Stockport primary care trust has pioneered a model for assuring quality of provider services. Rebekah Cresswell explains
Following Commissioning a Patient-led NHS in 2005, there was uproar among some healthcare professionals, managers and unions over the proposal that primary care trusts should no longer directly provide clinical services.
The issue was debated so much that then health secretary Patricia Hewitt withdrew this aspect of the policy, saying PCTs could choose whether to stop providing services.
This went some way to allaying anxiety, but the direction of travel has remained to ensure services, and in particular PCT 'hosted' services, strive to deliver a better service that meets patients' needs within a quasi-market by introducing competition and contestability.
Although PCTs are working to meet these challenges it is difficult, particularly as many have merged during this period. But whether an organisation has merged or not, most have been subjected to organisational restructuring, which has led to a change in power dynamics.
Community-based services, traditionally provided by PCTs, are increasingly under the spotlight in relation to best value, efficiency and quality. Provider services are trying to carve out an organisational identity and develop organisational citizenship to establish themselves in their own right.
Although Stockport PCT was not affected by merger, it took the opportunity to radically alter its internal shape and working arrangements of the organisation. Stockport Provider Services has developed a service-level agreement with its host PCT and commissioners that not only details performance requirements and targets, but includes quality schedules for services provided. Within this framework, Provider Services has negotiated an incentive scheme with commissioners in relation to essential and enhanced targets.
At the inaugural meeting of the North West PCT quality forum at the end of July, there was a sense of people being proactive, but essentially feeling their way in the dark. For over a year Stockport Provider Services has been thinking about how to develop a quality assurance system that will not only ensure it is meeting standards and the key performance indicators, but how services build on the developmental standards and how they can use this information to market services as preferred providers and performance-manage important areas of activity.
The result was a service review engaging frontline staff up to very senior management. This involves collecting evidence, assessing the service against the core standards set out in Standards for Better Health, identifying areas of good practice and opportunities for development and forming action plans; as well as performance and benchmarking measurements.
A clinical governance toolkit has been developed that allows services to collect evidence to demonstrate how they are meeting Standards for Better Health. The evidence is then used in a two-yearly service review. This is a holistic assessment likened by some to the MOT and has proved extremely useful.
A service review proforma has been designed with measurable criteria for each core and developmental standard. At the back of the proforma, there is an index to organise evidence and templates for action plans. If a service identifies gaps in its compliance with the core standards, it draws up an action plan and has a year to implement it.
Each service is also asked to submit an action plan on one to three developmental standards between reviews. The action plans are then monitored via Stockport Provider Services' Standards for Better Health committee.
The data from the service reviews goes onto a database which, at a glance, can show levels of compliance for all the standards. It can be used to monitor progression, set business objectives for services and be used as quality assurance data to commissioners.
Stockport Provider Services is now a quarter of the way through its service review programme and the process has proved a success. It has also fed into other parts of the organisation and the development of strategies and demonstrates a well-managed, well-governed organisation.