Try asking GP colleagues what QIPP stands for. They might guess 'quality improvement programme for patients', but most will not have a clue. But for NHS and GP commissioners, Quality, Innovation, Prevention and Productivity (QIPP) has been, or should have been, dominating commissioning plans for the past two years.
QIPP targets are the basis on which the NHS is expected to contain rising costs and stay solvent. For that to work, GPs must adopt innovative approaches to healthcare in productive ways, preventing people with long-term conditions from deteriorating, while providing good quality care.
QIPP targets can only be met if frontline NHS teams put them into practice. SHAs now hold PCTs to account as far as QIPP targets go.
SHAs have agreed 'system' based QIPP plans with the clusters for the next four years whereby health and social care organisations, providers and commissioners redesign local care and care pathways for patients to receive high quality services, within the funding constraints of the NHS.
Consortia will take their share of responsibility for meeting these targets - which they can only achieve if GPs and practices in turn co-operate or, better still, conceive, drive and deliver change.
Problems for consortia
It will be difficult for consortia to 'own' QIPP targets that they did not set.
Local PCT/consortia QIPP plans may focus on reducing patients' needs for secondary care services, redesigning healthcare services, prioritisation and rationing of services (for example, reducing ratios of follow-up to first outpatient appointments) and management costs. As an example, in Stoke-on-Trent, the GP consortium is responsible for delivering £15 million QIPP savings in relation to the around £420 million commissioning budget for 2011/12.
Cuts, not innovation
While the word 'innovation' is rarely heard in relation to QIPP targets, 'cuts' is. All the above examples depend on GPs working effectively. That might mean referring only those patients they cannot manage in general practice, with maximum access to diagnostics not duplicated in secondary care. Or it could mean practice teams delivering effective health promotion or having easy access to local services.
Another example is community services and social care working in sensible, integrated ways with practice teams without barriers.
- Professor Chambers is a GP and a board member of Stoke-on-Trent commissioning consortium and honorary professor at the University of Staffordshire.