GP commissioning take home messages, written by Dr David Jenner (GP and NHS Alliance PBC Lead), are included in all of the clinical features in Guidelines in Practice. The complete archive of these PBC messages is below, and the associated articles can be accessed by clicking on the titles.
Although of particular relevance to commissioners and those involved in GP commissioning, these key messages are also useful for other healthcare professionals in primary care, highlighting the costs of referral and the areas of care that can be provided locally.
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GPs need training and resources to identify problem drinkers, Dr Jack Leach
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General |
16 (6) |
- Alcohol misuse is a major cause of avoidable use of healthcare resources and costs to commissioners
- As the root causes are often multidimensional, lead responsibility for setting a local alcohol harm minimisation strategy should lie with the health and wellbeing board
- This strategy should define the role of the CCG in commissioning services to address alcohol-related health issues alongside those of other agencies (e.g. public health and education)
- CCGs could work with practices and NHS England to use the quality and productivity markers in the QOF to review alcohol-related admissions and A&E attendances, and target interventions at these patients
- The commissioning of alcohol-related interventions from primary care is now complex, with NHS England responsible for QOF, and the Alcohol Directed Enhanced Service and public health able (potentially) to commission Local Enhanced Services through local authorities and CCGs.
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Lifestyle modification is key to managing type 2 diabetes in children, Professor Timothy Barrett
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Endocrine |
16 (6) |
- Type 2 diabetes is such a rare condition in children that each CCG is likely to be responsible for commissioning services for fewer than five patients
- CCGs, particularly those with high populations of non-Europeans, might consider prevention and awareness programmes for obesity and type 2 diabetes in children
- Such programmes would be best coordinated through Health and Wellbeing Boards, with links to education services
- Simple awareness programmes on the recognition of diabetes in children for primary care clinicians could include reference to type 2 diabetes and emphasise the need for same-day referral to specialist services when diabetes is suspected
- The best-practice tariff for paediatric diabetes does cover type 2 diabetes and is payable when strict criteria for a specialist service are met�CCGs should agree these with local trusts
- Tariff costs = £2764 for 1 year of outpatient care.
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New quality standards on the epilepsies will promote better care, Professor Helen Cross and Drs Colin Dunkley
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Central Nervous System |
16 (6) |
- CCGs should look to benchmark their current commissioned service provision against the NICE quality standards for the epilepsies in adults (QS26), and children and young people (QS27)
- CCG epilepsy leads working alongside local providers should map local care pathways to meet these standards, and look to commission new services where gaps exist
- These care pathways should be shared with local ambulance services, primary care, minor injury units, and walk-in centres to ensure patients who present with suspected symptoms of epilepsy are assessed and referred appropriately
- CCGs should look to commission epilepsy specialist nurses but should consider employment models that avoid expensive tariff charges each time healthcare professionals see or contact a patient, or else agree an annual budget with a local provider
- CCGs could ask practices to use annual epilepsy reviews to check that patients with active epilepsy have up-to-date care plans, and adequate medication for prolonged seizures if appropriate
- CCGs should monitor claims on the best-practice tariff for paediatric epilepsy to ensure that services meet the quality specification for this enhanced payment
- Tariff costs for outpatients:a
- paediatric epilepsy = £215 (new), £125 (follow up)
- neurology (non-mandatory) = £222 (new), £128 (follow up)
- best-practice tariff paediatric epilepsy = £173 (follow up)
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SIGN should review its guidance on anticoagulants, Dr Alan Begg
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Cardiovascular |
16 (5) |
- Although SIGN guidance relates to Scotland, many of the issues also relate to clinical commissioning in England
- The recommendation from the European Society of Cardiology on the use of CHA2DS2-VASc over CHADS2 in non-valvular atrial fibrillation is yet to be reflected in the quality and outcomes framework, or indeed recommended for use by NICE
- CCGs may wish to consider local incentive schemes to encourage practices to follow CHA2DS2-VASc if they consider the evidence on reducing thrombotic events in atrial fibrillation to be robust, and pending further guidance from SIGN or NICE
- The place of NOACs in the prophylaxis of thrombotic events in non-valvular atrial fibrillation should be clarified by CCGs in local formularies as NICE does recommend them as an option to consider against warfarin within their licensed indications
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