Commissioning: Polysystems - A successful commissioning model

Dr Anil Mehta explains that NHS Redbridge has already handed over significant powers to GPs commissioners.

Dr Mehta: ‘Use your PCT’s skills’ (Photograph: NHS Redbridge)

There is no doubt that the speed and scale of change being proposed in the White Paper has taken GPs by surprise and, in some quarters, their initial enthusiasm may have turned to anxiety and trepidation.

The dust is still settling from the impact of the White Paper on the clinical community but I suspect there will be three general reactions from fellow practitioners around the UK.

There will be a dedicated group of GPs who see the potential and embrace it whole-heartedly, a small group who stick their heads in the sand and hope it all goes away and the majority who agree with the principle but are concerned about increased workloads.

I say this with the benefit of hindsight having been involved in GP commissioning for the past 15 months in Redbridge, north-east London.

Redbridge has five area-based 'polysystems' covering Wanstead, Fairlop, Cranbrook, Seven Kings and Loxford. They are each managed by a GP board with responsibility for commissioning services and the health of their respective communities of between 40,000 and 70,000 patients.

A clinical director heads each polysystem and combines this work with their day-to-day responsibilities as a GP. We work closely with a designated chief officer from the PCT who provides business support.

I have found this relationship invaluable and it is something GP consortia should consider given the expertise that well managed PCTs possess.

NHS Redbridge is one of the first PCTs in the country to put GPs in the driving seat of change with real financial and decision-making power to improve health outcomes.

The borough's three practice-based commissioning clusters were replaced by the five area - based polysystems in 2009.

Polysystems cover GP surgeries, pharmacies, dental services, community services, community and voluntary services. They work on a 'hub and spoke' model, with a polyclinic including GP services at the 'hub' and other GP practices sharing in and linking to its services. Polyclinics' services also include X-rays and hospital-style outpatients' appointments.

Each of the polysystems will have its own polyclinic and the first to open is the Loxton Polyclinic. See the diagram below for the primary care services it provides.

Loxford Polyclinic

GP clinical directors oversee the development of their respective polysystem and agree strategic direction and alignment with delivery and quality, innovation, productivity and prevention objectives through a clinical commissioning board.

Core goals
Their core goals are to promote health and well-being among the community, maximise quality of life and independence for people with life-long conditions and improve services for people with non-critical acute care needs.

The polysystems are expected to oversee 80 per cent of the PCT's commissioning budget by the end of 2010.

The decision to introduce the model was driven by NHS Redbridge's commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The PCT has also worked in partnership with a software company to develop an advanced risk stratification and information management system that supports and informs the work of the polysystems.

In NHS Redbridge, we have been lucky to have a PCT brave enough to see that future improvements in primary care could be most effectively carried forward by GPs, even if this did ultimately point to its demise.

That is something to be applauded given the fact that NHS Redbridge made a commitment to this approach well before the publication of the White Paper.

Local residents also have an important role to play and a community panel is now linked to each polysystem providing patients with a real voice.

We are not always going to agree but we do share a common goal of improving local health services, and hope that focus will allow us to reach common ground on which to move forward.

Steep learning curve
The five polysystems have now signed off their first year work programmes which include two new care pathways for long-term conditions and specialist dermatology and ophthalmology services.

It has been a steep learning curve but we have covered a huge amount of ground in the past one-and-a-half years because we have focused on remaining positive and looking for solutions instead of problems.

My advice to GPs starting on the commissioning consortia journey is do not feel overwhelmed and make use of your local PCT's skills.

It would be extremely churlish to ignore what it has to offer, especially given the pace of change.

  • Dr Mehta is a GP and clinical director of one of five GP-led commissioning groups in Redbridge

Loxford Polyclinic

  • Agreeing two new care pathways for diabetes and coronary artery disease.
  • Identifying 2,500 patients with a high-risk life-long condition and mapping their use and cost of secondary care to provide more effective care.
  • More effective referral management for first time outpatient appointments.
  • New dermatology and ophthalmology pilots, which will have with greater focus on treatment in a primary care setting.
  • Creation of five community-led panels which meet on a bi-monthly basis with clinical directors to discuss commissioning decisions.
  • Opening of London's first purpose-built polyclinic, the Loxford Polyclinic, offering more than 30 services under one roof.

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