How to make clinical commissioning work

NHS Eastern and Coastal Kent has taken an innovative approach in its aim to connect clinicians with the commissioners responsible for healthcare provision.

This is all about matching clinical expertise with managerial know-how

The primary care trust has adopted a new way of working that is bringing the needs of local communities directly into the decision making process for new services.

Over the past six months, 11 GPs have been appointed as clinical commissioners, each working closely with a lead commissioner to help make important decisions about the way care is delivered.

Each lead commissioner and clinical commissioner works as a team to concentrate on just one clinical area - for example, respiratory services or diabetes - across the PCT area.

It is the role of the clinical commissioner as a community based healthcare professional to liaise with other clinicians such as GPs, nurses and consultants, and with relevant organisations, patients and the public to identify local needs and inequalities to influence and shape services for their own areas of specialism.

Consulting with colleagues

Medical director Robert Stewart, who has been trailblazing this way of working, says: “Our new clinical commissioners are consulting with their colleagues out in the community to make sure we are commissioning the right pathways for patients. They have the full support of the practice based commissioners in making sure these new pathways are more productive and will improve patients’ experience.”

Dr Stewart says it has been crucial to get the practice based commissioners to sign up to the concept.

“In addition, it has been important that this new cadre of clinical leaders were not seen as having a GP provider bias but acting as commissioners on behalf of patients. Another essential element was ensuring that the clinical commissioners were not parochial but acting across the totality of the PCT area to build up an understanding of the needs and concerns of all of the practice based commissioners.

“The recruitment process for every clinical commissioner included a formal interview at which each candidate had to prove that they had the right competencies and understanding for their role.

“To help with ongoing development, support is being given via a successful clinical leadership programme.”

According to assistant director of commissioning Alison Davis, this new approach has made a vast difference to the commissioning process.

“This is all about matching clinical expertise with managerial know-how,” she says.

“In fact, it has been so successful that other lead commissioners who do not have a clinical commissioner are now asking for one to be appointed.”

Ms Davis feels it is crucial that two commissioners - lead and clinical - value each other and are able to work in a clinical managerial partnership.

“The clinicians are fundamental to agreeing the proposed pathways in our determination to have a more productive NHS locally.

“The clinical commissioner can then act across the health economy, linking in to our practice based commissioning clusters as well as our colleagues in secondary, community and even tertiary care,” she says.

Ms Davis’s thoughts are echoed by Sheila Pitt, who is head of cancer, long term conditions and therapies.

Ms Pitt says: “It is easy for a non-clinician to make assumptions on what is needed and what will work. A clinician knows just what is needed and just what will work.”

Moving forward

The success of clinical commissioning depends on the active involvement of clinicians at all levels in the process by feeding in issues and helping to develop the solutions.

To do this effectively, the PCT has committed itself to providing clinical leadership training. It is now accepting GP registrars to do four month placements within the PCT to experience commissioning and learn about the PCT’s business. As part of the training, the GP registrars are attached to a lead commissioner and focus on a commissioning project.