Groups Of Clinicians With Real Budgets Hold Key To Affordable, Patient-centred And Clinician Led NHS, Says Report

Main Category: Public Health
Article Date: 25 Nov 2009 - 2:00 PDT

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The government should consider radical alternatives to one of its key health reforms, practice-based commissioning, by enabling groups of GPs and hospital-based specialists backed with real budgets to join forces to deliver better and more affordable patient care.

This is the key recommendation from a report published today by the independent health research charity The Nuffield Trust and the NHS Alliance. The report examines how the NHS can finally achieve one of its central policy goals of engaging front-line health professionals in how patient services are designed and delivered and how NHS money is spent. This has long been a goal of government, but practice-based commissioning has struggled to deliver better services for patients or financial savings since it was introduced in 2005.

The report outlines how groups of clinicians based in hospitals and in the community could come together to form new organisations that take on responsibility for the health outcomes of their local communities. They would form Local Clinical Partnerships and be handed real budgets to design, deliver and commission local health services. The report argues that this model holds the promise of re-engaging clinicians in reform and delivering a health service that is affordable, centred on the needs of patients and led by clinicians.

Report lead author Dr Judith Smith, Head of Policy at the Nuffield Trust, said: 'The NHS is facing the greatest financial and leadership challenge it has encountered in a generation. If clinicians are going to play a key role in designing and changing services during this uncertain period then radical action will be necessary. PBC has shown patches of promise but we need a more far-reaching alternative that re-engages GPs and other clinicians in this agenda. We believe groups of clinicians working together in local clinical partnerships could not only revitalise local commissioning but also improve the quality of care patients receive and potentially save the NHS money at this critical time.'

Julie Wood, Director of PBC at the NHS Alliance and one of the co-authors of the report, said: 'The time is right for those involved in the NHS to consider the options for improving health care beyond PBC. While PBC has worked well in some areas, there has been no consistency of implementation across the country. We need to build up on what has worked in PBC and this report shows that encouraging clinicians to form their own organisations, with fully devolved responsibility for 'make or buy' decisions, will allow the NHS to provide better health services for less. For this to work we will need organisational and personal incentives to be aligned to ensure GPs and specialists are engaged.'

Similar models have proved to be effective in a number of international health systems. Beyond Practice-Based Commissioning: the local clinical partnership says there is sufficient international and UK evidence about the benefits of these groups to suggest they would be effective in unleashing the innovation and energy that clinicians have for service design and development - as long as they are given the right incentives, have high quality management and infrastructure support and are given responsibility for decision-making.

A number of essential requirements would need to be in place to ensure local clinical partnerships could succeed, including:

-- Budgets - clinicians would need real budgets. In return they would have responsibility and accountability for the health outcomes of their local communities, the experiences of their patients and their overall financial performance. They would have full responsibility for the provision and commissioning of local healthcare.

-- Clinical involvement and ownership - they would have to be developed and owned by a variety of generalists and specialists. In most cases they would be led by doctors, although nurses from primary and community care, pharmacists and allied health professionals would be actively involved. They would include specialists who would be contracted to the organisation from local foundation trusts or community provider agencies, employed by the local clinical partnership, or engaged in the organisation as partners or via contracts. Ownership would be determined by whether they want to be purely provider organisations, if they provide and commission care, as well as the range of specialties they cover.

-- Size and geography - ideally, they would be based on a geographical community but the crucial factor is that they develop from the frontline as independent collectives of clinicians who are committed to working together. They would need to be of sufficient scale for managing clinical and financial risk and for keeping management and transaction costs in control so that they can be effective commissioners.

-- Aligning incentives - the right incentives would need to be designed and aligned to encourage GPs and specialists to engage with the new organisations. This would be vital given GPs' general disenchantment with PBC.

Notes

1. Beyond Practice-Based Commissioning: the local clinical partnership, by Dr Judith Smith, Julie Wood and Jo Elias, will be free to download from Tuesday, 24 November from http://www.nuffieldtrust.org.uk or http://www.nhsalliance.org.uk

2. The report has been informed by a series of interviews and two workshops held with clinicians and managers active within practice-based commissioning, academics, and policy-makers expert in this area. In these interviews, people were asked about their views of the role and potential for groups of clinicians to assume responsibility for health provision and commissioning in the NHS. As context to the study, a review of the research and policy literature on physician groups, multi-specialty groups and primary care organizations was undertaken, including material from the UK, USA, Australia and New Zealand.

3. The Nuffield Trust is a charitable trust carrying out research and health policy analysis on health services. Our focus is on the reform of health services to improve the efficiency, effectiveness, equity and responsiveness of care. Key current work themes include new forms of care provision, commissioning, efficiency, international health reforms and competition policy.

Source
The NHS Alliance

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