Viewpoint - How discussion with peers helps

Paul Corrigan likens the variation between practices in commissioning groups to the curve of a ski slope.

Paul Corrigan: one practice can refer five times the patients as another (Photograph: JH Lancy)
Paul Corrigan: one practice can refer five times the patients as another (Photograph: JH Lancy)

People ask me what GP-led commissioning actually looks like. The best way I can exemplify how it works is to describe how leading GPs have peer-to-peer discussions about variations in the referrals made by their GP practices.

For many GPs their initial exposure to how GP-led commissioning works is by compiling and then discussing a 'ski slope' diagram. The ski slope consists of a diagrammatical representation of the different rates of all of the GP practices in a commissioning group concerning a particular medicine or a particular referral. The phrase ski slope is used to describe the line that can usually be drawn along the data from different practices.

It is a ski slope because it starts high and then develops into a swoop down to a low point. And the slope typically shows that one practice refers four or five times the number of patients for the same procedure as another. There is then a mean line for all of the practices showing where the average is.

The straightforward action for a lead GP is to take these data and discuss these patterns with the different GP practices. Why do you refer four times as many patients as others? It may be clinical or it may be to do with its population.

The same data raise the question with another practice about why one GP refers only a quarter of the patients that one of their colleagues does.

What the ski slope diagram does is provide the lead GP with the data to ask the question. It does not assume there are no answers to the questions but it starts a conversation about why.

The aim of the conversation is to find out the reasons why there is such a wide variation of practice within a similar geographic area.

These data have been in the NHS system for many years. A lot of PCTs have tried to use the data to limit unwarranted variation between practices.

Peer-to-peer discussions
What is different with GP commissioning is the quality of peer-to-peer discussions that take place using the data.

Lead GPs know they have a wider responsibility to the public than just their own practice. And the GP practice knows it has to take responsibility for the referrals it makes.

One of the main problems in the NHS is the unwarranted variation that exists between different professionals. One of the immediate outcomes of GP-led commissioning has been to start to confront these variations through peer-to-peer discussion. The ski slope shapes the discussion.

  • Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com

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