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Lean and keen

We're passionate about this area and that's what makes Bassetlaw Commissioning Organisation (BCO) the size we are – 12 practices covering 110,000 patients in north Nottinghamshire.

One thing that makes us unusual is the level of support we've had from our PCT, NHS Bassetlaw.

Although the PCT remains the statutory body until authorisation, we have now assumed responsibility for statutory duties and delivery of the strategic and QIPP plans (£5.7m for 2011/12).

We have invested time and effort in existing PCT staff who will be part of our future. I attend monthly staff briefings along with the chief operating officer to ensure that staff feel supported during the transition process.

We've had a phase of voluntary redundancy and lost a lot of good staff – up to 30-40%. It's a tough period to go through for a small group.

The organisation is now led by a committee, which consists of the GP chair and six other GPs, a chief operating officer, a chief finance officer, a general manager, a nurse, a public health manager and two non-executive directors.

Each practice has a lead who co-ordinates commissioning activity within the practice, and the leads meet on a monthly basis to ensure a regular flow of communication.

We also hold regular member meetings for all primary care staff to update them on developments and to obtain their views on the way forward.

Incentivising improvement

Practices that make a significant contribution to delivering QIPP efficiencies in the four areas – referrals to outpatients, emergency admissions, minor attendances in A&E and prescribing – receive some funding at the year end to reinvest back into local services and patient care.

The funding allows practices to increase capacity and capability to support change.

We began working with NHS Bassetlaw very early in the commissioning cycle and jointly developed the strategic plans for 2011/12, including GPs attending with the PCT to present the plans to the SHA.

We achieved a 12% reduction in first outpatient referrals in six months by utilising other clinical skills and alternative services in the community where possible, without denying any referrals or adopting any form of referral management service.

We believe this is sustainable change, led by clinical behaviour, and we have now extended our focus to emergency admissions, A&E attendances and prescribing.

Plans are in place to deliver a saving of over £1m in prescribing budgets.

We have re-specified and successfully tendered improved and integrated musculoskeletal and dermatology services locally, bringing services closer to patients, and are now using the learning from this process in a number of other clinical areas.

Working together

We are currently leading the redesign of acute hospital care, with the involvement of all stakeholders. We are developing an assessment and treatment centre model locally that will reduce admissions and improve diagnostic and social care services.

We are also working to improve the integration of paediatric and obstetric services across the hospital sites in Doncaster and Bassetlaw to improve the quality of care offered to children and families.

This work requires regular and consistent liaison with the media and local politicians.

The BCO committee has consistently challenged providers to improve quality and has introduced monitoring of key performance indicators to assist this.

An example of this was identifying a delay in surgery for patients with fractured neck of femur, leading to an improvement in the pathway and reduced waits for theatre.

We've been green-rated by the SHA recently and are aiming for full authorisation in October 2012.