Dr Peter Brindle, a practicing GP and previous Lead for Commissioning Evidence Informed Care at the West of England AHSN talks about his new role as Medical Director (Clinical Effectiveness) for Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG).
I’ve been in my new role for about seven months and it is a very different role for me, with an extremely steep learning curve – but I think I am beginning to get to grips with it!
What is my role?
My motivation in taking this role was to make a significant difference in improving the health of our population through looking for variation in performance and clinical practice across our healthcare system, to understand what optimum might look like and then to promote changes to reduce the unwarranted variation.
We have finite resources in terms of staff and money so on behalf of our population we need to make every effort we can to maximise value. This is exciting because this approach can both improve care and save money at the same time.
What have I actually been doing?
So far I haven’t yet done as much of this as I would have liked as I have responsibilities in a number of other specific areas, for example in cancer services, urgent care, medicines management, research and development as well as diabetes outcomes.
I have had to acquire a lot of new knowledge in these areas to that I can ask the right questions and make informed decisions. There have also been a lot of new people to get to know, both within the CCG and also our providers, and as a clinician, mastering the processes, governance and language around commissioning healthcare has been a challenge.
We have also been going through a reorganisation, with a merger of three CCGs. It takes a lot of time to design a new organisational structure, prepare job descriptions and interview many people, but we should be through that shortly.
This merger and associated restructuring is a crucial part of creating a new and functional healthcare system, but it is tremendously difficult for everyone involved. Despite this uncertainty, the staff have been amazing in the way they have kept on with the day job of planning and commissioning care for our population.
Soon the reorganisation will be complete, and I will lead a small clinical effectiveness team who will be using benchmarking tools and examples of great practice to find unwarranted variation. They will then work with clinicians and managers, using improvement techniques to promote positive changes that bring better and more efficient care to people.
Too much ‘re-invention of the wheel’ goes on, but we don’t have the time or money to waste on doing that, so it is crucial we learn from other CCGs and international health systems who have pioneered approaches and services, evaluated them and shown what ‘works’.
What are my main observations so far?
- The importance of working with all our providers to build a system-approach to our challenges. In the past there has been a tendency for services to be led by a provider perspective which has led to many fragmented services with variable standards. We need to plan and deliver services starting from the patient and population perspective leading to a standardised approach balanced where needed, with a strong locality emphasis sensitive to specific population needs.
- The constant requests and need for more investment in a range of different things. Balancing these demands is thought-provoking and challenging – every pound spent on one area is a pound less on something else. Once again, a population view is needed to prevent slipping into overspending on areas that are driven by strong and articulate interests. A relentless focus on getting value from our interventions will release resources from which all can benefit.
- From a personal perspective, there is a big demand for me to attend many meetings which, although they are useful, does mean I have less time to build effective relationships and to drive change arising from small group conversations. Getting the balance right is a work in progress…
- Sometimes the idea of ‘dedicated health service staff’ typically brings to mind the image of a nurse, doctor or someone in a clinical role, but I never cease to be impressed by the incredible efforts of the staff in the CCG who are totally committed to improving patient care, especially while going through some uncertain times. They are dedicated to the needs of patients every bit as much as their patient-facing health service colleagues.
- There is never a dull moment – well practically never! It’s fantastic to be in the heart of some really significant decision-making in a challenged healthcare system. There is so much potential and I’m excited about being part of the change which is already taking steps to improve healthcare for our population.
How has my time at the West of England AHSN helped me in my new role?
- I learnt a lot about quality improvement tools and techniques from West of England AHSN colleagues which I continue to apply in my current role. I want to do everything possible to promote a strong culture of continuous improvement across BNSSG.
- I remain a champion for the use of evidence. I have seen how through the use of the best available evidence, significant savings can be made and patient care improved. Read some examples here.
- I have always been an advocate of evaluating our decision making and I am now better able to ensure evaluation is built into the processes of normal business, so we create our own evidence of whether our services are doing what we expect them to. Find out more about evaluation here.
- I made some great contacts with like-minded people who are passionate about improving healthcare by looking at the evidence, learning from the experience of others and applying robust improvement techniques. Some of those have joined the clinical leadership team within BNSSG and the rest continue to be very important to me in achieving my goal of better care for patients.
If you want to get in touch, you can contact me on firstname.lastname@example.org or @petbri on Twitter.