Crawley practice-based commissioning
The population of West Sussex is around 800,000 and Crawley Practice Based Commissioning (PBC) Consortium is one of several for West Sussex, serving a population of 110,000 to 120,000. This is an ethnically mixed population with approximately 12 per cent black and minority ethnic residents. Crawley has a larger ethnic minority population than the average for England and the South East Region. Crawley residents are disproportionately represented in Administrative, Elementary and Operative professions with a noticeable under representation at Managerial and Professional levels. This means that, although many of the population are in employment, they are not well off and are not very engaged in keeping healthy in order to keep on working. The West Sussex Local Area Agreement has prioritised reducing premature mortality and alcohol related harm, and increasing adult participation in physical activity.
As part of the transition to GP commissioning under the NHS White Paper, a number of arrangements have been set in train across West Sussex. These include the setting up of support for GP Commissioning Consortia in a number of areas including primary care and mental health.
Joint commissioning between the NHS in West Sussex and West Sussex County Council has previously largely been managed through a Joint Commissioning Board, a body which did not have formal decision-making powers. Work in 2010 has looked at how current and future commissioning structures in health and social care present an opportunity for engagement, so that GP Consortia are best positioned to effectively joint commission integrated care services at a locality level. Work is now being undertaken to set up a formal agreement for joint commissioning under Section 75 of the NHS Act 2006 and this will be subject to endorsement by GP Consortia and formal agreement by the board in March 2011. The PCT and the Council are currently developing ways to engage GP Consortia in the joint commissioning governance process.
Dr Amitabh Bhargava is Chair of Crawley Practice Based Commissioning Consortium and has been Chair of the Professional Executive Committee and Medical Director of Crawley Primary Care Trust (PCT). Amit has been a GP since 1991. He is now a GP Principle in the Southgate Medical Group, Crawley. He is National Co-Lead of the NHS Alliance GP Commissioning Federation and South East Coast Strategic Health Authority (SHA) Primary Care Lead for Improving Access to Psychological Therapies. As is clear from the range of roles he fulfils, Amit has a broad general interest in health and wellbeing, as well as in medical treatment and is therefore interested in the role of local government in health.
Amit says that when he acted as a GP adviser to the Department of Health on primary care issues in the early 2000s, during this time he became increasingly aware that some policies that had wide ranging affects did not have a strong evidence base. This is one of the reasons why he believes GP Commissioning will have much to offer to local communities, as local commissioning should be based on evidence of local needs. In Amit's view, the biggest priority for Crawley is the development of health and wellbeing services for older and disadvantaged people and children. “Prevention of illness is the greatest area of need and has the least investment”, he says. The mutuality of benefits which health and local government could offer each other increased when the personal relationships between colleagues in local government and health developed, sometimes over hard fought games on the squash court, curries and beer. These good personal relationships on and off the court were important to develop strength and trust to work together on a health and wellbeing programme that was developed in 2006/7. The Crawley Practice Based Commissioning Board saw grants to the Health and Wellbeing progamme as a means of investing in prevention. For example, it funded work on tackling obesity, and subsidised a GP liaison officer between the Health and Wellbeing programme and GP practices across the locality to draw their attention to health improvement opportunities for their patients, such as free swimming accompanied by 30 minutes of healthy living advice.
The Health and Wellbeing Board works on a neighbourhood basis, involving local Third Sector organisations. “We had a good Local Strategic Agreement” says Amit, “but clients were still often looked after in silos. We have looked at how we can align work programmes - both to improve the experience of patients and service users, but also with the intention of reducing waste. We are currently developing big projects on alcohol reduction and dementia, including funding support workers.”
“One of the success factors for joint working was that the Chief Executive of Crawley Borough Council has attended the Health and Wellbeing Board meetings where our strategy is developed”, says Amit. “Because of this, other senior management from the area also attend Board meetings regularly.” He believes that the new local Health and Wellbeing Partnerships proposed in the NHS White Paper will be an important catalyst to bring GP Commissioners and local authorities together.
The Health and Wellbeing Board members have had meetings with the Practice Based Commissioning Group, some in council premises. As they move to fully-fledged GP Commissioning Consortia, Amit thinks that governance structures will need to link up joint commissioning and the Health and Wellbeing Board with GP commissioning. “We want lean decision-making structures with a focus on delivery and outcomes.” He strongly believes that localism in health planning is very important. “We need to be able to make decisions for small populations, at super-output area level and then aggregate these upwards, perhaps through the Consortium Health and Wellbeing Board. Decisions about what will work for individual patients can't be done with a broad brush. It has to be done by individual strokes”, Amit argues. This is his strongest reason for supporting GP-led commissioning. “GPs are not just people who write prescriptions. We've been doing commissioning for a long time, we understand the practice and the community. We understand the importance of factors like housing, neighbourhoods and social life for health inequalities. That's why I foresee local authority members attending the GP Commissioning Consortia Board meetings in the future. Our approach for joint working has to be ‘human beings trusting human beings to create solutions' “.
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2 December 2010