• Bassetlaw Commissioning Organisation
• Salford PBC Consortium
• Westmorland Primary Care Collaborative
Winner – Westmorland Primary Care Collaborative
Westmorland Primary Care Collaborative (WPCC) describes its approach to commissioning as ‘take the long view – get a grip, get the foundations right, get the services right and watch the tanker turn’.
Using this approach, it has brought finances under control and reduced hospital activity.
Patient care is starting to move into the community, leading to it being described by Sue Page, chief executive of NHS Cumbria, as ‘one of the best examples of how clinical engagement and working together can bring about new and improved services for patients’.
Previously known as South Lakes Commissioning Group, WPCC consists of 20 GP practices in South Cumbria caring for a population of 110,000. It is a national ICO pilot – a model combining commissioning and provision within a single organisation.
In 2010/11 WPCC had a real budget of £82m. Financial results are impressive – it reduced PbR spend in 2010/11 by £2.8m compared with the previous year. Its prescribing budget was underspent by £220,000, with zero growth compared with 2009/10.
Community services achieved a £300,000 cost improvement and were underspent by a further £105,000. This has allowed WPCC to deliver service change at a pace not seen before in its health community.
Innovation and change
Integrated electronic health records
WPCC invested £500,000 to enable all GP practices and community services to move to EMIS Web, delivering a shared record across the whole of primary care with the capacity for interoperability with the local acute hospital trust.
Records can be accessed remotely via a secure network. This increases patient safety, promotes integrated working and reduces travel and administration time as notes are updated in real time.
It has created huge efficiencies for community teams and they are now starting to reap the benefit of a shared record, not only among community services but also within general practice. WPCC sees this as an essential building block for an integrated health system.
Building capacity in primary care
Medicines managers, employed by all practices and funded by the locality, deliver cost-effective prescribing, leading to zero growth in prescribing costs last year.
Referral support is provided by practice-based facilitators who promote adherence to referral guidelines, resulting in a 5.6% fall in first outpatient attendances last year.
Performance is fed back to practices through detailed profiles, which has increased awareness among GPs regarding outpatient referrals and clinical behaviour.
Integrated urgent care system
Over two years, WPCC has transformed urgent care services. Alternatives to an acute hospital bed are in place, with 51 GP beds and a primary care assessment service at the local hospital to which GPs can send patients for diagnostic tests and assessments by a team of GPs and nurses.
There is also a community short-term intervention service, community IV antibiotics and hospital in-reach by liaison nurses. These changes generated a £1.7m saving last year on urgent admissions and excess bed days.
WPCC host the diabetes service for the whole of Cumbria. It is fully integrated and community-based, with consultants, nurses and dieticians all moved out of a hospital setting. It also delivers a patient education programme across Cumbria.
Ms Page says: ‘This financial year, the commissioning group has led contract negotiations with its local acute provider [agreeing a £117m contract]. This has given clinicians the opportunity to sit together in a room with NHS managers and thrash out what they really want delivered, and at what price.’
She adds: ‘This will help ensure that all health services can work together to try and keep local people healthy and independent for as long as possible, and has served as an example to other commissioning groups within the PCT area.’
The group is also in a strong position to face future change. Dr Hugh Reeve, chair of WPCC, says: ‘We are delighted to receive this award, which recognises the hard work and innovation of our practices, community services and fantastic support team.
‘WPCC is now joining forces with five other commissioning groups across Cumbria to form a single CCG, and this award is a fitting way to mark the end of one era and the start of a new one.’
Strong clinical leadership and delivery that is constantly tracked.
Sir John Oldham, national clinical lead for quality and productivity, Department of Health