GP-led Community Service Delivery

GP CommissioningThis is a new era for the NHS, a time when GP practices can begin to deliver the services that patients want, close to home.  We haven't had a chance like this since the PMS contract of 2004, or Fundholding in the 1990s.

Health services can now care for many diseases that only a few decades ago were fatal.  Each disease or disorder that becomes treatable goes through these stages:

Treatment Named
One or two expert consultants use their knowledge of the body and metabolic systems, to work out one or more treatments.  A few patients benefit from their care, which is pretty much Trial and Error Intuitive
Once the treatment is better understood, other doctors can read the published papers and also treat people with the same condition.  Care is still often provided in an intensive care environment like hospital, although some disorders can now be treated in GP surgeries Evidence Based
Treatment is well understood.  There are guidelines which are fairly specific, and if the risks are low, the guidelines or protocols can be followed by a nurse or Health Care Assistant (HCA) Precision

So diseases such as Type 1 (insulin dependent) Diabetes, which in 1970s involved trial and error under the supervision of a hospital consultant, is now routinely managed by patients in their own home with a blood glucose meter and calibrated syringes dispensing insulin.  Care is moving closer to home.

The patient will see you now, doctor

So fewer and fewer people actually need the intensive care environment of the hospital.  Outpatient suites in GP surgeries are right in the centre of the community, and hospital consultants (specialists that patients need to see for intuitive medicine and many evidence-based medicine conditions) can come to the patient.

And with the changes to commissioning and the rise of the Clinical Commissioning Groups, it is GPs who can decide what the services are, and GPs who can recruit the consultant and hospital team to come into their community.

Why GPs?

That's a discussion for another blog.  Basically GPs are here to stay (many GPs stay in one practice for 20, 30 years.  Most hospital managers and administrators stay in the one job for 2 years on average), so they have to live with the consequences of their decisions.  They make decisions which are more in the long-term interests of patients.

Company structure

I'm company secretary to a GP-led organisation, Easington South Health.  GPs are the partners, and the company provides a medical service involving hospital consultants, and a medical service involving 7 GP practices.  The company writes the bids for services and handles the administration, then doctors get on with what they do best - looking after patients.

The consultant-led service is for menorrhagia.  We decided that our population deserved the best care, but because care ownership is low, we wanted to bring hospital servcies into the community, and contracted with a top gynaecologist to provide a menorrhagia service.  It's in pilot stage, and it took a year or so for the PCT to issue the specification for us to respond, but the GP led service won the contract.  There's many pitfalls though.

The GP practice servcie is anti-coagulation (INR, warfarin).  Many GP practices in Easington district (population 100,000) were already providing different intensities of service as a LES (enhanced service, receiving a payment per patient in addition to the GMS core funding).  The different contracts were getting increasingly difficult to manage, so the PCT decided to rationalise and issued an AQP (Any Qualified Provider) invitation.

The GPs realised the danger, and joined together under the umbrella of Easington South Health.  The GPs providing this service aren't the partners of Easington South Health, and nobody gets favoured treatment - every GP practice that takes part gets the same payment per patient, meaning that they keep the income, they keep the work, and of course they cankeep the staff.

Pitfalls

There are lots of thngs that can go wrong, and we're probably working through most of them.  CQC registration is fraught with difficulties.  Setting up the company is enough of a challenge.  Winning tenders to provide services and then dealing with the responses of your rivals who lost out or who see you as a threat all have their place.  I hope to explore this further in future blogs.

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