NHS Alliance PPI Network Lead Georgina Craig gives The Commissioning Review an outcomes-based commissioning case study from Slough CCG
Outcomes-based commissioning is about strategic change management. It requires commissioners to give up ‘control’ and hand the baton for implementation to providers and communities, creating space for innovation.
So how might it apply in primary care and to co-commissioning? I believe it is all about involving the community.
NHS Alliance PPI Network Lead Georgina Craig gives The Commissioning Review an outcomes-based commissioning case study from Slough CCG
Outcomes-based commissioning is about strategic change management. It requires commissioners to give up ‘control’ and hand the baton for implementation to providers and communities, creating space for innovation.
So how might it apply in primary care and to co-commissioning? I believe it is all about involving the community.
Commissioning that is deeply person-centred; engages GPs in questioning their own preconceptions AND keeps them on board, so they own community led change that is worthy of celebration.
That is why I want to tell you about the work that Slough GPs have been doing with their community. Like everyone, Slough need to make a fundamental shift in the way general practice behaves and supports people to keep well.
To explore how to deliver change, Slough applied to the ‘PM Challenge Fund’. Dr Jim O’Donnell, clinical chair of Slough CCG, worked with the 16 Slough practices to support them to develop Slough’s bid, determined to ensure that:
– GPs better understand what matters to the community.
– The community helps define how funding is spent.
– Changes are innovative and sustainable.
– Changes empower people to cope with life and care for themselves.
With Experience Led Commissioning support (ELC), the CCG introduced a co-design programme to help them deeply understand what matters to people in Slough. Working with GP patient participation groups, the community asked: “What can happen because we work together to improve the support that people living in our community get from primary care services to keep well and live life to the full?”
The CCG then presented the community’s vision to the GP community and made a direct contrast between what the community valued – solutions that were generally more sustainable – and what GPs had determined on their own.
These insights shaped the final bid. It was successful.
On-going engagement: On 15 May, all practices engaged in a further conversation with people who use services. In practice waiting rooms, over 550 people shared their stories of keeping well. Analysis will support design of a change and final outcomes framework for commissioning a new approach to primary care provision.
As well as application of demand management systems like GP led telephone triage, new solutions include:
– Peer support linked to practices: infrastructure support commissioned by CCG to develop peer support for people living with LTCs, carers and older people led by trained volunteers; supported by PPGs
– Simple Words Training: to spread use of a new lexicon, co-designed in Slough by doctors and community
– Group consultations: training and mentoring for clinicians and facilitators to support group consults with people with LTCs (up to 12 per group consult)
– An urgent mobile number for a known GP or nurse and permission to call 24/7 for people at high risk of hospitalisation
– Pester power driving service use: education in schools; with lesson development funded by the CCG so children educate their parents on how to use NHS services well
Why community involvement adds up
Financial benefit has come from better insights shaping better commissioning and service redesign.
Compare investment plans developed within community input versus what was finally submitted to PM Challenge Fund:
Before talking to their patients, GPs and commissioners planned blanket seven day working, from 8am – 8pm.
However, people said they really wanted:
– Access to a mobile number and permission to call in an emergency (reassurance) for families coping with complex health needs.
– A two hour ‘open access’ session every day and MAYBE one session at the weekend.
– Flexibility; longer and shorter appointments; different formats like group consultations, telephone, email; improve and build peer support.
The community’s ideas are more sustainable and less costly. It is a great story and it challenges us all to stop, listen and learn before we assume we have the best solution.
We look forward to sharing the next chapter as the story unfolds.
