Working in NHS communications has never been easy. Fighting media fires about the MRSA super-bug one day, and MMR vaccinations the next, health service PR is a world of surprises. And now, as part of the NHS Improvement Plan, practitioners have a new challenge to deal with - practice-based commissioning.
As part of the Government's drive to introduce local-level decision-making and offer more choice to patients, GP practices are being encouraged to take more control of their own budgets, giving them the freedom to commission services to suit the specific needs of the communities they serve.
The more people demand these services, the more funds the GP practices can get, creating a payment-by-results system that will benefit the doctors most skilled at anticipating and serving local needs.
Stretched to the limit
Ostensibly this all seems like change for the good, and from the Government's point of view it is a major part of its strategy to improve the NHS. However, some are concerned about the implications for stretched and scarcely resourced comms departments, specifically those within Primary Care Trusts (PCTs) - the bodies with regional responsibility for GPs' surgeries and other primary care services.
Michael Smeeth, head of UK healthcare at Fleishman-Hillard, and a former NHS communications officer, warns: 'There is a lack of understanding among the public - and NHS staff - about what practice-based commissioning means.' He adds that because PCTs are relatively new organisations, they are not necessarily prepared for the comms issues that practice-based commissioning will create: 'It will cause problems. PCT communications practitioners will find a massive increase in demand for their services.'
So, what are these new comms challenges? As well as the internal issue of educating staff on practice-based commissioning, PROs will also have to work hard informing people in the local community about the new choice of services available to them. PCT communications teams will also have to work harder to support GPs.
As they are on the front line dealing with patients, doctors will have an enhanced communications role when it comes to explaining the reforms. Smeeth adds that these reforms will also have the effect of creating multi-tiered GP practices.
'The GPs who more effectively engage with patients and offer a better service will prosper. Practice-based commissioning will clearly highlight differences between them.' He points out that these disparities could cause knock-on problems for PCTs' public relations - GPs aware of the benefits could demand greater comms support.
Practice-based commissioning will also have the effect of making PCT communications teams more locally focused. With many PCTs covering large areas with 15 or more GP practices, communicating the reforms will be no easy task.
Helena Reeves, director of comms at South East London Strategic Health Authority, says she and her team are still assessing the implications, but have identified enhanced local engagement as a key issue. 'Communications officers have really leapt on the big question of creating a patient-led NHS,' she says.
'The challenge we now have is bringing it all down to a local level. We need to move away from a media focus to more individual communication, working with GPs to help them have a dialogue with local people. I think our communications role will shift towards delivering information through frontline health professionals rather than trying to do it all ourselves.'
One concern is whether PCTs are going to be given additional resources to cope with these issues. In areas such as finance and human resources, the NHS is clearly prescriptive about what a PCT needs, but no such minimum requirement exists for communications, something that is left to individual PCTs to decide.
With the prospect of PCT comms professionals finding their in-trays bulging with extra demands, some fear they will be stretched dealing with day-to-day issues, let alone having to find time for longer-term strategic planning and implementation.
Lynne Paramor, communications manager for South Hams and West Devon PCT, which has 18 GP practices, points out: 'A lot of GPs arrange their communications in their own way, which is all part of celebrating local decisions and diversity, but it means that it can be hard to know what's happening at one end of your patch from the other.'
The problem is that many PCTs covering large geographic areas leave their communications to one person, often a part-timer. In looking for a co-ordinated approach to something like practice-based commissioning, it is hard for PROs at PCTs to keep up with what everyone in their area is doing and to ensure the public are getting consistent and clear information.
Slow to change
Paramor fears that PCTs will be 'slow to invest in better communications because other areas are always fighting hard for any extra cash'. She agrees that enhanced PR is needed because patients have clearly voiced a desire for clearer and jargon-free explanations of NHS initiatives and what they mean for them.
However, she doubts PCTs are forward-thinking enough to begin investing now: 'I'm not sure that PCTs know how much more work they will have to do.
'I worry that PCTs aren't aware of communications until someone comes up and slaps the issue in their face. I don't think anyone yet knows how this is going to pan out - I work in the NHS, and I don't know.'
Jonathan Street, director of Nexus Communications Group, says better resourcing is vital. 'There is a strong need for better comms at PCT level. Compared with hospitals, PCT comms is under-resourced and doesn't have the same quality of people.'
He adds by way of conclusion: 'There is a huge challenge here, and if it's not resourced it won't be done well. For PCTs to really make their mark in local communities, there is a big job to be done.'
WHAT IS PRACTICE-BASED COMMISSIONING?
Practice-based commissioning (PBC) is seen as a major plank of the Government's plans to improve the NHS. As of April, GP practices have the right to hold budgets for commissioning services.
Many of these are designed to bring down the traditional barriers between primary and secondary care, making more services available locally to reduce pressure on acute services further down the line.
Local fracture clinics or 'walk-in' cardiology units are examples of how PBC budgets could be spent. There are no targets, but every Primary Care Trust (PCT) is expected to encourage GP practices in its area to adopt the scheme, and the Department of Health hopes that all practices will be involved in PBC by 2008. Using the indicative budget they receive from their PCT, GP practices are expected to identify the health needs of the local population and, in conjunction with stakeholders, identify appropriate services to be provided. Because the budget is indicative, overspends will be met by the PCT but budgets are expected to be balanced within a three-year cycle.
There are financial incentives for GPs to take part - commissioning their own services may mean practices can make considerable savings. Under the deal, GPs will be allowed to re-invest 50 per cent of any savings they make in patient services - the other 50 per cent will be retained by the PCT to cover overspend. The financial flipside for GPs is that managing budgets will involve more administrative costs. PCTs are working with practices to develop cost management systems, and practices will be able to offset their costs against total savings before they are split between the practice and the PCT.
However, additional investment in communications personnel or a consultancy is unlikely to be part of this formal cost evaluation.