Northamptonshire County Council has been developing links over the past couple of years with GPs in a variety of ways. One key opportunity has been the development of its relationship with a very large Practice Based Commissioning Group, Nene Commissioning, which covers the vast majority of the county, where the Primary Care Trust and the County Council are substantially co-terminous. Nene Commissioning is an award-winning not-for-profit community interest company, covering 76 practices in the county, over 350 GPs and a population of over 650,000. It is the largest consortium of its kind in the country.
It is also the lead NHS organisation for Northamptonshire Integrated Care Partnership, one of 16 pilot national integrated care pilots, which is developing new models of long-term condition management to help patients remain independent for longer and have more choice in their end of life care. Nene Commissioning is clinically led by a Board consisting of nine elected GPs (including a Chairman), two appointed practice managers and a Chief Executive. It operates through a locality structure with monthly meetings of representative GPs taking place within four geographical areas
There is active current discussion in Northamptonshire about how to take forward structures for GP Commissioning Consortia - a number of local agencies are encouraging GPs to give an early lead in saying how they would want GP commissioning to work. While this discussion moves to its conclusion, the County Council remains keen to build on the Integrated Care Partnership which has been in existence for 18 months. This is not currently a legally constructed entity, but is led by senior local authority and NHS managers, clinicians and GP commissioners and representatives of Age Concern/Age UK.
“We had struggled for years to move forward integrated care services”, says Andrew Jepps, Head of Service for Planning and Commissioning in Northamptonshire County Council's Adult Social Care Department.
“There have been real challenges in individual agencies making key business cases that allowed them to see return on investment just in narrow terms. Recently though, from our perspective in the Council, we believe there has been a change in thinking about how business cases are developed and considered. Engaging with key clinicians across primary care and acute settings has been really helpful. In the Council, we took the view that we would try to think what we would contribute to NHS commissioners' work - for example, by helping speed up hospital through-flow. And health partners have seen how they can help with our objective of reducing home care admissions”, Andrew explains.
“Now through the Integrated Care Partnership and Nene Commissioning, we believe we have good relationships with a number of GPs and it feel like there is a solid basis for further work with GP commissioners. And we believe the partnership approach has helped us work more close with the PCT and acutes as well.”
Andrew describes an example of how opportunities for joint commissioning can be exploited.
“We had an opportunity last year with a community hospital ward that had to close for three months. We had wanted to develop a model of bringing more health and social care expertise into people's homes and also into specialiast care centres, for example to do re-ablement work. Because of the community hospital ward temporary closure, we simply had to sort out the best way of doing this within a few weeks. We were able to demonstrate that we could reduce hospital admissions to a third of their previous rate and also reduce the average length of stay in the relevant specialist care centre beds by 9 days. So we had evidence that different ways of working could have good outcomes and save money. Now we have worked with the PCT and Nene Commissioning through the Integrated Care Partnership to develop a business model that goes much further to exploit our joint assets. This includes NHS commissioners buying beds in specialist care centres and the local authority showing where the money goes in social care (for example on community equipment and new staff to increase reablement) - a real opportunity for win-win.”
Andrew believes that the local authority now has several key contacts in the GP community who have a good understanding of what the local authority can and can't do. He hopes that these good relations will stand the County Council in good stead when it comes to involvement with future GP Commissioning Consortia.
“We've already had a meeting about possible future joint and lead commissioning, whatever these arrangements may eventually come to look like. I expect that there will be hiccups, not least as we know that PCT colleagues have real challenges in managing the transitions with a reduction in their capacity. But to us this means that the County Council should act quickly now to be at the table when new commissioning structures are discussed.”
There is enthusiasm from Northamptonshire's Cabinet Portfolio Holder, and a number of health colleagues, to be early adopters of the proposed new public health structures. Although the Director of Public Health is not yet jointly appointed with the council, there is a public health funded post in the local authority who works alongside the DPH. There is also a transitions group chaired by the DPH working through the arrangements for the forthcoming transition of public health to the Local Authority. Andrew has been struck by how his own engagement with public health colleagues at the PCT has often been in different contexts to his engagement with other PCT commissioners - although colleagues in his team have had good and regular engagement on health improvement issues. This suggests that adult social care commissioning could take opportunities to work yet more effectively with public health colleagues in the new arrangements to come. He believes that the new structures could bring opportunities for thinking about public health perspectives across the wider activity of the Council, and indeed across the whole range of interactions with health colleagues.
“A key involvement I have with the Director of Public Health is around the Joint Strategic Needs Assessment”, he explains.
“But although it is a health and social care profile of our residents, a JSNA doesn't in itself tell me what I ought to be commissioning in social care. Sometimes that is just because the commissioning decisions are another process, informed by the JSNA. But sometimes there are other, interesting issues - for example, the different kind of language that we use in different organizations and disciplines. I would hope that we could all take advantage of the forthcoming changes in NHS commissioning and in public health to bring the two closer together with social care and Council strategies for a more holistic approach to common objectives on prevention and health improvement.”
Andrew Jepps, Head of Service for Planning and Commissioning, Adult Social Care, Northamptonshire County Council, firstname.lastname@example.org.
Nene Commissioning website: http://www.nenecommissioning.com/