Case studies on GP commissioning
It's never too soon to prepare for change. Our case studies on GP commissioning give a snapshot of how some local authorities and their NHS counterparts are getting ready for the significant changes in health structures that will affect partnership working for some time to come.We know from the round-table discussion hosted by Local Government Improvement and Development (LGA) in November that local authorities, GPs, public health professionals and the voluntary sector are committed to working together to meet the needs of communities. In some areas, work is already well placed to create a fully integrated, place-based health and social care system. In other areas, preparation is at an earlier stage. East Riding of Yorkshire Council, for example, has groups looking at resource allocation and transition of services from the PCT to the council. East Riding is also considering how it can be more proactive in providing public health interventions in fields such as bariatrics and smoking cessation via council facilities such as leisure centres. Hertfordshire and other authorities are currently working with the Department of Health to pilot the development of a Health and Wellbeing Board.
It was acknowledged that not all authorities have quite such advanced plans to take on their new and additional health responsibilities, and resource constraints are worrying all authorities. Some of the issues that have emerged in preparing our case studies suggest a need for further developmental work in at least two areas.
It will be vital for a genuinely integrated, cost-effective system that public health professionals, GP commissioners and social care commissioners understand each other's remit and priorities and how each can help the others - in some areas, although the three partners are working pairs, there is less evidence that the whole three points of this important triangle are joined up.
We will need to work at developing a common understanding of public health across the NHS (and GPs in particular) and local government to break down cultural and language barriers. While local government public health professionals tend to have a very wide interpretation of public health to include the wider social determinants, the “causes of the causes”, primary care clinicians are, understandably, concerned with those issues on which they feel they can have a direct impact, such as getting people's blood pressure down, keeping them out of hospital etc. Of course, there are many different roles involved in improving the health and well being of communities and individuals, and many different forms of interventions, some clinical, some social and economic, but it is essential that when one person talks about “public health”, that there is a common cross-sectoral understanding of what this means.
As well as area-wide partnerships, one important need identified at the round-table discussion - which would help address the two issues described above - is the establishment of more local, possibly ward-level links, between GPs and local councillors, and also involving community representatives, schools, leisure centres and other professionals such as health visitors, to develop responses to local health challenges and inform commissioning processes.
Principal Consultant, Healthy Communities Team
8 December 2010