Guest Editorial January 2011

Christina Walding


January's guest editorial was written by Christina Walding, Associate of the NHS Institute, on behalf of Mark Jennings and Robert Varnam who led the Expert on Call on 20th January 2011.  Follow this link to hear the recording.



Clearing the fog on GP Commissioning through partnership

Mark JenningsOur experts for January are Mark Jennings (pictured left) and Dr Robert Varnham (below).

Originally qualified as a Charted Engineer, Mark has been an NHS Manager for over 25 years with experience at National, Health Authority and Trust levels including Director of a major acute hospital.

Subsequently Mark held the role of National Lead for Clinical Systems Improvement with the NHS Modernisation Agency where he led the development of guidance and systems to help the NHS improve patient flow. He also led a Prime Minister’s Delivery Unit review focused on the patient journey through the emergency care system and Mark was a member of the Department of Health project team responsible for delivering the maximum 4-hour Accident & Emergency wait.

At the NHS Institute for Innovation and Improvement based at the University of Warwick Mark held the post of Priority Programme Director and was responsible for leading work focused on helping the NHS improve the quality, productivity and efficiency of care. His role includes publishing the NHS Better Care, Better Value Indicators and leading the Institute’s High Volume Care Programme.

Mark joined The King’s Fund in 2009 where he led the Health Care Improvement Directorate and the Quality in a Cold Climate Programme. In 2011 Mark established Oxyjenn Consulting and now works as an improvement consultant with NHS organisations at a local and national level. 

Robert VarnhamDr Robert Varnam is a GP in inner city Manchester.  He has been a member of the GP Faculty at the NHS Institute for Innovation and Improvement for the past three years, developing and delivering tools, training and coaching for improving quality and safety in general practice.  He is an experienced international speaker on leadership, policy, engagement and improvement.

Robert is the Interim Clinical Lead of the RCGP Centre for Commissioning, a partnership between the Royal College of General Practitioners and the NHS Institute.  It supports GPs, practice teams and commissioning consortia to improve patient outcomes through excellent commissioning and excellent care.  He is leading the development of a Commissioning Competency Framework built on values of broad engagement, collaborative working and a needs-led NHS.  The Centre's team of 50 local Clinical Commissioning Champions are working with NHS Institute staff to support the engagement of local practices and the development of GP commissioning consortia.  They assist GPs in identifying and meeting their learning needs regardless of their current level of involvement in commissioning. 

Robert is the Clinical Lead for Practice Accreditation at the Royal College of General Practitioners.  This new scheme promotes continual improvement in the quality, safety and responsiveness of general practice care, and rewards teams for meeting evidence based criteria.

Robert’s PhD explored the role of patients in patient safety, and he maintains his research interest at the University of Manchester as Honorary Lecturer.  He is passionate about holistic approaches to quality which engage the whole team as well as patients and the public, and which acknowledge that even the best people need good teams and systems to deliver excellent healthcare.

The Current Context

The White Paper ‘Liberating the NHS’ presents significant opportunities to GPs and clinical leaders to transform the way healthcare is commissioned. GP consortia will shortly be responsible for the bulk of NHS resources and spend. They will be expected to commission the majority of health and healthcare services.  Commissioning end-to-end patient pathways, driving outcomes through a new Quality Outcome Frame, the advent of concepts such as a quality premium all represent significant opportunities and challenges. Commissioning competence, QIPP, safety, governance, improvement and leadership capability will all be central to the success of GP consortia. So how do we ensure that the opportunities arising from Liberating the NHS are realised?

The RCGP Centre for Commissioning

The RCGP and the NHS Institute for Innovation and Improvement have come together to create the RCGP Centre for Commissioning. The Centre was opened in December 2010 and will be integral in helping GPs and emerging GP consortia develop the skills, competencies and expertise required to deliver clinical leadership and service development. The Centre will drive a profession led reform ensuring that GPs and GP Consortia are equipped for the task ahead of them. From the individual challenges of leadership through to commissioning safe and high quality care for patients, the centre will provide a range of proven, cost effective and best practice solutions. Consortia leaders and grass root GPs will be enabled to simultaneously manage organisational change, lead improvement and address unprecedented financial challenge. 

Key commissioning competencies

What core competencies will enable GP Consortia to achieve the opportunities presented by the Liberating the NHS White Paper?

  • The ability to lead people: A collaborative approach to change, involving personal integrity and continual development; skills in building and supporting teams, creating and communicating vision, and leading others through times of change will be required if GPs are to be led effectively. 
  • Leading a consortium: Commissioning consortia, regardless of size, may have many different functions and key relationships.  As complex organisations with important responsibilities, Consortia require a breadth of skills from everyone involved in leading and contributing to their formation and activity.  These include partnership formation and maintenance, business leadership and organisational governance.  Effective Consortia will be built on effective leadership and meaningful partnerships.
  • Serving local community: The local community forms the purpose, the context and the lead partner for successful commissioning, ensuring that the healthcare system is responsive to the needs and priorities of local people.  Effective consortia will build partnerships with local authorities, providers, the third sector and the community,
  • Leading commissioning: Commissioning is a collaborative multidisciplinary process which can be a powerful driver of positive outcomes for patients and communities.  Consortia need highly effective teams which bring managers and clinicians together to evaluate needs and opportunities; create vision and priorities with the public; and specify and manage contracts with providers.
  • Leading improvement and innovation: Commissioners are accountable for ensuring the services provided to local patients are equitable, accessible, acceptable, safe, effective and efficient.  Consortia are well placed to create a culture of quality among providers in all sectors.  By building relationships with lead clinicians and managers, consortium leaders can embed values of quality, innovation, prevention and productivity into the health economy .