This case study was developed prior to the NHS Listening Exercise. The outcomes of this exercise have led to some changes to the policy, and this case study may not reflect the current policy position. More information can be found in our detailed response to the NHS Future Forum.
This case study looks at the work taking place in Medway to establish a successful commissioning consortium.
Medway GP Commissioning Consortium (GPCC) brings three former practice-based commissioning localities together to cover a population of 283,000. There are 61 GP practices in the area, which recently voted overwhelmingly to form a single consortium covering Medway.
The consortium has the same footprint as Medway PCT and the Medway Unitary Authority. It has applied to become a pathfinder and is currently developing its work plan.
Medway GPCC is fortunate in having already established a number of key relationships. The transitional board engaged with the SHA, the local foundation trust, mental health trust, Local Involvement Network (LINk) and community trust to find out which form partners thought was most desirable.
Philip Masterton-Smith is Transition Programme Manager for Medway PCT and is also currently working for the GPCC during this transition period. He says,
“It’s worth knowing about the genesis of the GPCC. We had three effective PBC localities each with a population of around 90,000. In December it went to the LMC, and there was a vote for a transition board to prepare an option appraisal on which route to go down – whether to have one or more consortia covering the area. The virtually unanimous vote was for a single, pan-Medway, consortium, and the process that followed has ensured that the consortium has the full support of all practices within Medway”
What’s being done?
The engagement started early, and continues. Five members of the transitional board were already members of other committees or boards, such as the Local Strategic Partnership and PCT board so the links that already existed can be sustained.
The vote by all Medway practices in mid-March 2011 gave a mandate for further engagement and developing a constitution.
The board is also now looking at a work programme. One of the likely areas in the work plan is urgent care. This will require further engagement with, for example, the acute sector, the ambulance trust and the local authority, to help keep people out of hospital.
As well as focusing on this specific area of care, the consortium is planning to take responsibility for delivery of the entire PCT Annual Operating Plan. Additionally, it is working with the PCT to develop a QOF+ approach to enhance performance through referral management and prescribing.
The GPCC is building on the previous work of practice-based commissioners in the area. Practice-based commissioning had already made steady inroads with demand management and keeping prescribing costs down.
In addition, a number of local services had already been commissioned through PBC, including a primary eye acute referral service (PEARS) and an outreach dermatology service. These have already improved patient experience through moving care out of the acute hospital setting and into the community.
The transitional consortium board has agreed a founding set of principles for its constitution that has been shared with all practices, and voting is about to take place to elect the first ‘shadow board’ members who will be in office for at least the next two years.
The consortium has started to prepare a business plan that will demonstrate how it will deliver against the Annual Operating Plan and how and when it will lead local service redesign programmes.
In parallel with this work, detailed arrangements are being put in place to ensure effective clinical leadership and engagement in all areas of consortium responsibility.
“I would be happy to share information with other consortia. We have an advantage with our existing relationships that may benefit others. One of the differences between Medway and other GPCCs is that we have one consortium, one PCT and one Local Authority with co-terminous boundaries.
“It does give us different problems to other GPCCs. We haven’t progressed as far as some – we don’t have a constitution and have only recently put in for Pathfinder status – but I expect it will be a bit of a ‘tortoise and hare’ outcome. The key measure for us is that the process we have followed has ensured that we have the full support of the Medway GP population and true democratic legitimacy.”
The consortium would like to tap into others’ experiences as much as possible to learn, while not going down the one-size-fits-all route. One area they need to work on is the Accountability Agreement, and they hope the Pathfinder Learning Network will be a significant asset for sharing best practice.