Frequently Asked Questions
How will the nursing profession be represented in the Erewash Consortium?
The current proposed structure is to include nurses in the clinical executive group which will include GPs, practice managers, managers, finance, and patients. This group will be accountable to the board for ensuring that the consortium meets its strategic goals.
Nurses will also be involved in specific work streams which will look at new pathways and more efficient use of resources. As they are key to integrated working with our community services they will also be included in the reviews of those services.
However as part of the listening exercise that government is holding further guidance may be produced as to how to involve other health professionals in clinical commissioning and so it may be that we have to change our current thinking.
How will you be keeping everyone informed? How will you cascade information?
It is recognised that communication needs to be addressed.
The current lines of communication are through the practice representative who should feed back to the practice what is happening in the consortium, in terms of our achievements, our developments and what is being discussed at the monthly meetings.
Practice manager representatives also attend the monthly meetings and they feed back to practice managers.
Notes from the meetings are distributed to practice managers and GP representatives.
Additionally there is a website nhserewash.com which shows current events, news, minutes of meeting etc.
Throughout this development we propose to develop a newsletter in addition to the above but would welcome any further suggestions as to how to improve communication throughout the group.
When will we know who will be chair?
Dr Avi Bhatia has been elected as Chair; this was formally announced at the meeting on 26th May 2011
What will be the arrangement re the Commissioner Provider split?
There will need to be clear boundaries between the provider and the commissioner. Currently this will mean, as a minimum that there will need to be separate boards and a member of the commissioning board will not be able to be a member of the providing board.
Where necessary, EU regulations will be followed for the procurement of services to ensure that competition rules are followed.
As we build our governance arrangements we will need to ensure that it can be demonstrated that commissioning with our provider organisation is at ‘arms length’. It could be that through the development of the white paper and the accreditation process that more guidance will be received as to what would demonstrate independence.
How will the role of the GP being the patient advocate be managed?
We would like to attain lay/patient representation for the board , as well as ultimately setting up PPGs either within our constituent surgeries or for the consortium itself or both. We would hope these would create direct liason with patients to let them have a say in planning their healthcare and services. We would also plan to increase awareness of the consortium via various media as time progresses allowing further information for patients as to what we are both doing and planning to allow their input at early stages.
The policy is risky and untested – how will this be managed?
Before any consortia is approved to be a statutory organisation it will have to go through a rigorous accreditation process to demonstrate that it has all the required systems, processes and policies in place to ensure sound governance, both clinical and financial, and that it adheres to them. It is likely that this assessment will include a 360 degree evaluation by stakeholders, desk based review of key documentation, face to face meeting with the NHS commissioning board, and a site visit. The domains to be tested will be
- Clinical focus and added value
- Engagement with patients and communities
- A clear and credible plan to deliver quality improvement within the allotted financial resource
- Capacity and capability to deliver all responsibilities
- Collaborative arrangements for commissioning with other consortia, local authorities and the NHS commissioning board.
What if the GP Consortia fail?
If GP consortia fail to become accredited, or become accredited but fail to deliver the likely outcome will be that they are managed by another consortium or they merge with a neighbouring consortium.
In terms of Erewash, as said when we were making the decision to be a consortium or a locality within a larger consortium, we will continue to identify our risks and work to mitigate them and as more information becomes available regarding management allowances and costs and risk sharing agreements we will constantly review our position, working with neighbouring consortia as necessary to ensure a successful and satisfactory outcome.
What if individual GP practices fail?
The ultimate sanction is that if a GP practice fails it will not be able to practice in its current form. Current messages from the DoH is that the consortium will be expected, in the first instance, to ensure that practices meet their objectives but where necessary the consortium will need to refer practices to the NHS Commissioning Board who will have the power to manage a practice or close it.
However it is in nobody’s interest in the consortium to let any member practice fail. Hence as a group we need to ensure that we engender a supportive approach between all practices and work with each other to ensure that each practice is able to contribute to the overall goals of their consortium
How could little practices attend the meetings and do more admin work – economies of scale are lost by small practices?
It is a challenge for smaller practices to be involved. In the longer term it is envisaged that the number of meetings that need to be attended is reduced and it is hoped that by working with the practices in the development stages the administrative burden of being part of the consortium will be kept to a minimum.
There is now a GP from a smaller practice on the clinical executive team and so he will ensure that when the team are discussing service development they are mindful of small practices and the challenges they face
With alternative providers what if NHS Hospital fails due to lack of resources?
It will be the responsibility of the commissioners to ensure that there are suppliers in the market to deliver all services required and to manage the market accordingly.
How do we obtain improved public health information?
We are currently in the process of developing an information pack for practices that will include public health information. We will be visiting all practices to discuss this information and part of the discussion will be concerned with what additional information we require in order to understand the full picture.
We will then work with public health colleagues to ensure as far as possible that we receive the information that is required.
We need better information, how do we get this?
As above. There are currently many initiatives in development to ensure that practices have a good set of accurate and timely data in a user friendly format which they can interrogate according to their particular issues. Hopefully during the practice visits we will be able to get a better picture of what practices would like to see and refine the information provided accordingly.
We are looking at developing a dashboard of real time information for urgent care and again would welcome any suggestions as to what you think would be useful so that we can work with the developers to establish what is possible.
What will the ‘must do’ be and what will that leave us to do?
The must do’s are to deliver a clinically safe, effective service within the financial budget and to ensure sustainability over time to meet the increasing demand.
It will be for us to decide how this is to be achieved by targeting, in the first instance, those areas where we can have the highest impact in terms of cost and improved outcome and developing and following cost effective pathways in those areas.
How do we ration?
It is envisaged that currently there will be no need to ‘ration’ per se beyond the use of the procedures of limited clinical value that have been in place over the last year or so. Our first step is to reduce clinical variation across the area and strip out those referrals which could have been managed in primary care or utilisation of other community based pathways.
In many areas peer review has demonstrated that referrals can be reduced with no detriment to the patient (indeed it could be argued providing better quality for the patient as a trip to the hospital is avoided) by use of expertise and knowledge within the practice.
A local audit has recently shown that approximately 90% of T & O referrals that were discharged after the first appointment did not need to take place.
How will we spread the responsibility to include patients and elected representatives of allied health professionals?
Currently the intention is to have patients and nurses represented on the clinical executive group, and to continue to include them in any service redesign projects and service review.
We also need to engage with the wider community to ensure that they know, understand and are part of some of the difficult decisions that may be ahead. We will be working with the Public and Patient Involvement team to ensure we do this in an effective and productive way.
What are the development needs of the consortium and how will they be met?
The development needs are varied and depends on the individuals within consortium.
There will be organisational and leadership development regarding the business of the consortium. Jill Matthews is working with the Leadership Academy http://www.leadershipeastmidlands.nhs.uk/ to develop a series of training courses to meet the needs of the GPs and other professionals who will be involved in the management and development of consortia.
Some of the training will be by formal training sessions but additionally there will be mentorship opportunities and shadowing. Some learning will be by partaking e.g being involved with the contracting rounds for the acute sector etc. and other will be by small workshops and continuous explanation eg finance. There may also be some one off development days for the board members to work on the joint vision, strategy and approach to clinical commissioning.
In terms of the group as a whole and the individual practices it is the intention to have regular practice visits which will offer opportunity to discuss and understand the impact of the changes at practice level, in addition the QUEST session may, along side the clinical topic provide a quick update on clinical commissioning.
How much clinical time will be lost by GPs?
Currently this is an unknown quantity and is likely to vary over the development of the consortium.
It is currently ‘budgeted’ that the Board, consisting of all 13 practice representatives will ultimately meet quarterly.
The members of the smaller clinical executive group (currently three members plus the Chair) will dedicate about one session per week with the chair dedicating about three sessions. Some of this time will be met from GPs own time if they already do a reduced number of sessions in their surgery, that is to be negotiated with each individual and their practice.
Additional GPs may also be involved in contracting and pathway development work which will fluctuate over the year.
GPs will also need time for training and development which at this point is an unknown quantity. But it is the intention to backfill all work to enable the employment of locumsalaried GPs