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Sorting the consortia

Sorting the consortia

Insight: Consortia
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Election and pathfinder status
Clinical cabinet members were elected by their fellow GPs in
Bexley, a model backed by the British Medical Association.
Twenty-eight out of 29 practices in the borough voted to
decide which GPs will take responsibility for delivering health
services in the area.
Bexleyheath GP Dr Howard Stoate, a former Labour MP, was
elected chair, along with four other clinical cabinet members.
Around the same time, Bexley GPs were named as one of
the first groups of GPs selected to be a GP pathfinder during
a visit by Health Secretary Andrew Lansley.
All practices in the borough are represented by the clinical
cabinet, with each locality lead representing GPs in that area
of Bexley.

Future focus
In the next year, we plan to take the first steps towards that
future, by making major changes to care for three types of
patient: those with long-term conditions; the elderly; and
those needing unscheduled care. In each case, we want to
put primary care at the forefront, working with experts across
secondary care and the community.
To support those changes to care, we will make
improvements to how services are organised, particularly for
hospital and other acute care, and also for primary care – for
example to the way we collect and use information.

We will improve how we work with patients to manage
long-term conditions. That will improve outcomes, give
patients a better experience and cut costs. We are planning
to focus first on 'high-impact pathways', such as diabetes and
COPD, introducing a whole-pathway tariff and reducing the
need for acute admissions.

We aim to make four main changes:
Reduce hospital admissions
Identify the most regular users of hospital services,
then stratify them according to complexity of need and
commission services to meet those needs. We will use active
case management, personalised care planning and support
to self-care through technology such as Telehealth, a system
which helps people manage their condition at home.

Manage chronic conditions
Long-term conditions (LTCs) are both a health and social
challenge for patients, and require a co-ordinated approach.
We will use our Joint Commissioning Unit (JCU), a shared
mechanism between the consortium and Bexley Council,
to ensure that health and local authority funding is used
collaboratively and effectively to deliver a cohesive system of
support for our residents with LTCs.

Improve care of older people
We will help them to live free of illness for as long as possible,
and will provide an integrated and financially viable solution
to unscheduled care. We plan to bring together the care provided by Accident and Emergency, out-of-hours services,
the London Ambulance Service, walk-in centres and GP
practices to care seven days a week.

Proactive community care
We want to have proactive high-quality care in the community,
which eliminates unnecessary stays in hospital, coupled with
quality care in hospital that minimises the time spent there.

Unique practice
Bexley's Primary Care Chest Pain Clinic sees patient from
deprived areas travel to Harley Street for specialist heart scans.

The process, which uses a newly-developed Aquilion ONE
CT 640 slice scanner, is performed in Harley Street by the
European Scanning Centre. A complete examination takes
seconds, and gives doctors vital information that cannot be
obtained through traditional diagnostic tests.

The process creates 3D images which gives doctors
an accurate picture of whether a patient has coronary
heart disease, as well as information to decide on the best
management plan.

It has reducing waiting times and avoiding unnecessary
invasive angiograms and other less accurate, non-invasive tests.

Bexley's new cardiology service is made possible through
practice-based commissioning, the forerunner to consortia.
More than 80% of chest pain has no cardiac origin. Bexley's
scheme, with a cardiologist at the frontline and improved
triaging, ensures that only genuine cardiac pain is treated. It
provides a better service for all patients, at a far lower price.

Vital statistics

Area information

Population: 220,000.
Health: In line with national outlook, 70% of people say they
are in good general health.
Demographic: It has an ageing population, with around 15%
aged over 65, compared to 12% in London as a whole. Bexley
has affluent areas, as well as pockets of deprivation.
Recent health campaigns have focused on smoking, obesity
and healthy lifestyle initiatives to address a rise in long-term
conditions.
Finance: The Care Trust is to break even in 2010/11.
Expenditure for 2010/11 is £347m.

Shadow board composition
Dr Howard Stoate – Chairman.
GP since 1982 and a partner at Albion surgery.
Dr Varun Bhalla – North Bexley member and a partner at
Belvedere Medical Centre in Bexleyheath for more than 20
years.
Dr William Cotter – Clocktower member and is a senior partner
at Bellegrove surgery in Welling.
Dr Sid Deshmukh – Frognal member and a senior partner of
Sidcup Medical Centre.
Dr Günen Üçyiğit – member appointed by salaried GPs based
at Bursted Wood surgery in Barnehurst, south-east London.

Dr Howard Stoate
Bexleyheath GP

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