Agenda item

A representative of Stockport Managed Care Consortium attend the meeting to discuss progress with developing GP lead commissioning in Stockport as part of NHS Reform.

The Scrutiny Committee is invited to discuss issues raised during the presentation.

Officer contact: Richard Popplewell, 0161 426 5001, Richard.popplewell@stockport.gov.uk

Dr Ranjit Gill, Chair of Stockport Managed Care Consortium, attended the meeting to update the Scrutiny Committee on preparations for GP lead commissioning in Stockport as part of the reform of the NHS.

Stockport had been selected as one of a number of Pathfinder pilot area/ early implementers of GP commissioning, building on the Practice Based Commissioning that had already been taking place in Stockport.

Dr Gill highlighted the following issues:-

• It was proposed that the current SMC would cease to be a company from March 2012 and would become a sub committee of the Primary Care Trust cluster, which would be possible as a result of legislative changes. This would allow for transitionary arrangements and structures to be created to transfer functions from the existing PCT to the future commissioning structure.
• A scheme of delegation had been agreed with the PCT Cluster Locality Board for Stockport which would allow £400m to be commissioned through the new structures.
• To facilitate patient involvement in commissioning and oversight each Practice would have a ‘Patient Reference Group’ (PRGs) through which practices seek feedback on services but also provide information about decision making. In many cases this engagement would be ‘virtual’ and take place through electronic means.
• Practices would be clustered for a particular locality, with each practice nominating a lead who would then elect a Locality Chair who would then form part of the Oversight Group which would monitor the decisions of the commissioning Executive. A member of one of the PRGs would also be elected to this Oversight Group, which would also include a representative from Health Watch and from the Council.
• A Group composed of clinical leads would also be formed to advise the Executive on its commissioning decisions.
• The Executive itself would include GP Executive Members and directors of the commissioning organisation. Following the Listening Exercise it was also planned to include at least one member of public, care, health professions (such as a consultant and nurse from a hospital out of area) and a representative of Public Health to reflect the challenge of reducing inequalities.

Councillors asked questions and made comments on the presentation, and the following issues were raised:-

• The involvement of the public in discussions and decisions about commissioning should make explicit the limits of what the NHS could provide. In practice, engaging the public and in particular vulnerable service users may be difficult.
• The key to improving outcomes would be to improve lifestyles and ‘anticipatory care’, which would mean more effective use of resources.
• It was important to ensure that Stockport gained from the changes to the NHS. Meeting the projected £80m shortfall in funding and improving outcomes at the same time would be a test of the success of the changes.
• Stockport had a culture of GP engagement in commissioning which would help ensure a smooth transition to the new arrangements.
• It was anticipated that the cost of the new commissioning arrangements would be less than the current cost of most PCTs. The ambition was to build on the strengths of existing GP practice and to integrate more IT, information and community services across the borough and to shift the balance of spending away from reactive hospital spend to preventative/ community based spending.
• It was recognised that there were very good facilities in many communities, but there remained serious inequalities. The challenge was to work more collaboratively with partners to address the wider determinants of ill health.
• It was important to involve groups and individuals not currently engaged who should be engaged. Ensuring transparency and openness in decision making would help the public understand the consequences of these decisions.
• Continuing the integration of services between health services and the Council was vital to ensure improving outcomes. The changes to the NHS structure should not detract from this work.

RESOLVED – (1) That Dr Gill be thanked for his attendance and presentation.

(2) That an item be included on the agenda for the March meeting of the Scrutiny Committee for a further update on progress with the development of arrangements for GP lead commissioning.