NHS Redbridge replaced its three practice based commissioning clusters with five area based commissioning groups called polysystems in Spring 2009.
Under the model, clinical involvement in decision making has increased and members of the local community are linked into the decision making process through community panels.
Clinical directors are on track to deliver £4.6million efficiency savings across a wide range of areas including negotiating with acute providers to have some services provided in the community at reduced tariff prices. The experience of those involved is relevant to the development of GP commissioning consortia.
How it works
Each polysystem is managed by a board of local GPs which is responsible for commissioning services. A clinical director oversees the work of each polysystem, agreeing strategic direction and alignment with delivery and quality, innovation, productivity and prevention objectives through a PCT-wide Clinical Commissioning Board. Their objectives are to promote health and well-being within the community, maximise quality of life and independence for people with long term conditions and improve services for people with non-critical acute care needs. Five community-led panels meet bi-monthly with clinical directors to shape commissioning decisions. The polysystems now control most of the borough’s £400m commissioning budget.
NHS Redbridge has worked with a software company to develop an advanced risk stratification and information management system that supports and informs the work of the polysystems.
What has it achieved?
To date, clinical directors are on track to deliver £4.6million efficiency savings through reductions in outpatient visits, medicines management, full utilisation of independent sector treatment centre contracts, negotiation of out-of-hospital contracts with acute providers at reduced tariff prices, new out-of-hospital contracts with new providers for assessment services and a reduction in emergency care activity.
Child immunisation and breastfeeding rates are up 10% on last year, 2,500 patients with a high risk life-long condition have had their use of secondary care mapped to provide more effective care and there is more effective referral management for first time outpatient appointments. London’s first purpose-built polyclinic has attracted more than 1,000 new patients, also accommodating up to 300 outpatient appointments a week.
NHS Redbridge believes the polysystem scheme can offer clear lessons for the implementation of coalition commissioning policy:
- Commissioning, or rather investment decision-making, happens at many levels.
- It is essential to understand what good care looks like at a practice level and how we agree the standards and measures that will deliver this for individual patients.
- A locality or polysystem focus is critical to bring together and manage a federated primary care workforce, with a geographical focus to improve out of hospital and primary care delivery. In Redbridge, a 50-70,000 population was felt to be about the right size for this – the workforce together commit to the standards of care.
- System leaders can then come together at a higher level to manage hospital commissioning risks and consider how whole journeys of care are transacted across the healthcare system with a focus on types of care for populations rather than individuals.
- This is enabled by technology that delivers robust, reliable and near live data to enable care and commissioning decisions, with universally agreed data standards which cover process quality, patient and clinically defined outcomes and cost. This requires continuous measurement and presentation in a format that all clinicians understand.
- Behavioural change and improvements come about by harnessing what is important for the clinicians, which is generally patient care and quality, not short term financial incentives.
Further information
If you would like further information on this case study please contact Elizabeth Wade, Head of Commissioning Policy and Membership at elizabeth.wade@nhsconfed.org