, and they could perhaps be companies limited by guarantee.
Paul Bearman, general manager at Wyvernhealth