Developing a federated model of General Practice - Providers & commissioners working together in collaboration
A balanced and viable health economy is a statutory duty for a CCG, and my view remains the best way to achieve that outcome is for commissioners and providers to collaborate with the same goal in mind - a balanced and viable health economy.
As discussed in previous issues, the new contracting opportunities available, in prime, principle and alliance contracts lend themselves to this approach.
Why then is it that I regularly come across CCGs (not all by any means - there are some great examples in my work of fantastic engagement from CCGs) completely paralysed at the thought of speaking with or engaging with a GP Federation? I need to explain here that engagement is not meetings - I can get as many meetings as I want; engagement is "an arrangement to do something or go somewhere at a fixed time" for me the key point is the statement "to do something".
That something for me should be to collaborate (collaborate meaning "work jointly on an activity or project") on developing services, which make the appropriate shift from in hospital to out of hospital care, which of course is where the new contract options come in. Additionally, by including all possible providers in the collaboration we avoid/reduce conflict of interest problems, by ensuing everyone has a say.
Keep in mind at the end of the day whatever work and ideas
are produced it is down to the CCG to develop the service
specifications, not the work group, which of course means
ultimately it is the CCG who remain the decision making body on
what to commission and the procurement route to go.
Given the current financial position within the NHS, and the significant challenges we now face in the next 3 years, the newly emerging GP federations offer significant opportunity for CCGs. That opportunity though can only be realised where the CCG is willing to take a small risk and take the leap of faith that working in collaboration across providers is not going to see them facing challenges from those providers. The reason I say that is the other providers should of course be involved in the collaboration.
One health economy with one budget is surely now the way forwards, with a focus on placing the patient in the most appropriate setting for the level of care they require, with the healthcare professional best placed to deliver that care available in the location.
Interestingly those CCGs where there is no engagement are
often the only group missing from the federation meetings, as
it is now commonplace for the federations to work with the
local FT, Community Services, Community and Voluntary Sector, Local
Authority, Social Care etc. So common that many we support are
now developing strategic partnership agreements and I have now
been able to secure subcontracted work for federations from
those other providers.
"Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure than to rank with those poor spirits who neither enjoy much nor suffer much, because they live in a gray twilight that knows not victory nor defeat." - Theodore Roosevelt, 26th U.S. President.
This quote has never been more applicable than now; the CCGs not engaging can carry on as they are and many will end up over the abyss (instead of just staring in to it) or they can drive through clinical change.
To answer another prominent bloggers question, "what does the NHS need to change in to"? The NHS doesn't need to change in to anything, what it requires to remain the NHS as we know it, free at the point of access, is clinical change, with investment, real investment, in General Practice, via federations which work at scale and pace, to deliver high quality services, consistently well over all practices by having people work to agreed thresholds and standards. Those thresholds and standards simply require the right balance between standardisation and consistency, while also allowing for local empowerment and flexibility. Above all they require accountability from federation to practice for the services and outcomes, something those we support are comfortably achieving without the need for threats and/or confrontation.
It's not rocket science, but I am not sure CCGs unwilling to engage in "doing" will see it that way. I still see many instances daily of people creating bureaucracy for the sake of it, hiding behind "the system" rather than working to challenge the ways of the past and the system they work within. Time for some foresight and CCGs owning, driving and recreating their local system, not having one imposed that they maintain and then blame.
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