Skip to main content

Primary care organisation size and quality of commissioning

There is uncertainty about the best size for the primary care organisations responsible for commissioning health services in England. This includes the concern that small commissioning units are more exposed to financial risk, due to their smaller populations. Smaller commissioning units may also not have sufficient expertise or the required ‘market power’ to be able to negotiate effectively with health care providers to achieve good-value contracts. Alternatively, smaller organisations may have better local engagement and responsiveness for clinicians and patients.

In a study publishedin the British Journal of General Practice, Felix Greaves and colleagues from the Department of Primary Care & Public Health at Imperial College London investigated whether there is a relationship between the size of commissioning organisations and how well they perform on a range of performance measures. This included a comparison of primary care trust (PCT) size against 36 indicators of commissioning performance, including measures of clinical and preventative effectiveness, patient centredness, access, cost, financial ability, and engagement.

They found that 14 of the 36 indicators had an association with size of the PCT and with 10 indicators, there was increasing quality with larger size. However, when population factors including deprivation, ethnicity, rurality, and age were included in the analysis, there was no relationship between size and performance for any measure. Greaves and colleagues concluded that there was little evidence to suggest that there is an optimum size for PCT performance and that the variations in PCT performance were explained by the characteristics of the populations they served. These findings suggest that configuration of clinical commissioning groups should aim to produce organisations that can function effectively across their key responsibilities, rather than being based on the size of their population alone.

Comments

Post a Comment

Popular posts from this blog

What is the difference between primordial prevention and primary prevention?

Primordial prevention and primary prevention are both crucial strategies for promoting health, but they operate at different levels. Primordial prevention aims to address the root causes of health problems and improve the wider determinants of health. It focuses on preventing the emergence of risk factors in the first place by tackling the underlying social, economic, and environmental determinants of health. This involves broad, population-wide interventions such as: Policies that promote healthy food choices: Think about initiatives like taxing sugary drinks to discourage unhealthy consumption, or providing subsidies for fruits and vegetables to make them more accessible. Urban planning that prioritises well-being: This could include creating walkable neighborhoods with safe cycling routes, ensuring access to green spaces for recreation and relaxation, and designing communities that foster social connections. Social programs that address inequality: Initiatives aimed at reducing pov...
Post a Comment
Read more

UK Covid-19 Inquiry - The Importance of a Strong Primary Healthcare System

In my witness statement for Module 10 of the UK Covid-19 Inquiry, I discuss the pandemic's impact through from the perspectives of  primary care and public health, drawing on my extensive experience as a senior academic at Imperial College London and as a practising GP and NHS Public Health Specialist.  I emphasise that the pandemic disproportionately affected people who were clinically vulnerable, the disabled, ethnic minority communities and those living in deprived areas. The pandemic highlighted how structural inequalities, multigenerational housing, and employment in high-risk frontline roles exacerbated health disparities.  My statement also critiques the weakening of public health infrastructure - particularly for the control of infectious diseases - and the lack of integrated health data systems to identify at-risk groups such as the clinically vulnerable. I also advocated for a more robust preventive healthcare model that prioritises community-based primary care ...
Post a Comment
Read more

Protecting Young People from Meningococcal B Disease: The NHS Targeted Vaccination Programme

Meningococcal group B (MenB) infections are rare but can have devastating consequences. The decision to offer a targeted two-dose vaccination programme to Year 13 students and young people entering university or residential further education reflects concerns about recent outbreaks of meningococcal disease and the higher risk of transmission when large numbers of young adults mix closely for the first time in shared accommodation. The MenB vaccine has a well-established safety record, and evidence from the UK infant immunisation programme has shown substantial reductions in disease among vaccinated children. A targeted programme for those entering higher-risk settings is therefore a reasonable precautionary measure while further evidence is gathered on whether the recent increase in clusters represents a temporary fluctuation in disease patterns or a more sustained change in the epidemiology of MenB infection. The success of the programme will depend on achieving high uptake and ensuri...
Post a Comment
Read more