Tuesday, 24 April 2012

Patients Not Organisations

He was an elderly chap who wanted to know more about clinical commissioning. He used services regularly, and valued a particular local service which involved social care, community nurses and traditional medical services.

'So,' he asked, 'What does this mean for me? Will I be able to use my local service?'

The answer is that as a practising GP I'm hopefully close to his needs, and that we are working jointly with local authorities and clinicians to not only sustain but to improve this service.

But is it that simple? As CCGs what will our role be in making these decisions? Well we certainly won't be doing it on our own. We are part of a system. The local authority will oversee public health, for example, which will commission some important services in primary care. Educationalists will oversee training and accreditation, which providers rely upon to maintain rotas. Networks will oversee specialised services. The NHSCB will hold primary care contracts. NICE will issue guidance to which we will be expected to adhere. Monitor will regulate providers and commissioners...The list goes on. Try describing it to patients.

So what is the role of CCGs? It is our responsibility to ensure these organisations work together for the benefit of local patients. To make sure there aren't too many cooks, working in isolation. Decisions made at each level will impact on others. Relationships will be key. Immature organisations will need mature relationships. We have to challenge each other to improve services, remove barriers to change and focus on patients.

We are all accountable to our populations, whatever the scale. I am accountable to my patient who needs his service to function and care for his wife. The challenge is to balance, and appreciate, national and local priorities. Patients have to be central to each, and will align the organisations involved. If we ask how our decisions benefit services at each stage then we will be successful in ensuring we maintain our focus on patients and not organisations. That is how we will be judged.

Saturday, 7 April 2012

Question Time

How will we judge the success of Clinical Commissioning?  Well, it depends who's doing the judging.  From a patient's perspective, we will be judged by our level of engagement and actions in areas that matter to the local population.  Engagement is meaningless without actions, and actions are pointless if they do not improve outcomes or matter to patients.

So do we know what local priorities are?  We are likely to know from a financial perspective - we can all name areas of 'risk'.  They are often contractual. We are likely to know from a quality point of view, or waiting time perspective.  These are regularly monitored.  But what matters to patients?  I don't claim to know all the answers - but it is important we find out.

Locally, we have consulted with patients, stakeholder groups and clinicans regarding our commissioning intentions and strategic plan.  It was extremely valuable, but was led by planning timescales and will be much improved next year.  These processes need to be ongoing, not based around deadlines for plans. 

I recently attended a local 'Question Time' panel, organised by Links.  It was a joint event with local councillors, social care leaders and community and secondary care providers.  What did I learn? 

First, the clear priorities were the same as those evident from consultation.  They centred on dementia care, care homes and services for those with learning disabilities.  Increasing problems, led by changes in life expectancy and the need to improve quality for those in need of long term care.  Second, these were questions I couldn't answer on my own.  The issues raised included social care, council services, home provision and healthcare.  The obvious benefit of answering these questions jointly highlights the need to improve the services themselves jointly.  Patients usually don't have one illness,  they don't need just one service, they need joint working around their needs. 

So how will we be judged by patients?  I hope we will repeat the panel next year, and will be able to describe how we engaged with patients to improve these services, what actions were taken together and how outcomes are improving.  Then we will have improved the system.