The King’s Fund has just published this report, which describes how the health and social care workforce are coming up with new models for delivering primary care, to support the “current system of commissioning”. The report is aimed at commissioners, GP staff, and related stakeholders, including social care and local authorities, and promotes improved liaison between all these groups to ensure stronger collaboration and networking, to provide a more integrated service to patients.
The report starts with an explanation and short history about the GP contract, describing the main variations, and the requirements for contracting for additional services, such as out-of-hours provision, minor surgery, and locally agreed priorities, for example, sexual health screening, weight management, etc. Figure 1 is useful, (although a bit blurry), as it lists the different funding streams together with the core contracts and the additional contracts.
A number of innovative case studies are included, looking at different settings:
- Town and country – with 41 practices
- Large urban area – 94 practices
- Inner-city area with ethnically mixed population – 36 practices
- Large rural area – 82 practices
Table 2 is also very useful, as it provides an overview of the case study settings, which describes the patient population, the Clinical Commissioning Groups they work with, the areas they want to collaborate on, the contract types they apply, and what they have achieved, namely “reduced spending, increased vaccination rates, better management of long-term conditions, reduced unplanned admissions and A&E attendances, and improved working relationships with other providers.”
The report looks into quality, accountability and performance measurement, and describes how the different settings organise their activities, measure performance, and promote improved partnership in different, innovative ways to support the needs of their populations. By sharing the risk, GPs are encouraged to work together to improve health care across the whole network.
Challenges to innovation
Whilst innovative practice is important in terms of improving quality and value for money, it is not always easy to develop new models of care. The authors describe the key challenges that can hamper future GP provider development:
- Structural instability
- Shifting accountabilities
- Provider engagement
- Payment models
The final section explains what support is needed and available, and suggests approaches that can be taken forward. This is very much an example of good knowledge management in practice, where, rather than working in silos, people work together and learn from each other, which is something that has been actively encouraged in the NHS since 1999.
This is a focused report and helpful because it looks at the various settings where GP practices sit, so it can be applied by everyone working to support commissioning in England. It has long been known that sharing knowledge improves practice, particularly when learning about what has not worked. One of the CCG managers interviewed pointed out that one of the benefits to commissioners, is that “….you’ve got a combined wealth of knowledge, risk, clinical delivery opportunities of four or five combined practices as opposed to putting all your eggs in one basket.” So, the risk is shared, which means that mistakes are likely to be spotted. Also, if GP surgeries are working together, patients can expect a standardised service across the locality. GP practices should work with Clinical Commissioning Groups to identify existing and potential networks. Perhaps within your own practice you could think about your informal networks, people you trust, who you go to when you want to discuss professional issues. How could this be formalised, and what innovative practices can you share?
Commissioning and funding general practice (PDF)
R Addicott, C Ham
The King’s Fund