Written evidence from Central London Healthcare
(COM 22)
1. INTRODUCTION
1.1 Central London Healthcare (CLH) is a
"not for profit" community interest company, bringing
together 23 GP Practices in the City of Westminster to commission
services on behalf of 130,000 registered patients. The organisation
was formed over three years ago and has been successful in developing
General Practice through providing innovative solutions to healthcare
needs and managing demand while maintaining quality. The resulting
hospital savings have been used to develop further services for
patients.
1.2 CLH welcomes the White Paper because
it will enable us to continue the journey we have begun to deliver
services which meet the needs of patients through locally based
GP and patient led commissioning. We therefore hope that as a
result CLH will be able to move more quickly and have more impact
on delivering outcomes for patients by being free of the constraints
and limitations of Practice Base Commissioning, under which the
organisation currently operates.
1.3 We have only responded to those questions
raised by the Committee where we believe our experience or expertise
as a well developed consortium of GP commissioners can be of value.
2. CLINICAL ENGAGEMENT
IN COMMISSIONING
How will commissioners access the information
and clinical expertise required to make high quality decisions
about the shape of clinical services?
2.1 In answering this question we are drawing
on the wealth of experience gained by over 200 clinicians, both
doctors and nurses, across 23 GP practices, many of whom have
an interest or background in a particular clinical speciality
or aspect of health care. CLH also has strong relationships with
secondary care clinicians as well as those working in community
services.
2.2 Typically, when looking at a particular
element of healthcare we will form a Clinical Reference Group
led by a Primary Care Clinician, supported by clinicians from
secondary and community care as appropriate. These groups bring
together the local clinical expertise as well as looking further
afield for evidence nationally and internationally.
2.3 CLH often operates through a combined
Clinical Reference Group, with a non-clinical Project Executive
Group ensuring that the clinical and administrative processes
of the care pathway operate in an integrated manner to deliver
high quality, effective clinical care with seamless easy access
to that care.
2.4 We fully involve our patients in the
design and delivery of services, and seek to improve clinical
quality and patients' experience of the services based on feedback
received from patients.
3. HOW WILL
COMMISSIONERS ADDRESS
ISSUES OF
CLINICAL PRACTICE
VARIATION?
3.1 We see developing practices as a key
element of CLH's role with the objective of all practices delivering
excellence in general practice. CLH has already achieved success
in changing GP behaviour and reducing variation through through
pro-active GP engagement and strong clinical leadership.
3.2 Examples of elements of our work which
have enabled CLH to work successfully to combat issues of clinical
practice variation are:
A set of quality standards that practices must
meet to be members of Central London Healthcare.
All referrals to secondary care through our Patient
Referral Service are peer reviewed by clinicians from other CLH
practices.
The provision of educational opportunities for
GP and practice staff, as well as the opportunity for practices
to share learning. Each practice also has a "buddy"
practice to provide mutual support.
A range of information provided to practices
to allow them to compare their practice with peer practices.
The adoption of a consortium approach to certain
services thus enabling a particular practice to choose not to
deliver a particular enhanced service but to offer instead that
service to patients through a nearby GP practice within the consortium.
4. HOW WILL
GPS ENGAGE
WITH THEIR
COLLEAGUES WITHIN
A CONSORTIUM
AND HOW
WILL CONSORTIA
ENGAGE WITH
THE WIDER
CLINICAL COMMUNITY?
4.1 Engagement is key to both ensure GPs
and practice staff are well informed and to ensure the consortium
is aware of the needs of individual practices and those of their
patients. CLH's size means that as well as formal communications
we can also maintain individual relationships across the consortium.
We are concerned that if consortia are forced to be substantially
larger than CLH, the collegiate spirit, peer comparison and collective
responsibility may be lost.
4.2 Within the consortium CLH holds a number
of forums which meet regularly for GPs, Practice Nurses, Practice
Managers and Senior Administrative Staff. We have an annual multi
disciplinary away-day, lunchtime clinical education sessions,
various Clinical Reference Groups. We also provide newsletters
for all staff and have active email exchanges on areas of interest.
4.3 CLH has a Management Board which is
elected by all practices consists of GPs, Practice Nurses, Practice
Managers, a Senior Manager from Social Care and the Chair of the
User Panel. The User Panel brings together patients from across
the consortium who are also engaged with their GP practices.
4.4 To engage with the wider community,
CLH Clinicians sit on a range of boards with colleagues from other
consortia, secondary care and community services (including social
care). As well as our clinical reference groups we meet regularly
with Secondary Care and Community Care Providers, Mental Health
Providers and the voluntary sector.
5. HOW OPEN
WILL THE
SYSTEM BE
TO NEW
ENTRANTS?
Will care providers be free to offer new solutions
which offer higher clinical quality, better patient experience
or better value?
5.1 In our experience the processes that
have been implemented to meet competition and procurement rules
have led to the development of overly detailed specifications
dictating to providers how they should operate their services.
These specifications are often developed without the involvement
of those directly involved in front line delivery. This has removed
the opportunity for providers to innovate. We hope in future,
while ensuring that legal and best practice requirements are met
with regard to competition and procurement, we can challenge providers
to provide innovative solutions to patients' needs identified
by GP commissioners.
6. WILL COMMISSIONERS
BE FREE
TO ACCESS
NEW COMMISSIONING
EXPERTISE?
6.1 With the small number of staff within
CLH, we have ensured we have access to a range of expertise and
experience from the NHS, the Third Sector and the commercial sector.
We believe there is much the NHS can learn, in commissioning,
contracting, procurement and performance management from outside
of healthcare. GPs as managers of their own small businesses also
bring expertise to this area of CLH's work. We supplement this
core expertise with access to specialists as and when needed.
We hope that a market will develop to allow GP commissioners to
have further choice in where they can purchase expertise.
7. WILL POTENTIAL
NEW ENTRANTS
BE FREE
TO OFFER
ALTERNATIVE COMMISSIONING
MODELS?
7.1 CLH believes that the challenges ahead
will mean looking at new approaches to commissioning. We will
need to commission in a much more integrated way both across health
and social care and across the various care pathways. With an
ageing population and the increase in co-morbidities very many
patients interact with a range of different health and social
care services. The current approach to commissioning can often
seem an inefficient use of resources resulting in uncoordinated
care for the patient, even though each provider may be meeting
their individual contract requirements. Commissioning in partnership
with patients will inform priorities and solutions for co-ordinating
care.
8. WHAT ARRANGEMENTS
WILL BE
MADE TO
ENCOURAGE THE
THIRD SECTOR
BOTH AS
COMMISSIONERS AND
PROVIDERS?
8.1 As GPs CLH views the role of the Third
Sector as critical both in terms of providing access to information
and evidence with regard to the needs of the groups of patients
the organisations represent, and as service providers. For example,
CLH already works closely with the Third Sector and is currently
working with Sense on MMR immunisation of child bearing women
from ethnic minorities as well as reaching parents who may be
fearful about having their children immunised. We are also working
with Marie Curie Cancer Care with regard to End of Life Care.
CLH is also seeking a suitable Third Sector representative to
join its Management Board.
9. ACCOUNTABILITY
FOR COMMISSIONING
DECISIONS
How will patients make their voice heard or their
choice effective?
9.1 CLH puts the patient at the heart of
all we do. We have an active User Panel of 14 members drawn from
our constituent practice and it is inconceivable that we would
make any significant decision without the approval of the User
Panel. The Chair of the User Panel is a full member of our Management
Board and other members sit on each of the key project groups.
The User Panel also conducts patient surveys, provides feedback
and recommendations on strategic planning, commissioning and service
design or redesign; leads on our innovation fund and determines
which projects will proceed together with the GPs.
9.2 We are however aware that it is impossible
for such a group to represent the full diversity of our patient
population. Therefore the User Panel has links with patient groups
and patients in their practices and the wider community. We also
engage with Third Sector organisations which represent particular
groups of patients. Where there is a particular need practices
make use of link workers to engage with certain groups of patients.
For example we have both older peoples link workers and Bengali
community link workers.
10. INTEGRATION
OF HEALTH
AND SOCIAL
CARE
How will any new structures promote the integration
of health and social care?
10.1 CLH already works closely with Social
Care and has a social care representative on the Management Board.
Within Westminster CLH and the PCT have undertaken considerable
joint commissioning and we believe there is scope to go further
in this process. We believe there are many opportunities to improve
services for patients and increase productivity, particularly
in regard to domiciliary care services, by jointly commissioning
services from providers who can provide both health and social
care services.
11. WHO WILL
DRIVE INNOVATION
DURING THE
TRANSITIONAL PERIOD?
11.1 CLH believes it has already delivered
innovation resulting in improvements for patients. CLH has a comprehensive
commissioning plan to deliver significant change. We will only
be able to proceed with this work and deliver benefits for patients
if we have access to resources to both progress this work and
prepare for the future of GP Commissioning.
October 2010
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