Freelance medical writer, journalist and editor
Mark, a former research pharmacologist, is now an award-winning medical writer and journalist. He has also published numerous medical economic papers in peer-review journals and is the author of 10 books on health-related issues
Primary care-led commissioning empowers and inspires primary care trusts (PCTs). Across England, PCTs are implementing numerous innovative initiatives to improve healthcare for their communities, ranging from local healthcare parliaments, to social marketing, to developing new ways to help people with learning difficulties.
Now we want to hear what you're doing. MiP welcomes innovative ideas from practice managers that can inspire PCT managers and help you formulate your business cases. This article looks at some examples from three innovative PCTs.
Walsall's local healthcare "parliament"
Walsall PCT established a local healthcare "parliament", known as myNHSwalsall, the first primary care members' body in England. The PCT expected 1,000 members to sign up to myNHSwalsall in the first year. However, more than 2,500 local people joined in the first 10 months, suggesting that the community felt the "parliament" met a real need.
"The parliament helps the PCT design services, set two of the PCT's eight local outcomes, and facilitates the move toward fully engaged and empowered patients," comments Paul Jennings, Walsall's chief executive.
"The process broadly mimics the structure of foundation trusts. However, unlike a foundation trust, where you need to opt out, patients and other stakeholders actively had to sign up for membership and we quickly filled the 63 seats on the parliament. There's been a remarkably, and unexpectedly, high degree of engagement."
Members of myNHSwalsall.net have access to a dedicated and password-protected area on the website where the PCT posts new information and documents. This facilitates the community's early involvement in decision-making.
Mr Jennings hopes that myNHSwalsall will help avoid the controversy that surrounded the closure of a hospital during a service reconfiguration a couple of years ago. "Even before we had written the consultation document, 14,000 people had signed a petition against the closure," he says.
"There seemed to be a perception that we were closing the hospital to cut costs. In fact, we were investing more money. MyNHSwalsall will offer us the opportunity to discuss why we need to consider certain options early on and avoid misunderstandings. It allows us to open a dialogue with the local community that run both ways, and build responsive services around the needs of our citizens."
Liverpool's tanker of flab
In Liverpool, 76,000 adults and 13,000 children are obese. So Liverpool PCT used "social marketing" to help Liverpudlians lose a tanker's worth of flab in a year.
Essentially, social marketing uses the same principles employed by commercial marketers – understanding the consumer, strategic thinking and building satisfying relationships based on emotion and rationality. However, rather than use the approach to persuade us to consume often-unhealthy products, social marketing aims to help us live healthier lives.
Liverpool instigated the largest social marketing campaign to tackle obesity locally in the UK. People who sign up to the challenge receive information about food and exercise, a pedometer and a tape measure dedicated to measure waist size – one of the best predictors of the increased risk of heart disease and diabetes linked to obesity. Among the other elements in the programme, food workers employed by the PCT educated people about diet and handed out free passes to local fitness centres.
The campaign aims for the city to lose a total of one million pounds of fat in a year. That's enough to fill the milk tanker that regularly tours the city promoting the initiative. "Obesity costs the NHS in Liverpool £5m a year and costs the city's wider economy by £15m annually," says Jane Thomas, Head of Insight at Liverpool PCT. "So clinicians have been very supportive."
Almost all PCTs pay at least lip service to social marketing. However, Ms Thomas believes that PCTs can't just bolt social marketing on to the communications programme. "Liverpool PCT has invested in social marketing as a discrete discipline and that helps account for the success of our programmes," she comments.
"Bolting social marketing on to communications can, for example, lead to problems if external agencies are not briefed properly by someone experienced in social marketing. For example, an advertising campaign isn't the same as social marketing. Yet unless the PCT manager and the agency are experienced in social marketing, it is easy to confuse the two. As a result, the project can fail to meet its objectives and the PCT can become disillusioned."
Ms Thomas believes that the support for the initiatives in Liverpool is, in part, a reflection of social marketing's previous successes in the city, such as a multiagency approach to alcohol abuse called Pssst (see Resource below). The various stakeholders – police, NHS, local authorities, trading standards and so on – agreed to ditch their logos and coalesce under a single brand. This produced a less fragmented service for people struggling with alcohol addictions that encompasses health, law enforcement, crime reduction and community safety.
Liverpool PCT also worked with Aldi (in a "snack right" campaign) and Boots to help local people eat healthier diets, quit smoking and exercise more by encouraging patients to engage with the PCT's health promotion campaigns.
The PCT's health trainers used Boots' consulting rooms. "We can demonstrate that social marketing approaches improve health outcomes and show an excellent financial return on investment," Ms Thomas comments. While success breeds success, she suggests that managers in other PCTs that would like to try social marketing approach should use the "hard evidence" from Liverpool and other successes to build their business case.
Helping people with learning difficulties
Meeting the multiple needs of people with learning difficulties and addressing the diverse issues that arise during their care can prove both complex and complicated. So Salford PCT and the Joint Learning Difficulty Service collaborated to develop a PCT Healthcare Facilitator to improve health outcomes in this often relatively disenfranchised group.
The current Facilitator, Cath Rotherham, worked previously in the Community Learning Difficulties Team. So she gained an excellent understanding of the health needs of people with learning difficulties and the obstacles clients and their carers face when trying to access mainstream health services. Ms Rotherham commented that such barriers include complicated signage, confusing telephone booking systems and letters that include medical jargon.
"I work directly with staff working in primary care to help them further understand the reasonable adjustments that they need to make that ensure their services are fully accessible to people with learning difficulties," Ms Rotherham says. "I can offer immediate advice or link the practice to others from the specialist team as required."
Salford PCT established the post three years ago. Since then, practice managers, GPs and practice nurses approach Ms Rotherham for support on a range of issues, such as the problems of obtaining consent to perform cervical smears in women with learning difficulties and offering patients alternative care pathways if they would not cope well with traditional tests. Ms Rotherham also worked with practice nurses and data-quality colleagues to install a "well-person check for patients with learning difficulties" onto the clinical systems.
"The well-person check is a clear example of a practice making 'reasonable adjustments' and actively promoting disability equality," Ms Rotherham comments. "The emphasis of my post is firmly on supporting mainstream providers to get their services right for this patient group by enabling more effective sharing of skills with specialist services."
Real-time commissioning data
Walsall PCT developed a new IT system called Chronic Disease Registry Intelligence. Practices agreed to upload data about chronic diseases, such as that from the practice's Quality and Outcomes Framework software, onto a central registry.
According to Mr Jennings, this produces a very powerful tool to plan future services. "Effective healthcare planning needs real-time, contemporous data," he notes. "The data is often out of data. We are still waiting for the Office of National Statistics to publish some data from the 2001 census – and the next census is only a couple of years away."
The system helps PCT and practices look across the patient's primary, secondary and social care. "The system allows us to be proactive and gain the information we need to plan and commission services at a practice, population and neighbourhood level," says Mr Jennings.
"We should be better able to move to preventative rather than just reactive services. This will be especially important if, as is likely, budgets will be tighter in the next three to five years." It's a truism – but nonetheless true – that prevention is better, and often cheaper, than cure.
A consistent approach to new media
Every practice, every PCT, every health promotion project (and sometimes even individual doctors) has a website. As Liverpool's Pssst website shows, the web is a great way to get messages out to patients. The Pssst website is accessible, informative, practical and even amusing. However, Ms Thomas stresses the importance of a consistent health promotion message.
"There are many ways to promote a health message," says Ms Thomas. "We use the internet and we've also found that the local paper a useful medium. We can ask the doctor, dietician and other experts who answer reader's health questions to tackle a particular problem.
"However, it is important that there is a consistent message across the PCT. If patients receive conflicting messages it can undermine health promotion. If a practice wants to raise an issue or develop a website, it's best to speak to, and work with, the PCT communications team."
Now it's your turn
So what have you done that's different locally? What's worked for you? How did you overcome the problems? How did you develop a business case for a new service? Now's the time to share your experiences in the feedback box below.
Your comments: (Terms and conditions apply)
"We want to develop a text service so that our younger patients can access general practice in a more 'user friendly' way using technology that they are familiar with. With high incidents of teenage pregnacy, STDs, drug and alcohol problems, and mental health issues, we want to ensure these patients are directed to reliable sources of help and information. Unfortunately our local PCT does not share our passion and will not help with set-up costs under PBC" – Name and location withheld