General practice plays a role in improving health services Providers and commissioners need to work together to co-produce contracts that deliver the right outcomes for patients.
A combination of an unprecedented financial challenge, an ageing population and a desire by patients to be treated in the community whenever possible, creates a challenge and an opportunity for general practice.
In Tower Hamlets, approximately 2% of patients, who are mainly housebound or terminally ill, currently receive proactive, co-ordinated care from their GP, district nurses, social services, mental health trust and other community services. This is managed by using virtual wards and multidisciplinary monthly team meetings. However, we estimate that up to 25% of patients in the future will need this type of proactive approach to minimise the risk of hospital admissions. Such an approach offers a win-win situation, better value for money for the NHS and, more importantly, it's better for patients who say they want to stay at home. It also builds on a system of general practice that many countries consider to be one of the best in the world.
In Tower Hamlets every surgery is now part of a federation, sharing experiences and expertise, and working together to provide integrated care and deliver key clinical outcomes – 94% immunisation rates for MMR and the best cholesterol and blood pressure control in the country for diabetic and ischaemic heart disease are some of our achievements.
General practice has a wealth of patient information that can be used to drive quality and help improve services. For example, we have co-designed dashboards across Tower Hamlets with data-sharing agreements which allow us to compare outcomes and learn from each other. It also means we can draw more funding into general practice and share staff. Examples include sharing a diabetic nurse across practices who is too expensive to employ on our own.
A report from The King's Fund suggests that federations move towards outcome-based contracting with commissioners encompassing population health, patient experience, access and financial performance. In Tower Hamlets this has made a crucial difference, but I would go a step further and suggest that local contracts need to be co-designed by providers and commissioners, as they have been here. The current procurement system is too rigid and inflexible and keeping them apart doesn't work. Health is a complex system.
To realise the report's vision of family care networks delivering truly integrated care with the patient at the centre, providers and commissioners need to work together to co-produce contracts that deliver the right outcomes for patients. Conflicts of interest can be negated through openness and transparency with non-clinical directors and lay members on the CCG board making decisions in such cases. What shouldn't happen is that the fear of a conflict of interest prevents innovative working that better meets patients' needs.
The King's Fund report does not propose replacing the national contract; on the contrary its recommendations offer an opportunity to shift care and resources into the community based on clinical evidence and patient feedback.
We also need to consider the role of consultants. They need to adopt an integrated, whole population approach across different clinical pathways. Our diabetic consultant is responsible for every diabetic patient in the federation. A big ask? Our consultant has provided training sessions, support for problematic cases and is always on the end of a phone to offer advice. This has seen a big shift to more diabetic care being provided in the community allowing him to focus on those they really need to see in hospital.
Any new model should sit alongside and be in addition to the existing one. It is important not to underestimate the importance of winning over hearts and minds to succeed; general practice needs to see for itself the benefits of this new way of working. As we have seen in Tower Hamlets, primary and secondary care providers and commissioners need to have the space and time to develop local solutions and find for themselves the "magnificent unintended consequences" that this way of working offers. The King's Fund report starts us on a very important journey to delivering improved community-based services for patients and reversing the decline in resourcing for primary care.
Dr Sam Everington has been a GP in Tower Hamlets for 20 years. Guardian Professional.
A combination of an unprecedented financial challenge, an ageing population and a desire by patients to be treated in the community whenever possible, creates a challenge and an opportunity for general practice.
In Tower Hamlets, approximately 2% of patients, who are mainly housebound or terminally ill, currently receive proactive, co-ordinated care from their GP, district nurses, social services, mental health trust and other community services. This is managed by using virtual wards and multidisciplinary monthly team meetings. However, we estimate that up to 25% of patients in the future will need this type of proactive approach to minimise the risk of hospital admissions. Such an approach offers a win-win situation, better value for money for the NHS and, more importantly, it's better for patients who say they want to stay at home. It also builds on a system of general practice that many countries consider to be one of the best in the world.
In Tower Hamlets every surgery is now part of a federation, sharing experiences and expertise, and working together to provide integrated care and deliver key clinical outcomes – 94% immunisation rates for MMR and the best cholesterol and blood pressure control in the country for diabetic and ischaemic heart disease are some of our achievements.
General practice has a wealth of patient information that can be used to drive quality and help improve services. For example, we have co-designed dashboards across Tower Hamlets with data-sharing agreements which allow us to compare outcomes and learn from each other. It also means we can draw more funding into general practice and share staff. Examples include sharing a diabetic nurse across practices who is too expensive to employ on our own.
A report from The King's Fund suggests that federations move towards outcome-based contracting with commissioners encompassing population health, patient experience, access and financial performance. In Tower Hamlets this has made a crucial difference, but I would go a step further and suggest that local contracts need to be co-designed by providers and commissioners, as they have been here. The current procurement system is too rigid and inflexible and keeping them apart doesn't work. Health is a complex system.
To realise the report's vision of family care networks delivering truly integrated care with the patient at the centre, providers and commissioners need to work together to co-produce contracts that deliver the right outcomes for patients. Conflicts of interest can be negated through openness and transparency with non-clinical directors and lay members on the CCG board making decisions in such cases. What shouldn't happen is that the fear of a conflict of interest prevents innovative working that better meets patients' needs.
The King's Fund report does not propose replacing the national contract; on the contrary its recommendations offer an opportunity to shift care and resources into the community based on clinical evidence and patient feedback.
We also need to consider the role of consultants. They need to adopt an integrated, whole population approach across different clinical pathways. Our diabetic consultant is responsible for every diabetic patient in the federation. A big ask? Our consultant has provided training sessions, support for problematic cases and is always on the end of a phone to offer advice. This has seen a big shift to more diabetic care being provided in the community allowing him to focus on those they really need to see in hospital.
Any new model should sit alongside and be in addition to the existing one. It is important not to underestimate the importance of winning over hearts and minds to succeed; general practice needs to see for itself the benefits of this new way of working. As we have seen in Tower Hamlets, primary and secondary care providers and commissioners need to have the space and time to develop local solutions and find for themselves the "magnificent unintended consequences" that this way of working offers. The King's Fund report starts us on a very important journey to delivering improved community-based services for patients and reversing the decline in resourcing for primary care.
Dr Sam Everington has been a GP in Tower Hamlets for 20 years. Guardian Professional.
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