GPs will increasingly call the shots about how and where money is spent in the local health economy, says Conor Burke

The primary care trust is moving ahead with a phased handover of its commissioning function that could eventually see clinicians in east London gain control of an annual budget of up to ₤400m.

NHS Redbridge’s decision reflects its Rich Picture, a visual map capturing the organisation’s five year vision of bringing healthcare closer to people’s homes.

The borough’s three practice based commissioning clusters were replaced by five polysystems earlier this summer following more than a year of intense negotiation between the primary care trust and health professionals.

The new GP-led network of care professionals will have designated budgets and eventually be responsible for commissioning services and meeting statutory health targets set by NHSR and the Department of Health.

It reflects the organisation’s move towards providing better access to health services closer to home as well as taking it step closer to becoming a world class commissioner.

The polysystems will:

  • Promote the health and well-being of all the people in the community
  • Maximise independence and quality of life for people with long-term conditions
  • Improve services for people with non-critical acute care needs

The decision to introduce the polysystem model is being driven by a commitment to give GPs the power to design and deliver services that improve health outcomes as well as patient experience.

The Royal College of GPs reinforces the need for a ‘federated’ approach to primary healthcare with teams and practices working together to improve services in its paper The Future Direction of Healthcare: a roadmap.

Each polysystem covers a distinct geographical area of the borough comprising 50,000 people and is managed by a polysystem board made up of local clinicians.

Clinicians’ intimate understanding of their communities will help them design and deliver healthcare measures that not only address current need but anticipate future trends, such as the rise in diabetes and obesity.

NHSR recognises that the polysystem boards have little or no direct experience of commissioning services and will provide the necessary training and support via a specially convened Clinical Commissioning Board made up of the five polysystem clinical directors and primary care trust officers.

The current governance arrangement will see the five polysystem boards report to the clinical commissioning board who, in turn, report to the PCT board.

The fledgling polysystem board’s first challenge is looking at ways of reducing the number of first outpatient referrals made by GPs.

There has been a 36 per cent increase in referrals in the past three years with huge variations in referral rates between different practices.

One practice made 400 per cent more cardiology referrals than a neighbouring practice incurring an additional £130,000 in annual costs.

The referral management scheme aims to reduce first referrals for out-patient appointments by 30 per cent by April 2010 making a £3m saving.

Several specialist areas have already been highlighted where referrals are noticeably high including ophthalmology, dermatology, trauma and orthopaedics.

NHSR has introduced a savings incentive framework to encourage both GPs and polysystem boards to meet the challenge.

Polysystems will play a key role in bringing the organisation’s Rich Picture to life by treating the majority of patients’ needs in the community saving un-necessary hospital appointments.

The polysystems will operate on a hub and spoke model with a polyclinic at the heart or hub of each polysystem with surrounding surgeries, pharmacies and hospitals forming the spokes that radiate out into the community offering a seamless level of healthcare.

The first polyclinic opened in April 2009.

Loxford Polyclinic in south Ilford opens seven days a week and offers more than 20 services including GPs, an in-house pharmacy, health living café and variety of traditionally hospital based services, including diagnostics and out-patient appointments.

The creation of polysystems and de-evolution of commissioning functions to their respective polysystem boards also has the potential to save the NHS money at a time when it faces severe spending restrictions.

Better access to healthcare and raising awareness of the need to adopt healthier lifestyles logically reduces the need for treatment, especially in illnesses aggravated by poor diet and lack of exercise.