Dr John Havard wants PBC to come off the bench and play the beautiful game of transforming community services
The Transforming Community Services programme is justifiably coming under fire from PBC. The tight deadline for PCTs to state their direction of travel has squeezed alternatives to acute sector management into a corner. But in Suffolk we are moving into extra time.
The vast majority of GPs have legitimate concerns about vertical integration. They are mindful of the last foray in the 1970s when some acute trusts sucked the community budgets dry to pay for acute overspends.
There is also an inherent structural concern when managing more patients in the community conflicts with acute sector income streams. The medium-term plan is for acute activity, and thereby income, to be drastically reduced. So offering community services may be seen as a compensatory gift for hospitals about to be seriously wounded.
We can see that the Department of Health and SHAs might prefer to have fewer organisations to performance manage and more stability in the local health economy. But this will not be in the primary interest of GPs or their patients.
PCTs up and down the country will only entertain ‘credible’ bids so our task was to use our influence to develop community services in an integrated way to encourage independent living and reduce admissions.
Our natural partner is adult social care services and our loose Federation of Commissioning Groups has expressed this in a bid to the PCT Board. Suffolk PBC consortiums are already running schemes to identify patients who are at risk of admission and then minimise this risk. Projects like this have demonstrated savings up and down the country and they need to be developed at the expense of acute sector activity.
As well as this admission prevention work with social care and community multi-disciplinary teams, we have a last line of defence in A&E – a trained carer who is paid to give 72 hours of round-the-clock live-in care to patients who arrive as an emergency in A&E. We find that these patients are often well known to social care but for a variety of reasons become unmanageable at home despite daily visits.
Social care seems the natural partner to manage patients better in the community but this is plainly not the preference of the DH and SHAs. The urgency with which PCTs have been told to give SHAs a clear steer on how to transform community services gives the established players a natural advantage.
Meanwhile we on the bench have a potentially great and experienced player: PBC could link our forwards and backs and get the whole team to perform better. We might struggle to persuade the referee to allow him onto the field and time is running out. The pressure on the officials comes straight from the DH guidance that states PBC has a key role in shaping the development of community services and must be fully engaged. Game on.
Dr John Havard is a GP in Saxmundham, Suffolk, and chair of the PBC consortium Commissioning Ideals Alliance
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