16649 Commissioning Newspaper-A4_Layout 1 04/08/2015 15:44 Page 7
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said. “A more business-minded
approach does not mean you have to
become a business. There is a
misunderstanding about what
becoming more business-like means;
it doesn’t mean having to be
aggressive.”
Dr Rati said there is still some reluctance
to be innovative: “There is a sense that
many are expecting the new vanguard
sites around new models of care will
develop all the answers but all areas
should be developing their own local
answers to local problems.”
Dr Johnny Marshall agreed and said that
although innovators wanted to be able
to develop models of care – regardless
of which provider delivered that care –
patients often still assumed that hospital
settings were the most appropriate
place in which to be cared for.
“How do you get leaders to invest in
care outside the hospital and disinvest
in hospital care when patients may still
turn up at the hospital?” he said.
Dr Jonathan Sergeant, clinical director at
Brighton and Hove Integrated Care
Services (a Prime Minister Challenge
site) and a member of NHS Alliance’s
national executive, said the challenge
was to bring the right people to the right
place at the right time with the support
of the right technology. This might be at
home, the supermarket or at school but
bearing in mind that ‘where’ is where
people want ‘where’ to be.
Making the general special
Dr Ribchester, said we should be
looking at giving generalists ‘specialist’
skills, for example training practice
nurses to spot cancer recurrence. Also
key would be to identify a care
navigator and to make greater use of
community pharmacy – an underutilised resource and especially
important in the review of complex
and elderly patients on more than 10
medications. Whitstable Medical
Centre employs 30 consultants – 20 of
them directly, including gynaecologists
and dermatologists.
All new models of care should
consider how to facilitate far greater
self-care and self-management and
drive prevention; how to manage
urgent care more effectively, deliver
wider screening services and early
diagnoses, reduce bedded care and
harness new drugs and therapies.
Care will not be delivered solely by GPs
but should be the collective
responsibility of all trusts, including
ambulance, and should encompass
social care, hospices, and the
voluntary sector.
Dr Rati pointed out that none of the
above would work effectively without
greater data sharing and broadening
access to patient records. And while
much data is available, we need it to
work much more intelligently. BICS, for
example, already shares summary
care records with its 18 community
pharmacies, and employs Cognitive
Behavioural Therapists. Dr Sergeant
emphasised the need for
commissioners to look at a holistic,
patient-responsive system.
Summary
All agreed that the starting point
for new providers, and
commissioners, must be a shared
culture that focuses on patient
need. A system that has
traditionally been frightened to
decommission and simply bolts
on new thinking is no longer fit for
purpose. Thinking must be brave
and bold, and supported by
equally brave and bold actions.
The centre must be prepared to
consider new funding models and
to encourage and incentivise the
innovation it demands.
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