The paper offers examples of nine clinical areas - COPD, dermatology, heart failure, long-term conditions, mental health, ophthalmology, orthopaedics, podiatry and urology - where practices can hone their commissioning processes.
It also includes tips such as having monthly practice meetings, setting up a skills directory of local clinicians and establishing a monitoring system for secondary referrals.
In the paper, Cheshire GP Dr David Colin-Thome, the DoH's director of primary care, suggests that a first step for GPs would be to carry out follow-up appointments in the surgery, rather than patients attending hospital outpatient clinics.
He outlines a three-step process, which starts with encouraging practices to take on outpatient work.
'Invest resources that would otherwise be spent on outpatient tariffs in redesigning services, by for example employing a specialist nurse,' he says.
'Invest freed-up resources in a case manager or community matron for people with a long-term condition.'
One case study in the report relates to a heart failure service used by the Markfield Medical Centre in Leicestershire, in which GPs have developed a new patient pathway using B-type natriuretic peptide blood tests.
One of the GPs involved, Dr Chris Trzcinski, said: 'It's a simple blood test, we get the results back within a week and have open access to echocardiogram for those patients who need it.
'I'm confident that it has improved the standard of care in our practice significantly.'
The report was backed by NHS Alliance chairman and GP Dr Michael Dixon.
He asked: 'Do we want to be led by others or do we want to lead the change ourselves and take a central role both as commissioners and providers of local services?
'This report provides an excellent and pithy starting place for practice-based commissioners.'
- The NAPC and GP are working together to help practices with practice-based commissioning queries. Turn to Ask the Experts, page 50, for details
The DoH document suggests practices:
- Set up a skills directory of local clinicians.
- Change follow-up appointment procedures.
- Take on work from outpatients that practices can do.
- Use funds from that work to redesign services and employ specialist staff.