Five practice-based commissioning (PBC) groups in Cornwall, of which my consortium is one, started designing their new referrals management service (RMS) when the King's Fund's Referrals Management: Lessons for Success report was published two months ago.
The report was sceptical of the amount of savings a RMS could produce but it also acknowledged the importance of good quality data intelligence and clinical collaboration. Both will be highly prized by the proposed GP consortia since they will need to understand NHS elective referral activity and budgets clearly, and work with their consultant colleagues to hone clinical pathways.
So the GP leads from the five groups had good reasons to go ahead. The groups represent 58 practices with around 525,000 patients and 500 GPs for which the Royal Cornwall Hospitals Trust in Truro is the main acute provider.
We are signing up practices to the RMS, which will cover the whole county except for east Cornwall practices - for which Plymouth Hospitals Trust is the main provider.
These practices are joining Plymouth-based Sentinel Healthcare Southwest community interest company (CIC), which already has a RMS. Like Sentinel, our PBC groups intend to provide the RMS through a not-for-profit CIC.
Business plan
The scheme came about when one of the five PBC groups, Carrick Commissioning Consortium, examined Sentinel's RMS results. Carrick drew up a business plan which NHS Cornwall & Isles of Scilly approved in June 2010. The proposed start time is January 2011.
We have organised patient and public engagement meetings to discuss our plans. The other main issues to sort out are premises, IT, staffing, the CIC and the service contract with the PCT.
Because of the White Paper plans, space in PCT premises has started to become available as staff members leave.
Most PCT premises have N3 connections to enable the delivery of new IT systems for the NHS and this will help with the installation of the RMS in terms of speed and cost.
Setting up the CIC will not present problems in itself.
However, the organisational logistics of such an undertaking, with so many practices involved, are quite complex.
Establishing an early dialogue between GPs and consultants is a top priority as clinical collaboration, using Map of Medicine (visual representation of high quality evidence-based care journeys - see www.mapofmedicine.com) as a tool, to redesign clinical pathways is vital.
When the RMS starts producing data, clinicians can fine-tune pathways and services to meet local needs.
- Polly Ellison is chief executive of Carrick Commissioning Consortium in Cornwall
