SPOT analysis: Autonomy, accountability and democratic legitimacy

This is the SPOT (Strengths, Problems, Opportunities, Threats) analysis for Autonomy, accountability and democratic legitimacy, as discussed at the Leading Clinical Commissioning event held by NHS Birmingham East and North on 20 and 21 July 2010.

Add your views at the foot of the page.

Strengths

• Decision-making closer to the patient by someone used to accessing NHS services
• Provides opportunities for integration across health, social care and public health
• Locally agreed pathways – clinically led
• Clinical responsibility
• Better demand/Management
• Autonomy: develop a new relationship with patients
• Democracy: large increase in legitimacy with health well being boards
• Clinicians leading decision-making process
• Autonomy to manage peers (primary care) much more focus on heath/patient outcomes rather than process/widgets
• GP consortia are statutory and therefore have statutory responsibilities
• Skills – good GP system
• Good pyhsio, good m/health, beacon practice
• Longstanding local experience – patient pathways
• Know what patients want/need
• Previous PBC/fund holding experience
• LA well practiced in democracy O/S, ward & UBC
• Partnership exemplars Children’s Centres
• Prevention of political Micro-management
• Strategic focus LA
• Passion for patients
• Local knowledge
• Better able to meet local need
• Less layers = cheaper therefore more to spend on care

Problems

• Privatisation of commissioning (taking out of NHS)
• Organisational turmoil (short-term)
• Lack of clarity about ‘what good looks like’ for localities
• Capability
• Capacity
• Developing structure
• Discussions with more groups/clusters
• Managing and performance productivities
• GP consortia need o understand the consequence of their responsibility and their accountability, how do we avoid history repeating itself?
• How do PCTs manage the transition whilst not forcing the solution?
• Managing risks, getting the consortia to understand the totality of the health system
• Skill transfer
• Increasing expectations (wait for mental health)
• Taking the community with you
• Not the best use of time
• Vulnerable people losing out
• Leading to loss of personalization
• Choice could decline
• Quality of care decline
• Morale decline
• Jobs decline
• Will a business model be as open and transparent costs in money
• Internal management of ‘outliers’
• Encouraging “independent” GPs/practices to work together
• Bringing together an in-house/external team
• Read across JSNA, national commissioning board al expenditure
• Unclear ‘local face’ of national bodies
• Capability al capacity to encourage creak solid enterprise
• Lack of skills in consortia & lack of knowledge of pathways
• Conflict GP provider and commissioner
• New structure may sideline skills & knowledge groups
• Danger unpick multi-skilled groups & teams
• Create post code lottery

Opportunities

• Strengthening of role of CQC – focus on outcomes for individuals  quality
• Broadening role of monitor – highlight areas of concern
• - strength of patient voice
• parity of provision in private and public sector
• Education/skills transfers
• New ways
• – working, community/acute services
• - use of technology
• increased power to promote health via well being
• local innovation and response to local need
• much better joined up approach to council/city wide health strategy and other council strategies
• increased speed of service improvements through clinicians led decision making
• greater opportunity for peers of primary care
• greater chance to improve preventions not just preventing ill health but also preventing inappropriate use of services
• Share good practice
• Develop specialties
• Community involvement share views
• Improve care
• Openness
• Choice privatilisation
• Develop local, patient-centred services (? For less)
• Bulk purchasing
• Higher quality care
• Develop new GP “enhanced services”
• Partnership working
• Better health outcomes
• Sharing devolved structures
• Ring fenced public health budget
• Better value community engagement
• Outcome focused
• Social focus better linked
• Build better relationship
• Registered and resident services
• Social enterprise support innovation
• Less red tape

Threats

• Mindset and culture of patients, GPs and other health and social care professionals
• Risk of post-code lottery
• Public expectation and affordability
• Transition period
• Swings in commissioning services
• May not be allowed to develop services in the community
• Lack of skills and experience to comprehend level of accountability
• Lack of vision about what we want GP commissioning
• Failing to achieve, to take forward current good practice
• More money wasted
• Decline in standards
• Not enough money in system
• Privatisation
• Public perception of GPs rationing “ to save money” “loss of trust”
• Failure to keep to budgets
• Destabilization of local health/economy
• Brain drain
• GP relationship child health inequality
• Net reduction in engagement activity
• Social enterprise robustness
• Decreasing level of scrutiny re quality (monitor CQC)
• Shrinking capacity/capability of LA
• Danger like fund holding lots of targets and micro management
• Close relationships so hard to say NO
• Collision between consortia
• More expensive as more dispersed
• Safe guarding and responsibility for prevention priority of this when cuts in LA
• Danger funding for clinical training reduced
• Poor relationships

See also: LCC SPOT write-up (Word doc) – plus comments