The first publication by NHS Clinical Commissioners, which includes the combined forces of the National Association of Primary Care (NAPC), NHS Alliance and NHS Confederation, includes examples from 12 CCGs across England where clinically-led initiatives have both improved the quality of healthcare services for patients and saved money. Earlier this month we looked at the first six examples. This week we look at the remaining six.
1. South Devon and Torbay CCG, Devon
PROBLEM: Men who have had raised PSA levels usually need regular follow-up monitoring, even if they have not had any treatment for prostate cancer. This can mean trips to a hospital outpatient clinic and a wait for blood test results. They may also need to return in six months for another test.
SOLUTION: Men have blood tests locally at surgeries and are contacted about the results by a specialist nurse. Hospital attendance only needed if results outside expected range or they are concerned about symptoms.
RESULT: CCG estimates 1,500 outpatient appointments annually may be saved.
QUOTE: CCG co-chairman Dr Derek Greatorex says: ‘Sometimes it does not take much of a change to make a difference.’
2. Bassetlaw CCG, Nottinghamshire
LEARNING: CCGs can bring down prescribing costs while also improving patient care.
PROBLEM: GPs looked at prescribing to ensure patients were getting appropriate drugs. Healthcare-associated infections can be avoided by cutting back on the prescription of drugs which can make it more likely patients develop clostridium difficile.
SOLUTION: Bassetlaw persuaded GPs on the strength of the evidence, with GPs being influenced by their peers to change their practice.
RESULTS: In 2011/12 prescribing dropped by close to 10% with a £1.5m saving which has allowed for investment in other services such as paediatrics locally.
QUOTE: CCG chairman Dr Steve Kell says: ‘The key driver for GPs is undoubtedly patients. Everything they do should be with that in mind.’
3. Oldham CCG, Greater Manchester
LEARNING: CCGs want to engage the public in difficult debates such as around priority setting.
PROBLEM: How should healthcare be prioritised in a world of limited resources?
SOLUTION: A dozen members of the public were recruited through community groups and four lengthy sessions were held.
RESULTS: Conclusions included contracting should be on quality not cost alone but could be with NHS or private organisations. Important for patients were decision-making transparency, involvement and an emphasis on outcomes.
QUOTE: Dr Ian Wilkinson, accountable officer for Oldham CCG, says: ‘The findings of the commission were presented to the CCG which was invited to add its thoughts.’
4. Bristol CCG
LEARNING: Input of clinicians is likely to lead to improved services, especially for disadvantaged groups.
PROBLEM: GPs, service users and voluntary groups concerned that the current provision of mental health services does not meet needs.
SOLUTION: Concerns about access to crisis teams and waiting times for treatment led to board looking at recommissioning some adult services.
RESULTS: Priorities include a locally accountable structure which focuses on city needs; improved working with social care, voluntary and community organisations, and primary care; and locally-based crises resolution and home treatment teams, and a model which addresses the particular needs of those with chaotic lifestyles.
QUOTE: Maya Bimson, programme director for modernising mental health services, says: ‘It is about recognising what Bristol needs and building a system for Bristol. GP commissioning has been at the heart of this.’
5. Rushcliffe CCG, Nottinghamshire
WHAT: CCGs tackling pathways for long-term conditions sufferers.
PROBLEM: COPD affects up to 4% of the population and is more common in deprived areas. Sufferers are likely to need regular input from healthcare professionals to optimise treatment and reduce the severity of symptoms. Primary and community-based care should manage as many of these patients as possible at home.
SOLUTION: Integrated COPD service which covers patients from screening and diagnosis through management in the community to hospital care. Included work with a pharmaceutical firm which provided a COPD nurse to work with practices with a high rate of COPD-related admissions. LINK
RESULTS: 2011/12 emergency hospital admissions for COPD sufferers dropped from over 800 the previous year to below 700.
QUOTE: Dr Neil Fraser, CCG lead for long-term conditions, says: ‘The expensive thing is often the thing that is bad for the patient as well.’
6. Bradford CCGs
WHAT: GP engagement with integrated care can drive projecys forward and will benefit patients.
PROBLEM: Bradford talked about integrated care before the arrival of commissioning.
SOLUTION: New model covers all community and social care services for adults. Pilots serving populations of around 25,000 set up, typically based around four to six practices, have teams of staff, community nurses, social services and voluntary sector, working together with a single point of access. Patients case managed with the aim of providing whatever is needed to prevent them needing acute care or long-term residential care.
RESULTS: Services will need to be available 24/7 to avoid patients being admitted to acute care out of normal hours. Proactive intervention could stop patients deteriorating and becoming an emergency.
QUOTE: Business manager Nick Nurden, of the Ridge Medical Practice, says: ‘What we are doing is getting people to work together. The vision is to provide right care, right place, first time.’