Consortia, Commssioning Groups and Coterminosity
Wednesday, June 22, 2011 at 10:19 Well, the Future Forum has reported and the Government has responded. What have we learnt that is new? I guess one thing that will have lifted our spirits a little is the announcement that GP consortia, or rather Clinical Commissioning Groups as we should now call them, should not cross local authority boundaries unless there is a reasonable justification.
At the moment if the East of England is typical (and there is no reason to believe that it isn’t) there is huge variation in size of Clinical Commissioning Groups (CCGs), covering populations of less than 20,000 up to populations of almost 600,000. Although many CCGs sit within one existing PCT area there are a number that cross both PCT and LA boundaries. The difficulties of mapping a practice population combined with the complex pattern of CCGs across the country means that producing useful geographical based information for CCGs is challenging.
Along with the announcement that the CCGs should not normally cross LA boundaries was the announcement that the CCGs should have names that relate to the area that they cover. Whilst new names may be a bit boring compared with some of the Apprentice style names that they are currently coming up with, it will surely make life easier for both patients and also those of us that work with health data if we can relate a CCG to the population it serves.
The age old problems of changing boundaries and new organisations have not been solved, but maybe life will be just a little easier than it might have been!
John Battersby
Eastern region Public Health Observatory
Reader Comments (3)
Lining up boundaries is welcome from an administrative perspective and in a linked data world being able to align boundaries is helpful as information about the same area can be combined and compared.
But how will the alignment of boundaries work in practice?
Under the localism agenda, more choice is passed to the citizen and they can decide which and where they choose their services. This includes schools, GPs, rcycling points, leisure centres, etc. Hence catchment areas for those services will in the future become less conformant but more disperse and dynamic.
So should the boundaries align with adminiistrative areas or with the population they serve?
What criteria will be used to define the boundaries other than using names and trying to align administrative boundaries.
It would be good to see how new technology and the wealth of information about places and people can be used to help decision makers to align those boundaries.
An interesting challenge!
This is a very timely blog!
Colleagues in the Department of Health are working on 'approval criteria' for clinical commissioning groups (CCGs), with a view to ensuring that their geographies are soundly defined. This is still work in progress, but I would be interested in hearing from AGI members, particularly those in PHOs, if they have done any work on the topic of consortia geography.
I'm particularly keen to understand what is known at sub-national level about emerging (proposed) configurations.
I was looking at GP Consortia definitions in West Midlands before the Future Forum reported to consider how we might provide cancer statistics to these new commissioning groups. As at 1st April only 3.7 of 5.4 million people and 604 of 997 practices were included in a GP Consortia which ranged in size from 9 to 50 practices each. The smallest consortia have a registered population of as few as 30,000 people, equivalent to a large electoral ward. Statistics for such small consortia are likely to become unreliable and it will become even more difficult not to identify an individual in them.
Information gleaned from colleagues in some of our PCTs revealed a mix of single PCT/UA wide consortia, multiple consortia within/across PCT/LA/UA boundaries which might be broadly delineated and another where the 2 approved consortia show no geographical separation at all. One exceptionally small GP Consortia includes only 9 practices spread across inner city/outer suburban areas where only 55% of their registered cancer cases live within 1km of the GP practice, and there are cancer cases registered with 54 other GP Practices within the same 1km radius of the consortia's practices.
ONS' annual mid-year estimates of resident populations whilst available at LSOA level are useless unless we can define the extent of the Clinical Commissioning Group by LSOA.
In terms of a localism agenda surely we have to understand the needs of the residents in the local area to provide the services those residents expect. If they then choose to register with GPs outside of the local area then maybe they should expect to forfeit access to the health services that have been provided in that area?