Clinical commissioners can help shape primary care

Primary care, particularly general practice, is well connected to the new commissioning system. This brings a sense of collective effort, mutual support, deep understanding of the challenges of the front line and a strong connection to everyday patient experience of healthcare services.

‘Despite being essential to success, many GP practices are finding the current environment increasingly difficult to work in’

Although clinical commissioning groups do not commission primary care, they have a duty to collaborate with NHS Commissioning Board colleagues to improve the quality of services. The board will certainly also be looking to CCGs for inspiration in developing new models of primary care.

However, primary care is at a crossroads. NHS policy over the last decade has focused largely on improvements in hospital care and the development of a payments, quality and performance system linked to this. The financial constraints on public services have revealed the vulnerability of a largely hospital-focused approach, due to its high-cost infrastructure.

Delivering upstream care and community-based services, particularly for frail patients and those with long-term conditions, is an essential part of meeting this challenge.

Clear roles

Yet despite being essential to success, many GP practices are finding the current environment increasingly difficult to work in. The number of patients requesting services is rising inexorably; the complexity and the demands of the care required are also growing.

‘CCGs will have a key role in developing a vision at local and national level. Robust dialogue with our peers can be expected’

At the same time, partnership profits are under significant pressure. The workforce is also changing rapidly with many more part-time and salaried workers in nursing and GP roles.

This leaves many of our colleagues asking how general practice can be made sustainable in the next few years. CCGs are well placed to lead this discussion.

The first challenge is to build a vision for the future of primary care services that will meet the challenges of the coming decade. This must include clarity regarding the key roles of general practice in gatekeeping, long-term conditions management and preventative care.

It must also consider the integration of services around the needs of discrete populations of patients. This may be by aligning additional services around groups of practices, including community nursing, social care and third sector services.

Potentially influential

Alternatively it may be by aligning general practice into other types of integrated service provision. Key issues of variability in service must be addressed, including access to services, responses to urgent care requests, optimising care for those with long-term conditions and the overall experience of care and quality of life for the population. CCGs will have a key role in developing this vision at local and national level. Robust dialogue with our peers can be expected.

For practices to survive in the current challenging environment they will have to adapt. This requires key skills among the practice leadership and an attitude that is flexible and outward looking.

‘CCGs provide an essential forum for their member practices to debate challenges and support each other in overcoming them’

Business development skills and expertise in change management will be required. Partnerships with other practices, community services providers and hospitals may be needed.

While these skills are evident in a number of practices around the country, they are by no means the norm. CCGs may be influential in supporting the development of these new proficiencies.

Alternative models

While it may be difficult for some GPs to accept that CCGs should play a role in leading change in their profession, it is difficult to see how change will happen fast enough, and extensively enough, without them.

The new groups provide an essential forum for their member practices to debate these challenges and to support each other in overcoming them. The experience of their leaders gained through their commissioning work will provide essential insight. Partnerships with other professional bodies such as the Nursing and Midwifery Council, the British Medical Association and the Royal College of GPs will also be critical in informing and advising practices.

Finally, and most materially, CCGs will be able to commission alternative models of care delivery that may support the change in primary care.

The levers available to them include local enhanced services, transformation funds that account for 2 per cent of their budget allocations and the opportunity to contract for integrated services that could include primary care.

Dr Shane Gordon is chief clinical officer at North East Essex CCG, Dr Amit Bhargava is chief clinical officer at Crawley CCG, Julie Wood is national director at the NHS Alliance and commissioning development director at NHS Clinical Commissioners