Martin McShane: Where to start?

Martin McShaneWe are only two months away from it becoming real for GP consortia. I was looking through the information going to one of our pathfinder executive meetings in the next week. The GP consortium is looking good for this year and will deliver within budget unless something unexpected happens.

Buried within the report was some worrying detail. The predominant reason they will be ok this year is because of factors beyond their control. Elective activity is below expected levels and that is something I know our acute provider wants to remedy! In contrast, outpatient referrals are well up and prescribing is overspent against plan. The order book is building, emergency activity is not diminishing, and all the indicators suggest the consortium could be heading for over trading in 2011/12.

The operating framework clearly states that a line in the sand will be drawn at the end of this financial year.  Any financial problems that start to stack up from April of this year will be the legacy the consortium inherits. How can this be handled?

More and more, working locally with our consortia and with occasional forays beyond the boundaries of Lincolnshire, I am convinced that the biggest benefit to be realised from these reforms will be a radical transformation in the culture and behaviour of General Practice. If consortia believe the problems can be solved by looking externally they will miss the real issue. The real challenge will be to accept that the most important thing a consortium can do is look at their own practices’ performance.  Proactively managing their impact on the rest of the system will be critical. Reading Atul Gawande’s latest article made me smile wryly – he seems to desire what we have but don’t fully realise the potential of: widespread, well established, primary care teams with a mass of data at their fingertips.

Consortia will need to make sure they have regular compelling information on what is happening to their patients. Practices will need to look at why they are referring and what value (cost x quality) that delivers and then open themselves up to peer review and quality improvement.  Most medical emergency admissions are associated with long term conditions. They will need to adopt the mantra that every medical emergency admission is a failure of their systems – until proved otherwise. That means linking emergency admission data to disease registers and using that data, allied to the “soft” intelligence that every receptionist, practice, and community nurse and GP has about the local population so as to prevent admissions and readmissions and ensure effective care is delivered appropriately.

If consortia externalise these issues, blame the rest of the system for their problems, then I believe they will struggle. To paraphrase an old truth: “If you want to drive change in the system, you must first change yourself.”

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.