Practice-Based Commissioning - engaging GPs and the public

the problem PCTs have a requirement to get GP practices engaged with the commissioning process, for two reasons:

• engagement at grass-roots level, being seen to consult
• GPs have the biggest effect on the cost of service delivery, as they are the ones making a decision early on in the patient pathway whether a patient should use the hospital (generally expensive if the treatment is appropriate for a community pathway) or alternative pathways (generally cheaper if they are available, but someone has to decide whether to set them up and if so, how to do so)

Many PCTs are having trouble convincing GPs to get involved, and then getting them to work together in clusters what pain this causes

• patient care may be compromised as patients go to hospital instead of more suitable community care
• scarce resources not available to spend on target groups such as CVD, obesity in the community because it was used up on hospital care
• GP referral thresholds not consistent
• PCT not scoring on the GP and public engagement component of the QOF

my solution

• working for PCT commissioners to help GPs understand what's in it for them (South Yorkshire 2004/05, Co Durham 2007/08)
• supporting GP clusters (and training others to support GP clusters) so the GPs can deliver effective PBC without getting disaffected because of the amount of time it takes (Co Durham 2007/08)
• working with GPs and PBC cluster to engage and align so they deliver a consistent clear message to PCT about what they want (Co Durham 2007/08)
• ensure GP cluster consults with other stakeholders, rises above "WIIFM" to look at the needs of the population (Co Durham 2007/08, London OOH 2007/08)
• doing the right background research, eg social marketing on obesity and worklessness, quantifying need using prevalence and referrals (Co Durham)
• setting up new pathways with appropriate consultation eg COPD home management and emergency (Co Durham)
• working with PBC Chair/ PCT Lead PBC Chair (Co Durham)
• credibility through also acting within GP Practice, both supporting the PBC board and as potential provider

what benefits this brings

• hurdles within PCT overcome because can illustrate what change needed and why
• credibility with GPs (+ provider side) mean they want to engage for the good of the community
• new pathways based on sound evidence - both evidence of costs and evidence of consultation/ pooling of ideas/ clinical In summary Hugo has been involved in PBC since 2004, when in South Yorkshire he helped PBC clusters and individual GPs to understand their role in context, to engage with the PCT, and he defined (with the Primary Care Foundation) the types and presentation format of information which brought about engagement and willingness to develop - and use - new pathways. Some of the GPs taught on Hugo's "Gaining Clinical Engagement" workshop for PCT and Acute managers. 2007/08 Hugo defined the role of a PBC support manager funded by a PCT, and Co Durham PCT retained him to mentor six such roles at 8a, one for each PBC cluster. Hugo also worked with the PBC Lead Chair (PCT Director) to develop PBC and public engagement within the PCT. Hugo is currently working within a PBC cluster to assess need, identify gaps, define new services and pathways, and implement them in wards with the highest deprivation indices for COPD, CHD, Obesity and Worklessness in England.

Hugo is Business Development Manager in Shinwell Medical Group, which can be found on www.shinwellmedicalgroup.co.uk, and on facebook http://www.facebook.com/#!/pages/Shinwell-Medical-Group/181626671880528 and on twitter www.twitter.com/shinwellmed