PRACTICE MATTERS
Archive: GP Commissioning
THE NORTHAMPTON OPTIONS IN PURCHASING PROJECT: INTERIM AND FINAL REPORTS
September and October 1992 The Project Team
These two documents report a project organised by the Northampton Division of GPs. Its purpose was to identify and evaluate the options available to practices concerning purchasing hospital and community services within the NHS internal market.
The report was highly influential both locally and nationally. A copy was requested by The British Library for its archive of important documents. The blue, spectrum diagramme was later copied and used within a report written by the BMA. While flattering, it would have been nice if they had asked; or even just acknowledged its source.
British Library ref: OP-LG/7445
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GENERAL PRACTICE - A FORCE FOR CHANGE
1993 Chapter 10, The New Face of the NHS. Ed Peter Spurgeon. Longman.
There is nothing like being asked to give a presentation or write a chapter for a book, to force you to get your thoughts in order.
This is actually the 2nd edition of this chapter; the original was published a few years earlier. Unfortunately - like so many books, including both editions of this one - it is now out of print and my copy of the 1st edition was never returned from a loan.
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General Practice- A force for change
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A SENSE OF PLACE: COORDINATING THE COMMISSIONING OF APPROPRIATE CARE BY DIFFERENT AGENCIES FOR LOCAL COMMUNITIES IN NORTHAMPTONSHIRE.
August 1993 David Webster and Andrew Willis Northants FHSA, DHAs, Social Services and GPs.
This project took the concept of locality commissioning to its logical end point, with all relevant agencies working together across all services, be they primary, community or secondary care, social services, public health and the voluntary sector.
Written over 20 years before national plans seek to coordinate local services in this way, the report emphasises the complexity and tensions involved in achieving what, no doubt, is a logical and worthy end point for a sophisticated, caring society.
This is another large file and, unfortunately, the diagrams lose clarity with compression. It will, therefore, be a bit slow to download even though this is a moderately compressed version of the file.
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LOOKING BEYOND FUNDHOLDING: INVOLVING ALL GPS IN PURCHASING
1993 Primary Health Care Management Vol 3;3; p4-5
This paper reflected the conclusions of the Northampton Options in Purchasing Project, describing a range of possibilities for GP involvement in the NHS internal market. Any of these might suit a particular geographical area better than others. This approach was at odds with government policy, which clearly favoured and facilitated fundholding over any alternative.
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GPS DEVELOPING LOCAL HEALTH SERVICES: THE NORTHAMPTON EXPERIENCE.
April 1994 Northamptonshire Health Authority
"It is only by all relevant agencies working together in a coordinated manner that effective services of high quality will be provided within the health district in a cost effective manner that is sensitive to the needs of local communities and based upon equitable use of resources."
This report was written from the perspective of general practitioners who sought to use the NHS reforms to bring about such change.
The Northampton Experience Report
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COHESION: THE CONTRIBUTION OF GP COMMISSIONING GROUPS TO THE DEVELOPMENT OF A PRIMARY CARE-LED NHS.
April 1995 The National Association of Commissioning GPs.
This short report offers 8 case studies to justify the association's claim that they produced genuine results. It argued for the expansion of this approach to the involvement of GPs in the creation of an effective, efficient, high-quality health service.
COHESION: The contribution of GP Commissioning Groups to the development of a Primary Care-led NHS.
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RESTORING THE VISION: MAKING HEALTH THE INCENTIVE.
September 1997 The National Association of Commissioning GPs
This was possibly the most important report written by the National Association of Commissioning GPs. After years of being out of favour with the government, or simply ignored for failing to follow the line of national policy, it came as a welcome surprise for the new Labour government to not only welcome the views of NACGP but even to commission this report.
It was produced after a single weekend workshop held by the Executive Committee in August 1997. The report had a significant influence on the content of the White Paper "The New NHS: Modern, Dependable" which was published on 8th December.
Brutal compression of the original .pdf document, which is over 50MB in size, produces a poor quality result but is reasonably quick to download.
Restoring the Vision pdf 2.1
If that is too blurry for you, the link below will be slower to upload but, while still compressed, is of higher quality.
RtV reduced
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DEVELOPING THE HEALTH SERVICE: CHAOS OR COHESION?
June 1997 Managing Community Care Vol 5 p 89-98
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This paper described models of commissioning at district, locality and practice levels. It challenged several assertions made by politicians from both the Conservative and Labour parties. It offered a logical means of developing a primary care-led NHS consistent with a quest for equity, and that truly supported the separation of purchasing from providing.
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(I only have a copy of this paper in the draft form submitted for publication. The electronic form outlasted the paper one!)
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REQUIEM FOR THE NATIONAL ASSOCIATION OF COMMISSIONING GPs
May 1998 NACGP Final conference
The National Association of Commissioning GPs was a rare thing - an organization kicking against the traces of doctrinaire national policy and managing to make a difference. A rebel organization, as seen by the government, but one which ultimately was in large part successful.
Of course, it was not completely successful. But it achieved much, moving in political eyes from unwelcome rebels to key influencers of national policy.
It had a singular purpose, and when it judged that purpose to have been achieved it closed its doors, albeit to re-emerge as a similar but different organization, the NHS Alliance, appropriately attuned to the new set of national circumstances.
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The following is the press statement that followed the meeting:
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DON'T BLAME ME: I'M ONLY THE GOVERNMENT
December 1998 Managing Community Care Vol 6;6; p265-267
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Reflections on progress 18 months after "Developing the health service: chaos or cohesion".
Many of the proposals in the original paper had by now passed into national policy. But there were two notable exceptions.
Don't blame me: I'm only the government
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MAKING A DIFFERENCE: FOUR KEY QUESTIONS FOR PRIMARY CARE TRUSTS.
September 2002 The NHS Alliance
This report followed a private visit to Kaiser Permanente Southern California, a health care system different to the NHS but with many conceptual similarities, and as such a suitable environment to catalyse new ideas for the NHS.
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The report focuses on four key questions to be faced by those responsible for providing local health care services. These covered the areas of:
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Access
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Information
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Personnel
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Commissioning
Making a Difference (Although compressed this is another large file. Please be patient with download!)
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Final draft for article following the Making a difference report.
October 2002. Journal of Healthcare Management.
A short article published in Healthcare Management following the Making a Difference report. Again only a draft here - and apologies for the typos.
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WHY GENERAL PRACTICE IS SO IMPORTANT TO THE NHS
October 2002 Pulse Medical Newspaper
This was one of the first pieces I wrote challenging the convention that hospitals inevitably come first within the NHS, and the more specialised they are the better.
Given the nature of the NHS, and the desire to do the best for the greatest number of people with the available resources, that is nonsense.
Piece for Pulse Oct 2002
[This piece is now also included in a blog post on this site dated September 2017]
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