This case study explores how Integrated Care Commissioning, a first-wave GP Pathfinder representing 26 practices in South Birmingham with a registered patient population of 155,000, has set up partnerships with local authority and third sector organisations to deliver new services for patients.
The relationships being developed is helping to bring services to patients, where previously none existed.
Before
Before ICC came into existence, the PCT had been starting to look at how to develop relationships with third sector organisations and had a strong working relationship with the Local Authority. However, there was limited clinical involvement in these relationships.
Under Practice Based Commissioning (PBC), a small number of practices in the Edgbaston area had identified a service need to provide counselling and support for patients with personality and eating disorders. The practices joined the ICC consortium in early November 2010 and were keen to ensure that the service continued to be supported under GP led commissioning.
Andrew Coward chair of ICC explains “GPs have learnt the importance of joint working with local agencies to commission services, focused on meeting the best possible outcomes for patients.”
The majority of patients with personality disorder and higher support needs have the choice of secondary or tertiary care interventions. Evidence shows that many people with personality disorders can be supported to lead ordinary lives if their interventions and support packages are delivered in primary care. The GPs felt this was a growing gap in their area and developed the specification for this service. Working with third sector agencies allows the service to be delivered from a non- health venue that is utilised by all members of the public, hence leading to greater opportunity for improving inclusion and reducing any potential negative impact of labelling. This is particularly important for people with personality and/or eating disorders who are able to maintain their independent lives in many other ways within the community, their family, and employment.
GPs worked with national guidelines to develop a service with a third sector organisation, St Martin’s Centre for Health and Wellbeing based in Birmingham to provide counselling and support services for patients with diagnosed personality disorders and/or eating disorders such as anorexia-bulimia.
Once St. Martin’s won the contract, a commissioner-provider relationship developed to ensure that the aims and objective and indeed the targets were delivered as first agreed. This involved meeting with St Martin’s and a lead GP and managers on a regular basis to develop the service over the course of the project to ensure it remained on track and made a difference to people’s lives.
Improvements
The biggest improvement for patients is the fact that a service exists within the community. ICC has commissioned this service as a pilot to plug a gap that exists within general practice. For most GPs there is very little support available to help patients with Personality Disorder within Primary Care.
Evidence shows that people with low-level personality disorders are much more able to remain independent and avoid secondary care interventions if they are fully supported in primary care. St Martin’s provide counselling and psychotherapy to deal with underlying issues and to provide people with the tools and skills to self manage and fully realise and use their own abilities and opportunities. Providing this in primary care area allows the individual to feel and remain in control and put the newly honed skills into practice in their daily lives in ordinary situations.
The service works hand in hand with GPs who support patients to manage their medication and general health and the counselling and support service provides strategies that enable individuals to cope with day-to-day living, contextualised to their own life and community. The counselling and support is there to help avoid expensive acute episodes that require more institutionalised intervention procedures that often involve the patient spending time in more medicalised care settings.
Future
ICC is looking at how they will continue this service and roll it out wider across the practices in the consortium. Currently ICC is seeking funding to support the service beyond the transition period into the future of GP led commissioning. Andrew Coward, Chair of ICC explains the importance of partnership working for the future and really values the work that has been achieved to date. “GPs are adept at developing partnerships. The greatest example being the patient-doctor relationship. These skills are imperative as we move forward with GP commissioning. We are seeking to succeed and this type of service really makes a difference for our patients.”
