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In conversation with Dr Sarah Schofield

In conversation with Dr Sarah Schofield
14 March 2017

Q. What were the biggest achievements for your clinical commissioning group (CCG) in 2016?

A. The whole CCG pulled together to deliver a break-even position in our finances at the end of 2015/16. All of our practices are part of GP federations and are working on new models of care. Many of the new services, for example care navigators, have been reviewed by Wessex Academic Health Science Network and found to be of high quality and cost effective.

Q. What are your biggest challenges at the moment?

A. Getting clinical engagement embedded in sustainability and transformation plans (STPs) – there is enthusiasm but no specific role in governance structure.

Q. How do you think these will be overcome?
A.Persistence is key. Identifying local leaders and enthusiasts from younger groups of GPs who have their futures to invest in. We must also keep patients involved.

Q. How do you think new models of care will develop over the next 12 months?
A. We must identify ‘what good looks like’. The money must be freed up from secondary care to develop primary care.

Q. How can integrated primary and acute care systems improve care?
A. By uniting primary, community and acute care systems (and sharing finances), there will be incentives for everyone to move patients safely through pathways. It will reduce spend on counting, coding, chasing paperwork across boundaries, and release funds for staff.

Q. How confident are you that STPs can deliver efficiency savings?
A. I think STPs will deliver efficiencies in areas where they are well funded, have long-term relationships in health and social care, and have CCGs that all use the same providers. I think they will be less successful in complex systems with multiple trusts that have been encouraged to compete for years, in areas where there has been lower funding, and where there are new relationships between health and social care.

Q. What problems do you expect CCGs to face when they implement the STPs?
A. Management of risk is a huge challenge. Trusts believe their regulator wishes them to achieve their own financial priorities instead of financial balance across the system. If we are unable to change the risk approach to one of ‘everyone is in it together’ the CCGs will struggle with implementation. Clinical staff will need to deliver the changes, so helping them to believe in the plans is very important.

Q. What impact, if any, do you think you have made for your patients’ lives?
A. Beyond the differences I make as a front-line GP, I have led a large group of clinicians in an organisation that has improved patient services and pathways. For example, the CCG purchased equipment for each of our practices that measured blood pressure and also identified if the patient has an irregular pulse suggesting atrial fibrillation (AF). The practices were trained to optimise management of ‘new AF’, which has resulted in over 60 fewer strokes in the first nine months.

Q. Is there anything you want to achieve in the next 12 months?
A. I have set up a clinical leaders group to ensure the future STP developments are clinically led.

Q. If you could improve one thing in healthcare what would it be?
A. I would like to eliminate avoidable errors – clinical, administrative and financial. This would make a difference to the stress our patients and staff cope with.

Q. What are the biggest problems CCGs face?
A. Instability of primary care – if primary care falls over, our hospital services will collapse. Financial instability is another issue. There is an increasing focus on structures and form, rather than function as part of the discussions of the STP. We must deliver change across our NHS systems and the right form of organisation should fall out of these steps.

Q. How do you think vanguards are developing?
A. We are one of the vanguard areas so I have seen the development locally. There is a lot of learning needed to ensure sustainability and good governance but there is enthusiasm from local people as well as GPs for the new vanguard model.

Q. How can mental health services be improved?
A. Mental health needs as much attention as physical health. The public’s understanding of mental health problems is limited because there has been so little coverage of it. We have increased our investment. We have two clinical directors in mental health. They work with our commissioning management team, patient groups, the voluntary sector and local clinicians. We host commissioning of mental health services on behalf of neighbouring CCGs. Parity of esteem is embedded in the board’s approach to improving services.
I am the CCG chair, representing local CCGs, sitting on the advisory board for the new mental health clinical strategy. And we work closely with our local mental health trust to support quality improvement work.
There is a long way to go, but we have made an enthusiastic start.

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