Filed Under (Primary Care Trusts, World Class Commissioning) by Paul on 26-04-2009
On April 22, by chance I spoke to the leadership of two very different Primary Care Trusts about their coming years work on improving towards world class commissioning.
They served very different populations one in the Home Counties and one in Inner London. What was most interesting were the differences and similarities between the two.
The main difference may not be surprising, but given the history of the culture of the NHS it actually should be. They were going about their core business of improving the health and health care of their populations with imagination and vigour and, because of this, had recognised how very very different their populations were. So whilst the way in which they did their work – their ‘competencies’- were being stretched in all sorts of ways by the task, they each recognised that their populations were very very different and needed vey different interventions.
Now you may feel that that doesn’t say very much. Its obvious that these populations are different. But in fact the culture of the NHS has been to always overplay the N in the NHS so that all of the staff and organisation seem nationally interchangeable. NHS staff are proud of this slotting in and out. Now the nature of PCTs is bringing a different set of expertises.
Of course the skill of having to understand the detail of health and health care needs in different places may in general be the same sort of skill, but doing it in a location where there is a stable well off population is different from a location where there are new refugees from very different parts of the world coming every week.
What was interesting is how taken for granted it is now that very different populations drive very different sets of needs and understandings. And therefore very different health services. For example the diabetes education service that must be commissioned in both places is very different and is very dependent on understanding the different populations’ needs.
We are becoming a lot more like the differentiation of service that exists as normal in local government.
However, and this was the subject of my discussion with the PCTs staff, whilst the experiences of the health services that they commission are different, they agreed that it was possible to understand the competencies that each PCT needed to develop to carry out their role with these different populations were the same.
Importantly, both PCTs recognised that whilst what they did may have different population outcomes, how they did it was similar. Crucially for both PCTs this year was one where, whatever their ‘scores’ from last year, they had to get better over this year.
The drive for improvement is now becoming a part of the genes of PCT land.