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Commissioning: GP-led NHS - East London PBC network's success

Will our strategy fit in with the new GP consortia?

A market stall was used to promote healthy living, including handing out vouchers for fruit and vegetables (Photograph: istock)
A market stall was used to promote healthy living, including handing out vouchers for fruit and vegetables (Photograph: istock)

NHS Tower Hamlets was one of the first PCTs to recognise and deliver on the need to invest in primary care to improve outcomes.

In 2009, it ploughed significant investment into creating GP networks to deliver care packages to its population of 230,000. Eight practice-based commissioning networks were formed, with each network consisting of four or five practices that collaborate and work together to achieve outcomes for specific care packages.

Now, the White Paper has left us wondering how much of the Tower Hamlets set-up will survive when commissioning consortia take off?

Performance managed
Our own Poplar & Limehouse network is dynamic and performance-managed and has successfully achieved diabetes and immunisation targets, which are priorities for our combined population of 38,000.

Until the DoH puts flesh on the bones of its GP-led NHS plans, the questions we do not have answers to include how big will consortia need to be and whether there will be GP provider groups (like our network) from which consortia can commission care.

We must wait and see, but if our network's practices can continue to work together, then our aims and objectives can be met.

PCT funding in 2009 provided each network with management infrastructure to oversee collaboration between practices and with local stakeholders such as borough councils, schools and charities.

This also enabled good practice, clinical knowledge and leadership to be shared within networks. The networks are geographically-based and aligned with local area profiles.

Our network initially agreed two care packages: for diabetes and childhood immunisations.

The packages were designed to ensure good clinical leadership from primary care clinicians to hospital consultants and specialist nurses. One of the keys to success was ensuring transparency of data to see how we were doing as a collaborating network and where help might be required. This provided the foundation for an integrated, coherent approach.

As the main care package, diabetes care was heavily funded. Outcomes data now coming through shows improvements in parameters such as BP control, lipid management and HbA1c as well as patients engaging more with personalised care plans.

Secondary care rapport
Another major benefit is from reduced use of secondary care, cutting costs-duplication. This has required closer working with secondary care colleagues to build good relationships.

We have regular meetings to update progress within networks and to troubleshoot problems with our workload. This has enabled secondary care to do what it does best: provide specialist care to the most complex patients.

This approach has reduced variation in care delivery and improved integration of the multidisciplinary team. Patients can access care developed locally for local needs. Specialist services such as dietitians, specialist nurses and phlebotomy are provided at practices instead of at distant central locations.

Good positive data early on are encouraging, and the outlook for long-term outcomes yet to be measured statistically is promising.

Funding primary care directly can be efficient and can improve patient satisfaction. Patient involvement with personal care plans increased from 2 per cent initially to more than 50 per cent for plans patients have facilitated and agreed to. Health parameters are also improving.

The funding model is similar to local enhanced services but with stricter performance management targets. This has incentivised practices within each network to work collaboratively, because performance is linked to network achievement as a whole (rather than individual practices') and is based on outcomes, patient experience, access and process management.

Interestingly, better health parameters are often achieved by smaller practices providing more personalised care.

PBC networks

PCT NHS Tower Hamlets

Networks Eight, all aligned with local area profiles.

Our network Poplar & Limehouse; five practices, 38,000 patients.

Initial care packages funded diabetes and childhood immunisations.

Diabetes targets Across network: outcomes (BP, lipids, HbA1c), patient experience, access and process management. Monthly meetings with secondary care clinicians and nurses.

Childhood immunisation targets Across network: more convenient access and improved uptake.

Children's centres
With immunisation care, children's centres have been established in the borough and provide a range of services for young children and families. We already had a good relationship with midwives and health visitors, so expanding this to collaborate further with children's centres has resulted in improved immunisation uptake.

One highly successful event was taking a stall in the local market alongside the children's centre on a weekend. This attracted local people with fun activities and provided advice on immunisation and improved access to immunisations. We also took the opportunity to promote healthy eating and by handing out vouchers to exchange at the fruit and vegetable stalls to foster community links.

Our network has also partnered with local leisure centres, workplaces, community centres and schools to promote the 'healthy weight, healthy lives' strategy.

Tower Hamlets is one of nine 'healthy towns' in England (the only one in London). It has tackled wider obstacles to achieving healthy weights by improving access to open spaces, safer routes for walking and cycling and tackling the proliferation of fast food outlets - a similar strategy has been used to develop smoking cessation services.

The Poplar & Limehouse network has also won a bid for local health trainers - a massive boost for our patients in the areas of smoking cessation, exercise, weight loss and motivation.

In a year, the network has achieved a staggering amount by working together for the benefit of our local health economy. In the post-White Paper world, hopefully the Tower Hamlets approach to better healthcare can be expanded.

  • East London GPs Dr Osman Bhatti is a member of, and Dr Luise Parsons chairs the Poplar & Limehouse network board. Chris Ley is the network's manager

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