Possible models of General Practice

Any number of organisations have looked at the possible models of General Practice in England (see below for some recent examples).  They have produced lots of glossy pages describing the issues and possible models.

So we thought we would produce a short list of the possible ways that a local community could get its GP service provided. In no particular order.

“The Status Quo”.  The partnership option.

Under the current circumstances, unless the government changes its attitude this is not a realistic option.

A Salaried service with GPs.

a)    Through Foundation Trust Hospital – Vertical integration.

b)    Through private companies i) groups of GPs, ii) multi-national companies iii) venture Funds etc.

A nurse led service

This would probably be with GPs as community specialists/consultants at a distance. (There would be no doctor as first point of contact, no legal right to a GP).

Walk In centres.

Patients would be triaged and referred onto the ‘appropriate’ Healthcare provider.

NHS111

All access to healthcare would be through NHS111 call centres

Federation

GP practices merge or federate to form a large organisation (Management & Admin merged to save money & probably staff used across all sites rather than based on a specific site).

Investment by Government

You never know it might happen. The government realises that the current system is the envy of the world and invests to support the development and innovation that has taken place over the last 30 years

I may look at the advantages and disadvantages of these options at a future date.

 Further reading

Nuffield Trust

http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130718_securing_the_future_revised.pdf

RCGP

http://www.rcgp.org.uk/campaign-home/~/media/Files/Policy/A-Z-policy/The-2022-GP-A-Vision-for-General-Practice-in-the-Future-NHS.ashx

Kings Fund

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf

NHS England A call to action

http://www.england.nhs.uk/wp-content/uploads/2014/03/emerging-findings-rep.pdf

How have the public influenced commissioning of healthcare in Aylesbury?

I asked my local Clinical Commissioning Group (Aylesbury Vale CCG) a question about providing examples of how the public has influenced commissioning in advance of their board meeting in public on Thursday April 10th.

Here is the reply from their clinical leads:

My Question: Can you please give examples of where the voice, opinions and experiences of patients and the public has influenced decisions made when commissioning services?

Christine Campling:

We did extensive public consultation on the inter mountain project by focus groups and questionnaires. There was full support for changing the range of options on outpatients to a mixture of face to face, telephone and Skype like consultations. We are currently running questionnaires on pain clinic projects, as we are redesigning the pain pathway.

Stuart Logan:

We have met with Patient Groups in the South Locality for their input into Live Well particularly the Haddenham Patient Participation Group.

We are involving Diabetes UK in the diabetes service redesign. They will have patients at the Stakeholders meeting in May inputting into the redesign process from day 1.

Juliet Sutton:

When they were doing a full review of Occupational Therapy and Speech & Language Therapy services for children, they went out and spoke to a lot of parents of children using the service.  Parents wanted shorter waiting times, a more responsive service, improved technology and access to health professionals in settings closer to them e.g schools and children's centres. All these views were incorporated into the new service design and there have been great improvements in the service since then. The children's physiotherapy service is currently under review and once again the views of parents and carers are being taken into consideration when making recommendations for service improvements.

We are currently undertaking a review of the services provided for children with complex needs/disabilities. Parental feedback is a large part of this process and their comments are being taken very seriously when planning future more integrated care. Single point of access is a recurrent theme from the feedback we have received and this will be one of our main objectives with future recommendations.

Lesley Munro-Faure:

commissioning plans are driven by localities and each locality has members of the public sitting on them who input into all the decisions that are made.

My comments: 

I had hoped that I might get a list of things the patients & public has said or suggested and a another list showing what the CCG had done as result of the comments from patients. 

I had also hoped that I would get examples showing actual changes in how services are commissioned instead I seem to have got examples of consultations & involvement in redesigning services. And there is nothing wrong in seeing examples of patient participation in redesign.

There are examples of good work especially with the work done by the therapy services for children.

The last paragraph of their reply puzzles me.  There are three localities in the CCG and I know that one of them does include members of the public in the group.  But the other two locality groups consist of clinicians only.  Anyway this last paragraph does not give examples of how the public have influenced commissioning.

I will follow up this answer at the board meeting and I will blog about it if anything new is mentioned.

Better Care Fund - Mission Impossible?

The government having just made the biggest re-organisation of the NHS is now insisting that local health and social care economies now embark on another! 

Health and Wellbeing Board which only came into existence 12 months ago are now developing plans to use the Better Care Fund.   This fund is drawn from existing funds from health and social care commissioners. The total could be around £4 billion for England and in Buckinghamshire the fund will be nearly £100 million. This is three times the size of the fund that other areas are implementing!  Are they being too ambitious?

What will this fund do?

The Better Care Fund is to be used to integrate health and social care services, especially for older people.  It is hoped that this integration will reduce costs and improve the quality of care (in that order).

Many of us have asked for a closer integration of health and social care and so we should be welcoming this new work.  But should the timer scale for developing the project be longer than 12 months?  Can these new organisations, barely out of nappies, successfully implement such a big change in the way services are commissioned?

 Patients, especially those with long term conditions  & the elderly need care and support and they get that support from many different agencies – the NHS, Social services, the voluntary sector, the private sector, families and friends to name a few. Currently some care is called health care and some is called social care. But patients don’t really care what it is called. Or who commissions & funds it.  What they want is for it to be provided without any gaps, when and where they need it.  

They don’t want to have to go to one lot of people for one sort of care and then go through another assessment for more support! They just want to go to one point to ask for help.

So this Better Care Fund sounds as if it a good idea. But some say it will not save money and will not improve services.  They say there is no evidence that it will achieve these objectives.

I am also concerned that locally the public and patients have not been involved in the design of this new service.   As usual we will be involved and consulted with in the middle of the process rather than at the beginning.   Who is to carry out that involvement?  It is Healthwatch Buckinghamshire who are virtually unknown to the population of Buckinghamshire.   Will they be able to carry out a meaningful engagement with the public, let alone real involvement in the design of the new service?

Finally who is going to manage this fund, who will monitor the quality (and quantity) of the care? Who will be accountable?

It’s a mystery!

You can see the latest update on Buckinghamshire Health and Wellbeing Board's plans here

Here is a review of the evidence recently published by the University of York which suggests that these schemes should be rolled out cautiously and may increase overall costs.

It’s the patient experience, stupid!

I have always thought that the main role of local Healthwatch was to collect the experiences of patient using the health and social care services.

But one of their board members is quoted in the minutes of their November board meeting as saying

 “Healthwatch Bucks could make a business case for the integrated collection, analysis & reporting of patient feedback across health and social service provision in Buckinghamshire”.

http://www.healthwatchbucks.co.uk/sites/default/files/board_minutes_11th_november.pdf

So why does this board member think Healthwatch Bucks needs to make a business case to do what it is contracted to do anyway?  By using the words ‘business case’ he is suggesting, in my opinion, that they should seek funding to do this job. 

They should be doing it now as part of their primary function, not asking for more funds!

I wonder if he has seen what Healthwatch Buckinghamshire says on its own website.

This statement is included as part of their ‘What we do’ section on the Healthwatch Buckinghamshire website

“Collect data and stories about the good and the bad, so we can use evidence based criteria to influence commissioning and policy.”

They expand on this theme in their ‘What will Healthwatch do’ section of the website:

“….seek the views of people about their needs for, and their experiences of, local care services.”

“Examine the quality of local health and social care services.”

“Make the views of local people known, and reports and recommendations about how local care services could or ought to be improved, to people responsible for planning, providing, managing or scrutinising local care services.”

http://www.healthwatchbucks.co.uk/

Even the CCG has something to say on the issue:

In their draft paper on the Review and Development of our (AVCCG) Commissioning Intentions they say:

“(the CCG will) Work closely with Healthwatch to expand the feedback we receive on patient experience from direct observation and feedback from patients, clinicians and the public including those from hard to reach communities. “.

http://www.aylesburyvaleccg.nhs.uk/wp-content/uploads/2013/10/GB-2013-10-4b.pdf

It is high time Healthwatch Buckinghamshire stopped talking and got on with its primary function.

Go out and collect the experiences of patients and carers of health and social care service provision.