GP-led NHS - Better activity data is needed

Inheriting outmoded PCT performance analytics will handicap GP consortia, says Paul Fitzsimmons.

Paul Fitzsimmons: 'GPs must work proactively with their PCTs to shape analytics and reporting' (Photograph: Anja Ulfeldt Photography)

The White Paper puts GP practices at the centre of healthcare reform. To support this emerging role, GPs need access to a wider range of performance analytics and reporting around commissioning than they have relied on so far to manage their own practices.

Reduced management capitation funding available for future consortia means they will need to find efficient ways of acquiring and deploying these systems quickly to drive future reform.

GPs are generally patient-centric, focusing on the individual patient's condition and marshalling the appropriate treatment to address it. The wider health community, efficient commissioning for its population and a service redesigned to maximise investment of scarce resources, are alien concepts to some and require a major shift in perspective.

In my view, if the complexity of information needed to enable decision-making at this level is considered, it is clear that few practices are geared up to work in the way they need to under a GP consortium-led commissioning regime.

Meaningful information
The urgent challenge GPs and fledgling consortia face is getting access to meaningful commissioning information on patient activity, so they can understand the impact their individual management has on the cost and quality of treatment.

Better data is needed to influence the coming year's round of contract negotiations with local providers undertaken by PCTs on GPs' behalf.

PCTs should be challenged to facilitate this evolution in thinking across all practices to align patient-centric GP behaviour with the wider commissioning picture. This is to ensure all practices are ready, willing and able to participate in line with their local consortium's policies in due course.

The Quality, Innovation, Productivity and Prevention (QIPP) agenda provides a sensible framework from which to derive immediate metrics while new national measures are being developed. GP leads can start to roll out performance management information to local practices, and begin involving them in the broader commissioning picture by providing access to performance issues that they can influence.

Highlighting individual practice variations in areas such as emergency admissions for chronic conditions, like asthma, or referral for procedures of limited clinical value, are examples of where quick wins can be delivered. Demonstrating the associated financial impact of these variations within a locality can stimulate GP-led discussions across the group about why they exist and how to reduce them.

Meeting future demands
GP consortia face real challenges. Funding the informatics needed will be prohibitively costly if they wait to inherit systems from PCTs. I believe this will be the case unless consortia can persuade PCTs to adopt cost-effective ways of providing informatics and help to develop these now to meet future demands.

Consortia leads need to persuade PCTs to consider outsourcing. They need to debunk outdated preconceptions that in-house systems are the cheapest option.

With modern web-based technology and a variety of skilled vendors offering proven hosted solutions, outsourcing health informatics reduces staffing requirements and aids rapid roll out of information on a large scale across multiple stakeholders. Outsourcing would also free consortia from taking on existing PCT infrastructure and the likely obsolescence associated with this.

Harnessing this approach brings the benefit of future-proofing the cost. System providers use ongoing research and development to continually integrate the latest technology and improve the end-user experience. As hosted solutions are largely subscription-based, ownership is easily transferable to future consortia.

Standardised reporting
GPs must work proactively with their PCTs to shape analytics and reporting to meet their own preferences, instead of rolling out standardised reporting that may be specifically designed for managers, not GPs.

Recent experience with one PCT has shown that while the PCT team wanted a range of functionality, GPs wanted a simple one-page narrative with values and a direct link to the underlying patient record.

Web-based reporting technology can accommodate both within the same system: GPs who want a more detailed commissioning view can retain this and others who wish for practice-centric data are accommodated.

Most GPs are motivated by three key factors: making their patients better, having more personal time and running a successful practice. Any implementation of new technology or policy must therefore be accompanied by associated rewards that address these motivators.

This approach raises GPs' awareness of the impact their management of individual patients has on the whole local health economy; an essential step towards fully participating in commissioning.

It also gets GPs and their practices engaged in using commissioning information to change clinical practice. It will help consortia to derive immediate savings and improvements to meet government-led agendas, such as QIPP.

Steps GP leads can take

1. Flag up interest in working closer with the PCT to deliver local QIPP targets and express concern over the lack of information to enable practices to play their part.

2. Scope out information needed to support GPs' future commissioning role and press the PCT on its plans to deliver this internally, encouraging it to explore outsourcing options.

3. Use professional networks to identify possible suppliers who could provide this alternative service and ask their PCTs to market test these now.

4. Actively lobby for involvement in next year's contract negotiations and information strategy investment decisions.

5. Open negotiations on incentives for delivering savings and how these should be reinvested to develop commissioning skills and infrastructure.

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