What does locality commissioning in Avon offer? Retrospective descriptive evaluation
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7089.1246 (Published 26 April 1997) Cite this as: BMJ 1997;314:1246
- a Department of Public Health Medicine, Avon Health Authority, Bristol BS2 8EE
- b Department of Social Medicine, University of Bristol, Bristol BS8 2PR
- Correspondence to: Dr Hine
- Accepted 1 April 1997
Abstract
Objective: To describe the impact, direct costs of, and participants' attitudes to the first two years and eight months of locality commissioning in Avon.
Design: Retrospective description of programme.
Setting: Thirteen localities in Avon Health Authority area, covering 982 000 population and 147 general practices.
Methods: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority.
Main outcome measures: Locality initiatives, perceived influence, general practitioners' attitudes, management costs.
Results: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents.
Conclusion: Locality commissioning has selectively changed services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes.
Key messages
Locality commissioning proved feasible in one of the United Kingdom's largest health districts
Locality groups were selective in scope, emphasising primary mental health and chronic disease care, guidelines, and outpatient access
Cooperation between general practices serving geographically defined populations was enhanced
Costs of general practitioners' participation were negligible, but some general practitioners contributed unpaid time
Lead general practitioners were frustrated by the lack of clear management framework and political impetus
Footnotes
- Accepted 1 April 1997