Streatham and Clapham Health

Editorial in the BMJ, a call to arms?

Reinvigoration will require more than just extra funding.

Have a read here, may need to log in for the full thing.

Pulse, the GP mag, does a weekly email on practical commissioning that you can sign up for and has useful information and discussions on its website, for which registration is required.

Recent stuff of interest:

Eight keys to PBC success from John Oldham’s survey of PBC for the DH:

1 Visible supportive PCT leadership

2 Clarity about roles between PBC and PCT

3 Monthly, accurate, timely comparative data at practice level

4 Locality structure within a PCT or within large consortiums

5 Management support by the PCT – this was a high leverage factor

6 Management allowance for consortiums – the amount was per capita based and the median was £2.50 per head of population

7 Incentive schemes – LES and so on

8 Meaningful involvement in PCT commissioning decisions.

Useful to benchmark where we are.

Also, a focus on data problems.

Key messages included making use of other sources, such as NHS Comparators,  Information Centre and others. We also have a huge amount in practices, which may become more accessible and usable with the Combined Predictive Model.

This enabling guidance is intended to help PCT providers of community services to move their relationship with their commissioners to a purely contractual one, consider what type(s) of organisations would best meet the future needs of patients and local communities, and how change can be managed to support the transformation of services to patients.

A report commissioned by DH on prioritising investments in public health.

Probably a little bit relevant.

A meeting at the King’s Fund, Thursday 19 February 2009, 10.00am–4.15pm.

Details here. Also a useful document to download

Should someone go?

Excerpts from DoH’s World Class Commissioning – Competencies:

World class commissioners will secure effective strategic capacity and capability to turn competence into excellence, transforming people’s health and well-being outcomes at the local level, while reducing health inequalities and promoting inclusion.

Competencies can be defined, taught, learned, put into practice, tested, observed and quality assured, but they are not an end in themselves. World class commissioners will also display visionary, inspiring leadership. The workforce will be motivated and fully engaged with local people and communities, aware of their needs, addressing them in the most effective ways.

Commissioning is essentially transformational, and not just transactional. It incorporates “contracting” and “procurement” but only as mechanisms for achieving the higher commissioning objectives. World class commissioners also display visionary leadership and operate with tact, assertiveness and skill. They draw legitimacy from being seen to be engaged with communities, with service providers and with partner agencies drawing complementary views into a credible and coherent plan to which all sign up – putting the “mission” into commissioning.

The JSNA will form one part of this assessment, but when operated at world class levels will require more and richer data, knowledge and intelligence than the minimum laid out within the proposed duty of a JSNA. Fulfilling this competency will require a high level of knowledge management with associated actuarial and analytical skill.

Employing their knowledge of future priorities, needs and community aspirations, PCTs will use their investment power to influence improvement, choice and service design through new or existing providers to secure the desired outcomes and quality, effectively shaping their market and increasing local choice of provision. This will include building on local social capital and encouraging provision via third sector organisations.

The Audit Commission has produced a report on PBC. Read here.

Commenting on the Audit Commission report on Practice Based Commissioning, Dr Laurence Buckman, Chairman of the BMA’s GP Committee, said:

“This report highlights what many GPs have unfortunately known for quite a while – Practice Based Commissioning (PBC) has great potential but that potential will never be reached if Primary Care Trusts (PCTs) continue to block initiatives and fail to support practices adequately.

“The BMA’s own survey of GPs¹ showed nearly a third of family doctors said their Primary Care Trust was either obstructive or uncooperative in relation to PBC. Two thirds said not enough resources were made available to support the workload. Is it any wonder that doctors who are initially keen to drive forward PBC find their enthusiasm drained when their efforts to improve services are blocked?

“In the few areas where PBC is working effectively then patients and practices are reaping the benefits. At its best it can free up NHS resources, give GPs greater control over service provision and improve patients’ access to care closer to their homes. The PCTs that aren’t operating effectively would do well to look to these models of good practice.”

1. The National Survey of GP opinion was published on 16 October 2007. The full survey can be accessed at http://www.bma.org.uk/gp