GP consortia bosses claim ‘networking and knowledge’ are vital to success in new commissioning landscape

Dr Stephen Shortt, chairman of the Principia GP consortium in Nottinghamshire; and Dr Steve Kell, executive chairman of the neighbouring Bassetlaw Commissioning Organisation, provided an insight into the new process at last week's NHS Confederation annual conference in Manchester.

We have come a long way and the key has been partnership working with managers at the PCT and in secondary care

In a session entitled Establishing Clinical Commissioning Groups: Getting Ready for the Future, they discussed the challenges and achievements experienced to date in switching to a clinician-led system. Dr Kell, whose group was among the first wave of pathfinder consortia, said: "In terms of delivering the new vision, we have now moved from planning to delivery. We have come a long way and the key has been partnership working with managers at the PCT and in secondary care. There is a saying that if you want to go fast, go alone; but if you want to go faster, take others with you.

"The PCT and commissioning group is now joined up, GPs are on the board and decisions are clinically led. It is this link-up with the PCT that led to the first improvements in commissioning seen by the group."

There are opportunities to offer care in a different way through these reforms, and in our future arrangements we have got to strive for improved care

Dr Kell said: "We told ourselves early on that information was key. Practice-based commissioning suffered because of a lack of information and handover. As a practice we received vaccination reports etc, but we could not tell anything about things like referrals to acute care or prescribing. Because of this, we arranged commissioning reports with the PCT and these now come on the last day of the month and that is working very well. As a result of these reports, we focused on outpatient referral systems. We looked at what we were doing and we worked on the mantra that, if a patient needed to see a hospital specialist, they could. But, if they did not need to, we looked at how we could manage them better in a primary care setting. We have to give patients quality alternatives so they can get an expert opinion without utilising consultant time. We made some changes and in the last six months of the last financial year we reduced referrals by 17%. I do not think that anyone has had a referral refused, but we give them better alternatives so that those 83% who do need to see a consultant can do so sooner and more successfully."

It is not about the size of the consortia, or how many people are in it. It is about outcomes and being passionate about every area and engaging with patients

Dr Shortt also spoke of the advantages of a joined-up approach, describing a decision-making board at Principia that includes specialists in acute care, long-term conditions, mental health, health and wellbeing, community services and prescribing, as well as GPs. And he added there was also a role for the independent and third sectors.

"We have got to work with whoever can help us to be successful in the face of a very difficult challenge," he said. "We do not believe all solutions are invested in existing staff and we think the independent sector will have a role to play in the future, particularly in specialist areas such as mental health services.

"We now have 70 GPs in the organisation who are doing fairly meaningful work and we have developed an organisational culture where we are very explicit about what we want. All the decisions we have taken and all the changes we have made are to improve all the areas that make clinicians tick.

We have got to work with whoever can help us to be successful in the face of a very difficult challenge

"It is not about the size of the consortia, or how many people are in it. It is about outcomes and being passionate about every area and engaging with patients."

But he did call on ministers drafting changes to the Health and Social Care Bill to ensure payments to providers were based on outcomes in a bid to ensure the activity commissioned by GP groups would constitute real value for money.

He said: "We have to have some payment reform based on shared savings. At the moment we do not know what we pay for, we do not know what we get for our money, and we don't always know what the outcomes are. We need to move to an area of real detail. There are opportunities to offer care in a different way through these reforms, and in our future arrangements we have got to strive for improved care."