Pathfinder's Progress - How our consortium is getting on

Dr Hamish Stedman, Fiona Moore and Scott McKenzie update on Hundreds Health-Salford's progress.

Fiona Moore and Dr Hamish Stedman: key to success will be HHS’s relationship with Salford City Council (Photograph: UNP)
Fiona Moore and Dr Hamish Stedman: key to success will be HHS’s relationship with Salford City Council (Photograph: UNP)

Our consortium, Hundreds Health-Salford (HHS) in Greater Manchester, has 55 member practices and a patient population of 240,000.

We described in GP in February how we started up and how (in December 2010) it became a pathfinder. Since then we have been refining our plans and working on organisational issues.

During the first months as a pathfinder, we became aware that although HHS had a good foundation on which to build clinical commissioning, there was a need for the consortium to reaffirm its vision, aims and values and to regain a mandate for them from its member practices and stakeholders.

Working together
So HHS drew up Principles for GP commissioning consortia, a document that brought together the consortium's visions with those of NHS Salford.

Its key message is: 'HHS, as a clinical commissioning consortium, will ensure true clinical engagement in the leadership and delivery of the commissioning agenda, will improve the delivery of health and well-being services for the population it serves and will enable them to live longer, healthier lives.'

The document clarified HHS's aims and values, including the behaviour expected from consortium members, and explained how our vision will be delivered through robust governance arrangements and by developing a commissioning plan based on the needs of Salford's population.

To complement this, we developed a constitution to provide direction for the transition period until we take over from the PCT.

The constitution document was put together using the previous interpractice governance agreement with HHS's members as a starting point. It now includes consortium structure, working principles and remuneration, and performance management - see the box below for the full list.

We have also agreed the structure of the HHS interim/shadow board with our practices and will be recruiting board members over the summer.

Although a comprehensive list of consortium responsibilities has yet to be confirmed, using the knowledge HHS has, the consortium is currently scoping the resources that will be required to support its anticipated functions.

CONSTITUTION DOCUMENT
  • Mission statement.
  • Objectives.
  • Vision.
  • Consortium structure.
  • Working principles and remuneration.
  • Communication.
  • Human resources.
  • Conflict of interest management.
  • Entry and exit (of member practices).
  • Roles and responsibilities.
  • Performance management.
  • Business process/decision-making criteria for service development.
  • Risk sharing.
  • Incentive payment.
  • Commissioning plans.
  • Signatories to the agreement.
  • Appendices detailing process templates, incentives and commissioning plan plus the roles of practices, localities, consortium, commissioning trategy groups and work stream/clinical leads.

Internal or external support
This scoping will result in assigning internal staff to support each function and/or a specification for the support to be brought in from outside the consortium. This external support could potentially come from a range of sources, including partnership with other consortia, local authority, commissioning support providers and so on.

HHS is also taking forward those arrangements that have proved successful over previous years, including the use of clinically led work streams.

We currently work on 26 different work streams, which are led by 36 clinical leads (the workload in some areas requires multiple lead clinician support).

For example, the 26 work streams include ophthalmology, mental health, diabetes, planned care, IT, health and well-being, active case management and neurology.

The work streams generally draw their expertise from secondary care, but are all chaired by a GP. Each work stream's clinical lead has a role description and terms of reference (ToR) for their work issued by the HHS interim/shadow board.

The ToR reflects HHS's commissioning responsibility to develop strategies that are specifically tasked to deliver health and economic outcomes, with a commitment to disease prevention and equipping patients to self-manage their care. This work underpins the development of HHS's operational plan for 2011/12 and beyond.

HHS has found that good communication - focusing on practice engagement, patient and public engagement, local authority liaison and the primary/secondary interface - is vital to its development and forward planning.

We have agreed with consortium members and stakeholders, that the high level plan for the next three years will be:

  • 2011/12: Recruit to shadow/interim board and spend time up-skilling board members.
  • 2012/13: Phased handover of responsibilities to shadow/interim board.
  • 2013/14: HHS to become an authorised statutory body.

Despite the uncertainties over the Health and Social Care Bill, we are making good progress.

However, we are acutely aware that the key to success will be the strength of HHS's relationship with Salford City Council, with which we must nurture a shared ethos for the delivery of healthcare. This is the relationship that will translate Salford's healthcare visions into a reality.

SHADOW BOARD
  • Clinicians.
  • Chair.
  • Performance management.
  • Local authority liaison.
  • Public health clinical lead.
  • Medicines management.
  • Neighbourhood leads (four).
  • Management support.
  • Accountable officer.
  • Finance officer.
  • Human resources.
  • Local authority.
  • Director of public health.
  • Non-executive directors (number to be confirmed).
  • Dr Stedman is the lead GP and Fiona Moore is head of clinical commissioning at pathfinder consortium HHS
  • The authors will be providing another update on HHS's progress in the autumn

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