Partnership and clinically-led collaboration for practice-based commissioning (PBC) are central to the ethos of NHS Birmingham East and North (BEN).
The PCT's chief operating officer, Andrew Donald, and its clinical director, GP Dr Richard Mendelsohn, take it in turn to explain their approach to PBC and why it works for them.
Andrew Donald: 'Our commissioning work is clinically led and I have a dream team: a hospital consultant, GP Dr Mendelsohn who is our clinical director, and two divisional directors who used to be practising clinicians. The team is not about clinicians becoming managers. Rather, it is a partnership approach, supported by our buddying system.
'My clinical buddy is Dr Pete Thebridge, our professional and executive committee chair. We developed BEN's new PBC scheme together, bouncing ideas around and testing boundaries. Partnership is key. The collaborative relationship between clinician and manager creates great energy, especially when developed over time.
'One of the strengths of our organisation is that we have had the same, stable senior management team since 2005. There is no doubt this has enabled us to maintain strong, energetic and productive relationships.
'This approach and our underlying ethos, which encourages all our people to think innovatively, has taken us to an interesting juncture. We are in the process of procuring one provider to manage end-of-life care. That single provider will manage all the other providers in the pathway, which involves up to 32 individual agencies or providers.
'We think this is unique, and the concept has been driven by the thinking and developmental work of our clinically-led commissioning team.
'Practically, this approach also sits within the NHS Quality, Innovation, Productivity and Prevention agenda. It is a change from our previous model, where we commissioned different aspects of the pathway separately and from different providers, and then spent the next 10 years trying to wire it together.
'I am not saying our system is perfect - it isn't. But I do think our direction is sound. I would like to see continuing clinical leadership and a genuine breakdown of some of the unhelpful barriers. This is not about just looking at what the DoH says has to be done but about being imaginative and working together to do what we need to do for our population.'
Dr Richard Mendelsohn: 'When I am not doing an evening surgery at the practice, I am part of a team supporting strategy and redesign in our PCT - bringing with me an insight into what it is like on the primary care "front line" every day. As a PCT directorate team we have any number of polarities to manage. The demands are complex so while the PCT encourages us to take clinical leadership seriously, clinical leaders can't sit by themselves.
'Partnering is central to our philosophy, whether it is buddying with clinical and managerial colleagues, collaborative commissioning or liaising with the local authority and the third and private sectors. As clinicians our buddies are generally divisional directors - in my case, the director who leads on strategy and service redesign. We work together on a core portfolio but are flexible, and can move focus from planned care one day to acute the next.
'Our underlying team extends further, including numerous specialist clinicians, and we tend to take a transformational rather than transactional approach. Of particular interest to me is the way we communicate and coalesce around long-term conditions.
This involves a wide range of people, some working on respiratory conditions or cardiovascular disease and others on sexual health and HIV issues or end-of-life care.
'I do not believe this crucial work can be done without the input of clinicians. In order to properly understand the population you have to bring the insight of people who have worked at the front line.
'I see it as a natural move along the continuum of care for my population - delivering advice and treatment to patients and then using that experience to deliver insight into providing better services.
'Developing clinical leaders who will support commissioning by supporting clinically literate models of service development is an investment for the PCT, but I do believe it produces the complement of skills and networks that needed to bring about significant change.
'I would like to see us as a primary care clinical workforce driving this agenda alongside our specialist colleagues.
'There is a need to move beyond a state of learned helplessness as clinical leaders to a point where we can partner on a mature basis to manage the NHS - painful as it might be to grow up.'
Working with local GPs
PCT: NHS Birmingham East and North (BEN)
Patient population: 440,000
GP practices: 79 Practices
Healthcare budget 2009/10: £735 million (excluding specialist healthcare)
- Mr Donald is chief operating officer at NHS Birmingham East and North and Birmingham GP Dr Mendelsohn is its clinical director for chronic disease systems