IN ACTION CASE STUDY
“raison d’etre”, he says, is training and quality. Indeed, his practice, Shakespeare Surgery, where he is a partner with two other GPs, was the first single-handed training practice in the North West and his team worked closely with the PCT to set up a group of clinicians focused on improving quality across the locality, particularly around pathway design and implementation. It was a natural progression for him to move on to practice-based commissioning, at a time when the Framework for Procuring External Support for Commissioners (FESC) process was underway. “It allowed the PCT to really engage with clinicians,” Dr Dalton remembers of PBC. “Historically, at that stage, we had been held at arms-length and we were part of the problem, not the solution, and that allowed us to get into the [commissioning] space.” As part of this process, a number of local practices started to group
together to form groups covering around 50,000 patients each, which began meeting on a monthly basis. “[To date], GPs have been peers, but have been suspicious of each other,” Dr Dalton explains, “by getting into a room on a monthly basis and to talk and exchange ideas, it starts to build a different ethos of trust and cooperation.”
SHARING AN UMBRELLA This cooperation and trust would become beneficial when those groups would merge to become five localities under Wigan Borough CCG. In the first wave of pathfinder applications, five localities in the Wigan area had applied to become separate CCGs, but were unsuccessful. Four of the five came together under a federated application for the third wave of pathfinders and it was accepted. The fifth locality – United League Commissioning – has since joined forces with Wigan Borough due to receiving a few red flags on its first gateway assessment. It’s been important to the ethos of the CCG to keep those locality groups under the larger umbrella brand, and they have been careful to formalise that federated agreement. “For us, CCGs are [built] around practices working together,” says Dr Dalton. “You can’t put 52 practices into a room; you can put 10 or 15 into a room and have some genuine dialogue.”
A MANAGER WITH A DIFFERENCE
Putting these ideas into play takes good management strategy, and this is where Anderson comes in. Her background is in health and local government, previously working for the council as a director of children’s services. She came over to work for the PCT as deputy to its chief executive, who was also heading up the local authority as well. She’s local too, having worked in Wigan for 25 years and knew many of the stakeholders already. Anderson, Dr Dalton and the rest of the CCG’s commissioning board
felt it was absolutely imperative to treat the commissioning group as a new organisation, and not get hung-up on how things used to be under the PCT. This comes down to setting different value sets and cultural aspects inside the organisation, while putting quality, clinicians and patients at the heart of every decision.
MORE THAN JUST PATIENTS The group is also very focused on integrating services across the entire spectrum of health and social care. This is an ambition they share with the local authority, which also happens to be housed on the same floor of the Wigan Life Centre, making it logically a lot easier for the CCG to collaborate with them on services. It also means that the people of Wigan are not just treated as patients by the CCG and residents by the local authority, but citizens who have a right to live comfortably. Integration lies at the heart of this ethos.
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