Foot in both camps

Simon Blackburn
Associate Director of Communications,
Baywide CCG

Despite its location, tucked away on the South Devon coast, and its relatively diminutive geography, Torbay enjoys what is widely seen as one of the country's most progressive health and social care communities.

Simon Blackburn
Associate Director of Communications,
Baywide CCG

In 2005, the Bay's primary care trust (PCT) assumed responsibility for providing and commissioning adult social care services. It directly transferred the employment of social workers to work alongside health professionals and created one of just a handful of Care Trusts in the country.

Now, Torbay's clinical commissioning group (CCG), Baywide, is continuing this tradition and has established a strong identity as an innovative yet pragmatic organisation, which is already testing some of the assumptions of how a CCG should work and turning this potential into actual and positive developments in patient care.

The Baywide board, chaired by GP Dr Samantha Barrell, has recently merged with the Care Trust's commissioning board to establish a committee that provides a strong mix of direct commissioning skill and experience together with the CCG's clinical expertise and drive. With delegated authority from the Care Trust and formal lines of accountability with the NHS trusts in Torbay and wider Devon, Baywide is in an advanced position from which it is already exercising strong influence on local commissioning developments.

This is strengthened further by Dr Barrell's joint appointment, both as Baywide CCG chair and as Clinical Director of Commissioning and Transition for Torbay Care Trust. This 'foot in both camps' approach – Dr Barrell also sits on the Care Trust Board – has not only bolstered the credibility of the emerging CCG from its inception, but is also helping to ensure the smoothest possible transition from the current, PCT-led commissioning structure to the new arrangements.

Beyond its organisational relationships, Baywide enjoys strong engagement with member GP practices through its active role in the locality meetings, where health and social care needs are identified and planned against at a more community-focused level.

A 'buddy' system pairs each board director with an unrelated practice to ensure resilience and cohesiveness across the entire network of practices. The chair of the Bay's Practice Managers' Association sits on the Baywide Board, together with a director-level practice nurse.

Local GPs have also enjoyed seven training and engagement events during the last six months and work continues to establish a strong, accessible communications service – practices are updated in quarterly newsletters, and the Baywide website is now live.

Clinician to clinician relationships across primary and secondary care have been top of the priority list for Dr Barrell and Baywide since day one, and exciting, sustainable strides have already been made towards breaking down the barriers which traditionally exist between practices and the acute hospital.

Two events have taken place with local GPs and consultants from Torbay Hospital, run by South Devon Healthcare NHS Foundation Trust, where very high numbers of clinicians have come together in an educational but informal environment to facilitate and attend workshops covering a range of primary and secondary care topics. Building further upon this success, shadowing arrangements are now in place between local GPs and consultants, providing each a unique insight into the other's domain.

"In essence it's a simple transaction of experience and understanding, but the potential for unlocking patient benefits and system-wide efficiencies is vast," said Dr Barrell.
"In the majority of places, relationships between GPs and consultants have not evolved along with the rest of the health service, despite the opportunity presented with the advent of practice-based commissioning. We are now in a position where this is fundamental to the success of the emerging health reforms and to achieving the fluidity of care across primary and secondary care environments which is necessary to realise the aspirations of the QIPP (Quality, Innovation, Productivity and Prevention) agenda.

"There is a real appetite to work together in Torbay, to create meaningful, patient-centred partnerships which transcend the anonymity of the referral."

There is also appetite to sustain and formalise this approach, with an innovative local Clinical Cabinet – a possibly unique forum that brings together commissioners, community service providers and acute services to give a system-wide perspective to developing and improving care pathways.

Patients are also at the centre of Baywide's structure, with a Patient Participation Group representing every one of Torbay's GP practices already up and running. Hosted by the Local Involvement Network (LINk), the group's terms of reference will give a formal reporting relationship with the board, adding a patient voice to strategic decision making. The group has already been tasked with conducting an examination of pharmacy medicines.

While barriers are being broken down and new organisational foundations laid, Baywide is also hard at work developing and managing frontline projects aimed at addressing some of Torbay's intrinsic health inequalities. The latest Joint Strategic Needs Assessment, developed by the local public health team, has driven a refresh of the CCG's commissioning plan, and each practice is being supported with establishing its own commissioning priorities as part of the GP incentive scheme.

A prime example of Baywide's own commissioned project work is the Targeted Alcohol Case Worker pilot scheme. This required a field-based caseworker to work directly with a cohort of 15 local people whose alcohol abuse has led to psychological, physical health problems, and a high reliance on secondary care services. By providing targeted and individually-focused care, the pilot had a dramatic effect, reducing A&E attendances by 76%, related ambulance activity by 85%, admitted bed days by 89% and an overall hospital tariff reduced of 92%.

The success of the pilot was such that a business plan to extend the work and to offer similar benefits to a further group of high-dependence people has already been established.

Similarly, Baywide's Weight Reduction Scheme – a project of targeted intervention to support a group of patients with a BMI of between 30 and 40 (with no comorbidities) – has been so well received following its initial pilot that places were filled within days when the scheme was extended.

The holistic scheme combines practice-based weight reduction advice and monitoring together with a tailored fitness and exercise programme delivered by a qualified personal trainer.
Eighty percent of participating patients achieved their weight reduction target within six months, with more than 60% percent reducing their weight between 5-10%.

Such examples of success illustrate the uniquely collaborative approach of Baywide's multi-clinical drive, making its day-to-day business about achieving better patient outcomes in response to the real needs of the communities now, while preparing the ground for the most significant shift in power and responsibility since the NHS was created.