The big-bang day for the coalition government’s restructuring of the NHS is either March 30 or April 1 next year – depending on which side of the divide you are on. But some of the changes are being brought on stream gradually giving us a glimpse of what the new NHS might look like.
In Wiltshire there is a single Clinical Commissioning Group, but it is dividing itself up into three ‘localities’ or local areas so as to keep closer to patients – there’s even talk of sub-localities. One of the first practical fruits of the new organisation has come from the GP commissioners Sarum locality which covers the south of the county.
Dr Celia Grummitt from the Cross Plain Practice which has surgeries in Shrewton and Durrington, has been master-minding a pilot scheme to bring the diagnosis of early stage dementia closer to home.
This pilot is for those with moderate and uncomplicated memory impairment where the memory loss is affecting a patient’s daily living. In the past this diagnosis and any prescribed treatment has been done by specialists and may involve an eight or nine month wait.
It is estimated that Wiltshire has about 6,300 people with dementia – and of these only about a third have a diagnosis.
Using money from the government’s push on dementia treatment which was passed to the Primary Care Trust (NHS Wiltshire), doctors in five Sarum practices covering 25,000 patients have been carrying out diagnoses and have got permission to prescribe Donepezil. This drug is one of a group of drugs (called ACIs) that can help memory loss and it’s been on the market the longest, so doctors know a lot about it.
Dr Grummitt sees this pilot scheme as “Bringing care nearer to home with support from specialist teams, but done by GPs.” She is adamant that this is not about taking work away from the centres of specialist care and so destabilising them, but creating a new balance between the GPs and the big hospitals with their specialists: “The phrase the funding follows the patient remains valid.”
It will, of course, take a while for the effectiveness and economics of the pilot to be gauged. It remains to be seen, for instance, how many of those who are diagnosed will take their Donepezil.
Stephany Bardzil, from the independent Wiltshire charity Alzheimer’s Support, told Marlborough News Online: “We are very interested to see the outcome of the pilot and for it to be extended to other parts of Wiltshire. The current waiting times for memory clinics are scandalously long. If some people can get the support and treatment they need more quickly through their GPs that is to be welcomed. However we do have some concerns that not all GPs will have the specialist skills needed to recognise more complex cases.”
In the near future, Alzheimer’s Support will publish a report on the barriers to dementia diagnosis in Wiltshire, based on surveys of patients and health service staff and on focus groups.
Dr Grummitt is very aware of the potential conflicts of interest as the GPs take on more work for which they will be paid. GPs will in many instances be commissioning themselves and their surgeries to carry out work and agreeing payments for that work. And the closer to home treatment comes, the more work the doctors will be commissioning from themselves.
She is optimistic about the future of GP commissioning: “It is going to work because of relationships. Professionals work better in a smaller area.”
“When the[Lansley] Bill was passed there was no going back – we couldn’t just hope it would go away. If we don’t drive it, the government will put someone in over us. So much has been dismantled – there’s only forwards.”
Some people say that the government’s already put that “someone” over the GPs – in the shape of both the Council-run Health and Wellbeing Boards and the NHS Commissioning Board with its local offices acting as a discreet (so far) strategic health authority.
The day Dr Grummitt spoke to Marlborough News Online another practice outside the Sarum area, over in the west of the county, had asked to join the pilot scheme: “The dementia pilot has opened clinicians eyes to what can be done.”
Once the genie is out of the bottle the pressure will be on for more of the same. The GP commissioners will not only have to manage their budget, they will also have to manage expectations.
And there’s a way to go yet. A report in 2011 on the relative rates of diagnosis for dementia put NHS Wiltshire at 161st out of 169 primary care trusts.
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