GP Nigel Campbell discusses the role and impact of local commissioning groups with Ciarán Galway.
“There’s so much more to be delivered locally and I think that’s where I’m a great advocate for local commissioning because we know our areas very well.” Nigel Campbell has been a GP in Lisburn since 1995 and is the outgoing Chairman of the South Eastern Local Commissioning Group.
“So our purpose as local commissioners is to assess the need of the local communities in which we live, then to plan for healthcare delivery to meet the needs of that community,” he outlines. The five local commissioning groups were first established in 2009 and are aligned with their respective health and social care trust areas, determining needs and making sure that they are met.
“It is an ongoing process and, of course, it means lots of meetings,” Campbell adds. “Primarily we need to spend time as local commissioners assessing the needs of the community. That means you need a lot of local information.” Consequently, the local commissioning groups regularly meet with patients, healthcare providers and the voluntary and community sectors in order to develop a full understanding of the needs in each particular area. Campbell continues: “One of the reasons why I think local commissioning is important is that those people involved in the local commissioning group are mostly people who work in their communities and work the frontline of healthcare provision.”
Unlike in England, where each area has two distinct organisations for both healthcare and social care, Northern Ireland has a combined, unitary system. “As an example of that, [for] a patient who is medically fit to go home, it will be the same healthcare provider who has paid for their stay in hospital who will also be paying for the care provision that they receive at home,” Campbell continues. “That is an advantage.”
Highlighting innovation, Campbell heralds the Northern Ireland electronic care record, which provides every healthcare provider with access to relevant information on the patients under their care, as a game-changer. “It reduces duplication,” he explains.
“A blood test being a very good example. If I do a blood test on a patient today and they go hospital tomorrow, the hospital can see that result without having to repeat it. And in referrals, traditionally the patient had to go and see everybody in turn to get the particular opinion that we were looking for. Now we can do it as a request through the electronic care record.”
The South Eastern Trust also pioneered the co-location of an out-of-hours GP and a limited opening hours A&E in Downpatrick. Campbell states: “Rather than have any one of those services fall over or cease to function because they couldn’t get the resources or the manpower, we put them both together to maintain a 24-hour presence at that site.”
Like other health and social care trusts, the South East has its own particular challenges. Campbell emphasises those posed by divergent local needs in the four main community areas – Ards, Bangor, Downpatrick and Lisburn. He observes: “We have too many hospitals, if we define them that way, but we need to work out what services are needed for Downpatrick in Downpatrick [and] what services are needed here in Lisburn for Lisburn patients.”
He thinks that local commissioning has worked well in the South East “because we have looked at each area separately and the model that we’ve come up with in each area differs slightly from the others, and I think that it is sustainable.” However, while patients served by Lagan Valley Hospital are relatively close to Belfast, those served by the Downe Hospital can live up to 30 miles from the major hospitals. Campbell concedes that there is a need to maintain a 24-7 urgent care response in each area.
Whilst championing the Health Service as a world class provider and the envy of other developed countries, Campbell does accept that healthcare across Northern Ireland is strained.
“Trying to deliver more and more healthcare to a growing population, with a greater number of elderly folks with long-term conditions requires more money,” he comments. “Of course, we don’t have more money, so it’s trying to get it to fit. We know the destination because that’s been outlined in TYC and I think we’re all agreed that that’s the right direction of travel. It’s just the steps, the route to that, that has proved difficult and change is very difficult in such a big organisation.”
Campbell argues that, instead of simply criticising delivery, there must be a reassessment of the current financial strain the system is under: “We need to think, well, what is the NHS going to provide or [are] there some things that we’re going to have to stop providing because we can’t afford to do it? And we are going to have to change the way it’s delivered to make it more efficient and less expensive.”
Providing an intriguing critique of policy direction, Campbell proposes a radical new approach to healthcare provision. Arguing against the top-down hospital-focused approach towards healthcare, he calls for an inversion which would place the patient at the core of all policy.
“So, for a patient – what can be delivered here, within this surgery? And what can’t be delivered here within this surgery? Could it be delivered within this health centre? And then what’s not deliverable there could be delivered in Lisburn in an enhanced local hospital environment. And it’s only when all of that is exhausted, or [the] healthcare needs are so complicated, that we then move up to the bigger hospitals.” He concludes that the Health Service needs to use people to the full benefit of their expertise, and “there’s lots more that GPs could deliver” with appropriate funding and resources.