New ways of delivering health care are being pioneered by groups of GPs as a precursor to them taking over NHS budgets. Health Editor Barry Nelson reports on some of the big changes taking place within the health service.

THE Easington area of County Durham has one of the highest levels of chronic respiratory disease in the region. Mainly a legacy from the now-vanished mining industry, the problem is so widespread that local GPs have decided to try a new approach.

The main concern is that too many elderly ex-miners are being repeatedly admitted to hospital because of a crisis in their condition.

This is not only distressing for patients, but it is costly for the NHS.

More to the point, by better management of these often frail patients, many of these hospital admissions would be unnecessary.

Working in a new way – and using new freedoms granted by the Government – GPs in the Easington area are pioneering the introduction of a more active way of managing patients with respiratory conditions.

Instead of waiting until they are so ill they need urgent hospital treatment, the patients, who usually have Chronic Obstructive Pulmonary Disease (COPD), are being given better, continuous support in their own homes.

This new approach is being led by the Easington GP Consortium, one of the new clusters of family doctors that will be entrusted with 80 per cent of the NHS budget in April 2013.

The GPs are being given greater freedom to develop better ways to treat groups of patients.

But, because the hand-over of responsibility for commissioning health services from primary care trusts (PCT) to GP groups will not happen for another two years, family doctors in Easington are working in partnership with senior managers from their PCT.

Pat Keane, deputy chief executive of NHS County Durham and Darlington, is also the PCT director attached to the Easington GP Consortium.

“COPD is a particular problem in the Easington area,” says Mr Keane. “Usually it is managed in the home, but when it flares up you can have people admitted to hospital five or six times a year. What we as a PCT are encouraging the GPs to do is to be innovative. If you can put in a good care pathway to support them better at home you should be able to reduce hospital readmissions and improve the patient’s overall health.”

The COPD project in the Easington area is typical of the kind of doctor-driven approach to healthcare which Health Secretary Andrew Lansley wants to promote as part of his Health and Social Care Bill.

Each of the seven GP consortia in County Durham and Darlington is working on ideas to tackle everything from care in nursing homes to improving how musculoskeletal injuries are handled.

Mr Keane’s twin roles symbolise the transitory state of the NHS.

In two years’ time, it will look very different.

152 primary care trusts will be replaced by about 500 GP consortia which will be charged with spending £80bn of taxpayers’ money each year on buying health care for patients.

Since last summer, and in line with the Government’s orders to slash management costs before handing budgets to GPs in April 2013, NHS County Durham and Darlington has seen staff numbers fall from 450 to 375. The wage bill will fall from £14.5m a year in 2010-11 to £9.9m in 2011-12 and will eventually drop to £7.7m by April 2012. “Staffing costs will have reduced by 50 per cent in two years,” says Mr Keane.

While it has been a painful experience for those concerned, everyone who has left the PCT so far has done so voluntarily. But another major hurdle for the remaining PCT staff is just around the corner.

“We are asking our staff to choose from one of three options by April,” says Mr Keane.

These include working for the new GP consortia, transferring to local councils, or working for the National Commissioning Board (NCB) being set up by the Government.

Nobody knows for sure where the NCB will be based, but some NHS insiders have suggested it might be situated within “The Kremlin”, the NHS headquarters in Leeds.

While the new GP consortia will probably set up offices in each of their locations, it is anticipated that they will share a central administrative hub.

In the coming financial year, some NHS funds will be handed over to GPs to try out innovative approaches to delivering health care, such as the Easington scheme. And the next big landmark will be the abolition of regional Strategic Health Authorities, in Newcastle and Leeds, in April 2012.

But the big bang will be when GPs are finally put in charge in a little over two years’ time.

“I would say that most GPs welcome the shift. There is an anxiety about what it will mean to them on a day-to-day basis, but there are enough GPs supporting all this to make it happen,” says Mr Keane.