Written evidence from Dr Peter Weaving
(COM 135)
DELIVERING HEALTH
IMPROVEMENTS
A stronger commissioning role for GPs holds
the prospect of decisions being taken closer to patients, a tighter
control of budgets and greater clinical input into the design
of services.
It nonetheless requires strong GP leadership
to fulfil these ambitions. From April 2010, an increasing share
of NHS Cumbria's annual £850 million health budget has been
directly managed by six GP-led boards representing Allerdale,
Furness, Carlisle, Copeland, Eden and South Lakeland.
These changes were introduced before the publication
of the Health White Paper and are part of a journey GPs in Cumbria
have been on over the last four years. Hard budgets directly managed
by GP-led localities include PBR, community services and prescribing.
DELIVERING EFFICIENCIES
Greater clinical engagement in Cumbria has delivered
tangible results for patients and taxpayers. The shift in the
delivery of health services from hospital to community has improved
clinical outputs and bucked the national trend in several important
areas.
For example, emergency admissions to hospital
in Cumbria have fallen by 6 per cent while increasing in most
other parts of the North West. New referrals to outpatient clinics
are falling and the prescribing costs for Cumbria are the lowest
in the North West.
The greatest challenge to further improvement
remains the inability of commissioners to ensure providers adhere
to commissioning intentions. In particular, the perverse incentives
of the PBR (Payment by Results) system drive activity rather than
patient-focused and cost-effective care.
DELIVERING REFORMS
ON TIME
The journey of reform which GPs in Cumbria have
been on to reach their current position as mature and experienced
commissioners has taken several years. The PCT has played an important
enabling role over this period and has actively transferred powers
to GP consortia.
The GP consortia are fully aware that they cannot
and should not take on PCT administrative functions. The consortia
in Cumbria are designing the level of business support needed
following disbandment of the PCT.
DELIVERING PUBLIC
SUPPORT FOR
CHANGE
GPs hold a special role within the NHS; accounting
for 90% of all patient contacts. The GPs in lead and support roles
in their consortia all hold ongoing clinical posts with patient
contact. Reforms should build upon this role and enable GPs to
engage with local communities beyond the practice door in an on-going
public conversation about local health services, their provision
and, more importantly, their development.
November 2010
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