A couple of issues this week that are worth a quick mention. Let’s start with this week’s BMJ and an article by Gutherie et al looking at high risk prescribing in primary care. It was actually an analysis of Scottish GPs; however although it is a different country I’m sure the results transfer to us in England. They asked the question, “how common is high risk prescribing of potentially inappropriate drugs?” Their results come as no surprise; in short it was relatively common but once more they found significant unexplained variation between practices. This variability is well known, be it prescribing or referrals and whilst the reform debate has been rumbling on we need to start questioning what are we doing to tackle it.
The challenges to the NHS are significant, the £20bn looms large yet we are still tolerating very significant amounts of resource tied up in what most agree, is unwarranted variation. Emerging clinical commissioning groups all need to have this right at the top of their agendas. Not least because it is an inefficiency that we can’t afford to carry any more. We have seen some really good examples of emerging clinical commissioning groups rising to this challenge and there is a real recognition from group leaders that this must be addressed; however all emerging clinical commissioning groups need to start looking in to the shadows of variability in their patch
My second point is one that I have made a couple of times; that of size. Does it matter? We are now post pause and many of you are keen to proceed, but what is the most effective size for local emerging clinical commissioning groups? We know that smaller groups seem to have good clinical buy-in, which can get lost in the complexity of larger groups. However smaller groups, even those of several 100,000, are at risk of financial volatility and also more importantly will incur basic set up costs. Each emerging clinical commissioning groups needs to start asking itself what it needs locally; not just the governing body but what else does it need to have locally to meet the needs of commissioning services for its population. Clearly the more of these fixed costs we have over smaller geographical areas the more inefficient we will be.
There is no prescribed answer here as it will depend upon each area’s particular characteristics, however these questions need to be asked and differing models such as localities under a larger emerging clinical commissioning groups explored to ensure the best local fit is determined.