Bexley Care Trust is part of the NHS South East London cluster and commissions health and social care to around 220,000 patients in the London borough of Bexley.
The trust is widely acknowledged as being ahead of the curve in the journey towards a clinically led NHS, having recognised the potential benefits of empowering GPs when practice-based commissioning was introduced around five years ago.
Bexley Care Trust has been working in partnership with healthcare data intelligence specialist MedeAnalytics to develop an informatics system to support clinical commissioning since 2009.
In July this year, MedeAnalytics launched its analytics solution Clinical Commissioner, having successfully piloted it with Bexley from 2010. The system comprises a suite of locally adaptable reporting solutions that can provide meaningful data to help GPs make commissioning decisions.
During the pilot phase, Bexley had identified a range of analytics needs it believed would empower clinicians. These included developing informatics around referral management, prescribing patterns, GP spend, vital signs data and QOF.
'Proper clinical leadership is required to have a strong, sustainable and well-run health economy with good patient outcomes,' says Dr Joanne Medhurst, joint managing director of Bexley business support unit.
'But progress is not about having heroic transformational leadership. For clinical commissioning to succeed, we need a distributive leadership model which faces in many directions and listens, collects and helps to establish a joint vision and deliver it together.'
With clear, demonstrable outcomes underlining its early embracement of clinical empowerment, Bexley has already reaped dividends. But its success is underpinned and supported by an informatics system that enables its clinicians to make commissioning decisions based on robust and reliable data.
'To empower groups of GPs, practice managers and healthcare providers, they must first understand their landscape,' says Dr Medhurst. 'Good informatics allows you to have an informed debate rather than an anecdotal one; you can look at outcomes, referral patterns and prescribing trends, and then discuss them through the wider network.
'Too many GPs are terribly disempowered because they don't have this information at their fingertips, and go down blind alleys because they don't really know where to focus. Technology is part of the solution. While on its own it won't dictate the vision or drive behaviour, it can help inform the thinking that determines the vision, culture and behaviour.'
Dr Joanne Medhurst: Good informatics allows you to have an informed debate rather than an anecdotal one
The main focus has been on non-elective admission avoidance - keeping patients out of hospitals and, in the process, reducing Bexley's bill from the region's five acute trusts. 'It's largely about helping our GPs in terms of case management - and the technology is absolutely core to it,' says Darren Blake, head of GP practice support at Bexley Care Trust.
GPs are asked to review the list to determine whether they can influence or avoid the admission. 'The challenge is to keep patients in primary care rather than have them go to A&E. GPs focus on the ones they think they can influence - and we have integrated team meetings to determine the best care plan to help avoid the non-elective admission.'
In the six months between April and September 2011, the number of 'GP influenced' non-elective admissions has reduced by 289 spells compared with the same period in 2010. This has yielded indicative cost savings (based on acute billing in the prior year) of £267,000 across all the practices in Bexley, and a reduction in non-elective admissions of some 200 patients.
Bexley also uses the MedeAnalytics Clinical Commissioner tool to monitor its quality, innovation, productivity and prevention (QIPP) schemes - assessing whether its schemes are delivering the required productivity and quality gains.
The value of data
Mr Blake says: 'It's about arming GPs with valuable data. It is now a way of life and you don't get through a day without speaking about it in one form or another. But for them the focus is not on pounds and pence, it's about clinical improvement and the betterment of patient care. The system is helping them to deliver that.'
The data at the heart of the system is vital to establishing performance and identifying needs. But it is only one component of a bigger picture.
'Technology is not where the solution to a problem starts, but it can certainly help craft the question,' says Dr Medhurst. 'If I was parachuted into another trust, I would first need to see their data - the prescribing trends and referral rates.
'I would put all of it together and it would describe the problem. The solution would be about creating the story and setting the vision for the future, which can be crafted together as a group. Technology enables you to create factually based stories, rather than anecdotal ones.'
The timetable for change is the biggest challenge of all. Emerging clinical commissioning groups must act now to ensure they are best equipped to meet clinicians' information needs.
- Dr Medhurst is the joint managing director of Bexley business support unit and Darren Blake is head of GP practice support at Bexley Care Trust