Through the ‘Patient Choice’ initiative, the development within health provision of a variety of providers at source, i.e. general practitioner (GP) or secondary care clinician point of referral, is anticipated to accelerate the improvement of services.It is expected that positive competition will identify and spread best practice which will become the norm. This model clearly has benefits and perhaps it is most applicable to localities which have a range of providers who can most effectively ice’ initiative and, hence,provide effective choice for the local population.There are, however, significant issues with such a model in geographical areas such as NE Lincolnshire where there are limited secondary care providers.Within such an environment, ‘Patient Choice’ may lead to patients having to travel significant distances and, as well as the practical inconvenience, leading to a degree of fragmentation of services.Within our locality we are currently developing an alternative proposal, that of ‘Commissioning in the round’, a co-ordinated community approach to the commissioning of services. If successful, it is anticipated that this approach will maximise the local resources currently available, while also achieving a clear direction of travel for the future development and provision of services. As a positive consequence, this approach is anticipated to maximise the range of appropriate choice of provision for our locality. To date the proposal has received the support of our professional executive committee, as well as initial support from all health organisations within northern incolnshire. The document moves on from discussing the principles and the proposed model to look at the first steps with the establishment of a locality board whichwill develop a clinical services strategy. This strategy is intended to focus on four initial areas of:. diabetes . coronary heart disease . chronic obstructive pulmonary disease (COPD) . cancer.By targeting these areas, the model will both address current priorities and also allow utilisation of the model from different perspectives as outlined in the document. It is anticipated that this approach,initially targeting four areas, will enhance local ownership and confidence, while allowing the refinement of the model by it being tested in the field. As well as addressing ‘Patient Choice’, it is anticipated that this approach will also appropriately co-ordinate other current national opportunities including payment by results and practice-based commissioning.
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