GP Commissioning

Second in our three-part series, we reflect on lessons learnt whilst developing new pathways for patient care.

Have you wondered whether the disruption to NHS is incompetence, or deliberate?  Polly Toynbee and David Walker have an opinion, and they've put that opinion into a book.

The argument is purely polemic.  It doesn't attempt to win over government supporters, only to explain to Cameron's opponents what they are up against.  They describe an ugly chimera of Thatcherite brain, liberal Tory heart, and Europhobic limbs, not so much a monster as a series of disembodied body parts held together by the suit they are inside.

All over the world, the NHS is admired.for:

* best clinical outcomes (on balance, UK has some of the best outcomes.  Where the outcomes are poor, for example cancer compared with other European countries, UK population unfortunately indulges in far worse behaviours of diet and exercise)

This is a new era for the NHS, a time when GP practices can begin to deliver the services that patients want, close to home.  We haven't had a chance like this since the PMS contract of 2004, or Fundholding in the 1990s.

Health services can now care for many diseases that only a few decades ago were fatal.  Each disease or disorder that becomes treatable goes through these stages:

Most healthcare providers, in UK the same as everywhere else, get paid for each activity they do.  If someone needs care, they get paid.  If someone is well, they don’t.  So there isn’t much incentive (for the healthcare provider) to keep people well, even though it is much better for the person, much better for the nation, and much lower cost.  Minney.org Ltd is working with one CCG to generate enthusiasm and involvement, and the results are fairly successful….

GPs know the most about the patients registered with them, and have the biggest incentives to innovate and to commission better services. So why aren't they embracing Clinical Commissioning and using it to improve healthcare right across the country?

It could be any of a number of reasons, and we believe it's about understanding.  What's more, with our experience of doing exactly this (supporting GPs to get engaged), we can demonstrate how we've made a difference, and how it could work for other CCGs.

Clinical Commissioning Groups (CCG), the organisations that will commission  healthcare for nearly 60million people across England at a value of around £70billion, are beginning to take shape.

They come in essentially three types, and if you want to supply healthcare to these CCGs, even if you are an established provider of healthcare, you need to understand what you are dealing with

When I arrived in Sheffield in 2004, my first task was to "kill" the ISTC (Independent Sector Treatment Centre) that had been "imposed" on the South Yorkshire SHA by the Blair government.

The local Chief Executives, of the PCTs, of the Teaching Hospital, Children's Hospital and Mental Care Trust, and most of the surrounding Trusts, couldn't see the point.  I went  about it in my usual diligent way,