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Culture club

Culture club
22 May 2013

Sandwell and West Birmingham clinical commissioning group (CCG) serves a very diverse inner city population of 525,836, through five smaller local commissioning groups with 110 GP practices as members.

Sandwell and West Birmingham clinical commissioning group (CCG) serves a very diverse inner city population of 525,836, through five smaller local commissioning groups with 110 GP practices as members.

The CCG is one of the few that straddles traditional local authority boundaries, a configuration which has made absolute sense for it as it’s built on years of working together.
Its population includes two of the most deprived wards in the country – inner city Birmingham and Sandwell. Social deprivation is a major factor in determining the poor health of our communities. People continue to have poor health compared with the rest of Birmingham and the nation as a whole. More than 100 languages are spoken with different communities requiring healthcare delivered in a way that is sensitive to their needs and changing demands. Good progress is being made at transforming the way in which healthcare is delivered against this challenging backdrop.
Sandwell and West Birmingham is a first wave CCG and was authorised with no conditions as a new statutory organisation at the start of April 2013. The CCG is eager to recognise that it inheriting the legacy from the Right Care Right Here partnership, a major transformation programme for their local economy. For more than 10 years, commissioners, providers of health and social care services have been working together on a shared vision for their patients. 
This partnership provides clear strategic leadership for the healthcare system and a consistent view of what is required to transform care. The partnership includes commissioners, providers (acute, mental health and community) and two local authorities.
GPs and clinicians have played an instrumental part in leading changes for many years. The partnership has seen a real and tireless commitment to improve healthcare services for this population.
A decade ago, four shared objectives were agreed:
  • To bring more health services to local community settings so that care is delivered closer to home
  • Ensure that people have the opportunity to benefit from healthier lifestyles
  • Ensure that all health services meet the specific needs of local people Deliver a new smaller specialist hospital Midland Metropolitan Hospital in Smethwick

This style of shared leadership is now more commonly seen across the country, but 10 years on, members of the CCG and its partners are still working closely together to improve health right across the system. A large number of modern primary care health centres have been built or older buildings modernised as part of this work, to improve the range of services offered in primary care.

A six storey high health centre has just opened its doors near the Bull Ring in Birmingham serving the large number of new flats in the regeneration area of Attwood Green.
New services are also being delivered locally with patients already benefitting from specialist clinics in a number of GP surgeries such as dermatology and gynaecology.
GPs have actively been involved in devising new pathways to ensure that
as much of the pathways are delivered locally as possible and appropriate. Working together with Sandwell and West Birmingham Hospitals Trust, the economy is creating an environment that sees the local hospital concentrating on specialist services with fewer beds and alternative ways of providing care in the community.
Their prevention approach is also ambitious with schemes such as the award winning Be Active scheme helping to encourage residents to choose healthier lifestyles in Birmingham. More than 300,000 members actively use free council leisure facilities to help shift the obesity bulge. It is no surprise that many of the leaders of the CCG were involved in commissioning roles in the past within primary care trusts (PCTs). I was a clinical director of commissioning for three years in the PCT as well as being involved in practice based commissioning and all local commissioning group board chairs had a number of clinical leadership roles.
When the reforms were announced for clinical commissioning, the GPs saw this as a natural next step on the commissioning journey. The CCG is committed to working in partnership, hence its vision of “Healthcare without boundaries” and one of its five sub-committees is devoted to partnerships, ensuring that wherever possible, the CCG looks to deliver with others where it makes sense to do so.
People are living longer in the area than previously but life expectancy remains short compared with other places in England. Infant deaths, premature deaths from heart disease, diabetes, stroke and cancer are the main causes of life years lost and low life expectancy which varies ward to ward.
The CCG believes that its membership approach, with strong ownership and understanding at ward or local level, will enable it to really get to the bottom of what is required for different communities it serves. We are acutely aware for example that language, religion and cultural beliefs influence the way our patients access lifestyle, prevention and treatment services. As part of the Right Care Right Here approach, we have well established clinical strategies around the ideal models of care for our patients agreed by all organisation. Each strategic model
ensures that where it is possible we bring out services into primary
care or community settings, leaving the hospital to concentrate on specialist acute services. This fits in with the needs of our patients who often need wrap around care – not just for their immediate condition – but a complex range of needs that also need to be considered.
Linked to deprivation, the population has substantial mental health needs support and the CCG. Within the CCG, clinical leads such as Dr Ian Walton are driving forward improvements in mental health, moving towards a more primary care based model. Dr Sam Mukherjee, who chairs their quality and safety committee, also led a programme across the local commissioning group to make improvements around patient experience for areas such as standards around communications using mystery shoppers and customer service training.
The CCG remains committed to changes big and small across the healthcare economy. There is a balance to be had between things which need to be delivered together as a range of healthcare organisations and things that are better delivered locally.
For example in the area covered by the CCG, patients can choose from a wide range of NHS provider organisations including eight hospitals. One area of improvement that the CCG is actively involved with is driving forward a shared basic information record between all healthcare providers to not only improve quality of care but also realise efficiencies and minimise risk for patients who use a number of providers.
With 10% of the healthcare budget spent on medicines, intensive local effort by practices for medication reviews, use of appropriate generic medicines and improving prescribing practice, have brought about substantial savings in the last few years. This money has then been able to be re-invested in patient care.
We feel that these reforms present an exciting opportunity for us as clinical commissioners – our practices have been involved in improving health quite often for generations and we are a continuity link between the different organisational forms seen during NHS changes.
Our passion for patient care means that we have always worked with whatever organisational form exists to drive forward improvements in healthcare. Clinical commissioning groups provide a real chance to bring about healthcare that is truly delivered from the grassroots, built on communities and local knowledge.
Done right, they should be able to move quicker at local changes to health and populations, something important for our area where we do see community changes.
To be successful we will need to break through traditional ways that services have been delivered in the past. It is clear from understanding our patient’s needs at local level, that unless we get the balance right between local and strategic, we won’t achieve the improvements in health.

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