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Home » Posts » Commissioning » Partnership working » Engaging GPs in commissioning: what works?

Engaging GPs in commissioning: what works?

33 Responses »
Oct 29 2015
Profile photo of Alison Turner
Posted by
Alison Turner
doctors

Within the English NHS, Clinical Commissioning Groups (CCGs) were designed to increase clinical involvement in commissioning – it was thought that GPs’ knowledge of patients’ needs and local health systems would drive more patient-focused commissioning built around local needs.  This new report asks if greater involvement has worked and if so, what specifically has worked?  It could be argued that there is a fair amount of variation across CCGs in terms of clinical engagement so this report asks some pertinent questions.

Method

The research team used a realist methodology which recognises that approaches work differently depending on a range of contextual factors and aims to help understand what works, for which people, in what cirumstances.  As part of the research, the team undertook 4 case studies, holding 42 semi-structured interviews with clinicians and managers and observing 48 meetings.

Specifically, the research asks:

  • what value do GPs bring to commissioning? (outcomes)
  • in what ways do GPs add value? (mechanisms)
  • what are the circumstances in which GPs add value? (context)

From the interviews, the team identified 4 underlying theories which could be further tested:

  1. GPs’ knowledge about patients will help them to identify problems leading to more prompt solutions;
  2. GPs’ knowledge about services will help them to improve service design;
  3. GPs’ clinical backgrounds enable a more robust relationship with clinicians within providers;
  4. GP and managers have a holistic relationship which enhances commissioning.

Findings

Unsurprisingly, the team found variation in governance structures across different CCGs – as a result, the involvement and engagement of GPs also varies.  The team found some evidence that, where GPs are engaged and involved, making use of their knowledge of patients and services, commissioning decisions are improved.  However, GPs were often reluctant to rely solely on their “anecdotal” knowledge, preferring to combine it with more objective sources of information and with higher level perspectives of commissioning managers.  The team suggest that this is supported by a number of mechanisms, including:  wide representation of GPs in relevant meetings; good preparation for GP representatives attending meetings; provision of quality data and analysis; and GP willingness to engage in person and via emails.

A key message is to make the best use of GPs' time

A key message is to make the best use of GPs’ time

The suggestion that GPs can engage in clinician to clinician discussions was also tested and there was some evidence that the presence of GPs in commissioning discussions can in fact add value.  However, this relies on : preparing GPs well through contextualised information and providing a supportive environment; ensuring those people attending meetings have the authority to make decisions or commit resources; and clear and regular communication to ensure all members are kept informed.

The relationship between GPs and commissioning managers was found to be dependent on mutual trust and clear roles and responsibilities

The relationship between GPs and commissioning managers was found to be dependent on mutual trust and clear roles and responsibilities

The relationship between GPs and commissioning managers was found to be dependent on mutual trust and clear roles and responsibilities.  However, from the examples given, the effectiveness of these relationships is as much about how they relate to others within the organisation and membership as how they relate to one another.  The research suggests that shared success can help to build mutual trust, with the example given  of one CCG which highlighted the preparation for and outcomes from an assurance meeting with NHS England to show successful joint working.

Commentary

There are some clear recommendations for CCGs to strengthen clinical engagement and empower GPs to bring added value to commissioning, including:

  • clarity regarding decision making and governance;
  • effective use of GPs’ time enabling them to focus where they can make a real difference;
  • clear communication with all GP members to ensure they are kept informed of wider discussions e.g. Health and Wellbeing Boards;
  • wide involvement of GP members to ensure it’s not the “usual suspects”;
  • high quality information for GPs about local services;
  • local consensus on what it means to be a membership organisation;
  • communication of achievements to encourage further participation;
  • opportunities to shape change programmes, e.g. meaningful outcomes.
To unlock the value of GPs, CCGs need to provide contextualised information and a supportive environment.

To unlock the value of GPs, CCGs need to provide contextualised information and a supportive environment.

Commissioners may wish to consider what proportion of their GPs are currently engaged, formally and informally, and how participation can be broadened to ensure a range of perspectives and to enhance the contribution of GPs. The report makes some practical suggestions, such as empowering GPs to have difficult discussions through robust information, preparation and support.  A key message is to make the best use of GPs’ time.  An insightful example shares very different experiences in two CCGs; one of the CCGs prepared a select committee type meeting with providers which involved preparing GPs to enable them to constructively challenge providers – in contrast, in another CCG, a lack of preparation meant that GPs felt unable to address issues directly in a meeting with providers.

Link

McDermott I et al (2015) Exploring the GP ‘added value’ in commissioning: what works, in what circumstances, and how?  PRUComm.

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Tagged with: clinical engagement, decision making, engagement, general practitioners, provider management, realist evaluation
Profile photo of Alison Turner

Alison Turner

I'm Head of the Evidence Analysis team within the Strategy Unit at NHS Midlands and Lancashire Commissioning Support Unit. I'm interested in how knowledge management can support value based healthcare and evidence based decision making. I've previously worked in a range of different healthcare settings, including acute care, commissioning, health services research and medical education. More recently, I worked at NHS Evidence and NHS Institute for Innovation and Improvement.

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  • 33 Replies
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Last reply was October 30, 2015
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  1. @Shand1963
    View October 29, 2015

    “@CommissionElf: Engaging GPs in commissioning: what works? https://t.co/34dwaVmqq0” interesting reading @DrJonGriffiths @SWhitehouse23

    Reply
  2. @ali_pals
    View October 29, 2015

    My latest blog @CommissionElf: Engaging GPs in commissioning: what works? https://t.co/urtjq4lz75

    DochkaH retweeted this
    Reply
  3. @CommissionElf
    View October 29, 2015

    Has greater clinical involvement in commissioning worked? https://t.co/9ZC09TWhWy

    Reply
  4. @CommissionElf
    View October 29, 2015

    What do CCGs need to do to empower GPs to contribute knowledge, expertise and skills? https://t.co/9ZC09TWhWy

    Reply
  5. @CommissionElf
    View October 29, 2015

    Hi @khcheck We’ve blogged about your recent PRUComm report on GP Commissioning @ali_pals https://t.co/9ZC09TWhWy Any thoughts?

    Reply
    • @khcheckreplied:
      View October 29, 2015

      @CommissionElf @ali_pals will read with interest and reply! Thanks

      Reply
  6. @CommissionElf
    View October 29, 2015

    What value do GPs bring to commissioning? https://t.co/9ZC09TWhWy

    Reply
  7. @CommissionElf
    View October 29, 2015

    Don’t miss: Engaging GPs in commissioning: what works? https://t.co/9ZC09TWhWy #EBP

    claudia_sykes retweeted thisIOWNHSLibrary retweeted thiskhcheck retweeted thisHiPPO_UoM retweeted this
    Reply
  8. @CommissionElf
    View October 29, 2015

    How can CCGs make better use of GPs time to involve them in commissioning decisions? https://t.co/9ZC09TWhWy

    khcheck retweeted thishippomanc retweeted thisali_pals retweeted this
    Reply
  9. @khcheck
    View October 30, 2015

    @CommissionElf Great blog from @ali_pals about our latest report: ‘engaging GPs in commissioning’. https://t.co/paZFD9H9NQ. @HiPPO_UoM

    HiPPO_UoM retweeted this
    Reply
  10. @hippomanc
    View October 30, 2015

    Engaging GPs in commissioning: what works? https://t.co/MTfzZTlUlH via @sharethis

    Reply
  11. @VJSharethis
    View October 30, 2015

    Engaging GPs in commissioning: what works? https://t.co/GZx0ZghyBB via sharethis

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  12. @DeBrun
    View October 30, 2015

    Engaging GPs in commissioning: what works? https://t.co/T88WFe0V0t via @sharethis

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