Monday to Friday, for weeks now, there has been a teleconference bringing together the leads from all the major organisations across Lincolnshire involved in health and social care. The ambulance and community services, acute and mental health plus adult social care, are all regularly represented. The meeting is chaired by a commissioner. The purpose is to share intelligence and efforts to support patient flow. We started this way of working last winter and it has resulted in more “jaw jaw” and less blame shifting,  as different contributors to the  system, all of whom are dedicated to patient care, appreciated the problems other organisations were struggling with and how they could help each other. more…

I sat down with a manager who has an in depth knowledge and experience of commissioning services for people with learning disabilities, as I wanted to understand why we seemed to be doing poorly on delivering health checks. It seems so simple. Practices should offer an annual health check to people with learning disabilities. There is a financial incentive—a National Directed Enhanced Service (DES) for GPs.  The objective of the health check is to address the fact that people with learning disabilities are more likely to have undetected or poorly managed health needs, contributing to earlier mortality. Reaching out in a proactive way to support and care for the vulnerable is something that I am sure the vast majority of professionals would agree is right and proper. Yet our measure of achieving an annual health check suggests it isn’t happening.

Yet, sometimes looking at a problem in depth reveals hidden barriers and complexities that give cause for thought. more…

The reforms grind on. In the stratosphere there is a lot of noise and turbulence—people arguing passionately and polemically. Meanwhile the architecture of a new system is being constructed around those of us working in the old system. People are wondering where their future lies, or if they have a future. The basic construct is becoming clearer to many of us and we are working to support its creation. This is driven by the desire to ensure that the good work done for the public and the patients in the past does not get lost in the transition between systems, and to try and secure the theoretical benefits of the new system. It is also to try and mitigate the unintended consequences, which might not be so beneficial. more…

We are now constantly discussing the transition process and the programme of work we have mapped, which we need to follow to deliver the structural changes demanded by the reforms. This sits alongside the planning process, with the plan for 2012/13 shuttling back and forth between the SHA, PCT cluster, Clinical Commissioning Groups (CCGs), various key providers and Health and Well-Being Board. Then there are the contract negotiations, which people who have been involved will know, have a degree of all-consuming intensity at this time of year. more…

I became interested in commissioning through Fundholding. Like the majority of GP practices that got involved we did so because we wanted to improve the experience and the services our patients received. We used the influence which holding a budget gave us to address quality.  For example, we improved the safety of anticoagulation management, we accessed investigations without having to send people to hospital so we could deliver more effective care, and we reduced waiting times for planned care. Fundholding made me realise that getting involved, as a doctor, in how the system was managed could improve quality for patients. The advent of PCTs drew me into the more complex and difficult agenda of large-scale change and whole-system improvement. I realised that if I didn’t want to disadvantage my own practice, because of the obvious conflict of interest I had in being able to influence funding flows across the whole system, then I needed to leave general practice and commit to commissioning. more…

The announcement last week of the design of the NHS Commissioning Board is critically important. It signals the end of the prolonged period of ambiguity which managers have experienced since the white paper was published in July 2010. For those who have been through the round robins of previous reforms there is a realisation that this time it is not about “rearranging the deckchairs.” Everyone is coming up hard against the fact that the way we have done commissioning in the past will not suffice in the future. more…

I was fortunate to be able to listen to Danna Safran from Blue Cross Blue Shield (BCBS) of Massachusetts at a recent King’s Fund conference. She was talking about the alternative quality contract (AQC). Double digit inflation in healthcare costs and a mandate for every individual to have insurance in Massachusetts drove BCBS to think hard about how to reduce costs whilst maintaining or, even better, improving quality. Sound familiar? more…

The year ahead will be important for the NHS. It will be a year that determines if the leadership across the system inverts and changes.

Currently it is based on compliance. Instructions are issued from the centre and the expectation is that they will be followed. Targets are set, with an implied threat that, if they are not met, the consequences will be personally felt. more…

“We need to think about networks and define if they are commissioner or provider led.” I heard this said a few weeks ago. I also heard it said 3 years ago. I think the first time I heard it said was well over 10 years ago.

Creating a taxonomy for networks seems to be a labour for Sisyphus. Having been involved, more than once, in trying to define and clarify the role for networks I have begun to wonder if we are approaching this with the wrong question. Perhaps we should be wondering not what a network is but why do we need networks? more…

Every two months I get to sit down with the GP Chair and Chief Operating Officer from each of the Clinical Commissioning Groups (CCGs) in Lincolnshire. Ever since the reforms were announced we have retained a focus on delivery. We have thought of the development of the CCGs as revolving around delivery. There is no point to a CCG unless it is driving delivery. At the meeting we look at delivery and the development of the CCG. more…