1. Nuffield Trust Breakfast Seminar:
GP commissioning and public engagement
Profile Governance
and
Origins
Impact
Patient and Questions
Public
Involvement
in Principia
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

2. Nuffield Trust Breakfast Seminar:
GP commissioning and public engagement
Profile Governance
and
Origins
Impact
Patient and Questions
Public
Involvement
in Principia
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

3. Principia; Partners in Health : profile
• Not for profit , Community Benefit Society company limited by guarantee
• Established April 2006
• Objective to develop new accountable and sustainable community facing
service model through:
1. Collaborative Practice Based Commissioning
2. Reformed community services
3. Community engagement
• Indicative budget; £96M / £156M in scope fair shares budget
• Horizontal and vertical integration and accountability
• Lay-professional governance arrangements with lay majority
• Three classes of stakeholders:
1. 120,00 public and patients
2. 140 WTE community staff
3. 16 General Practices ( c. 100 GPs)
• DH Social Enterprise pathfinder, Integrated Care Pilot, and 1st wave GPCC
pathfinder
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

4. Origins: fixing the delivery system, exploiting
the policy opportunities and mitigating risk
• Flawed clinical delivery system; quality issues endemic
• Commissioning a patient led NHS
• PBC and cost containment imperative
• Financial flows
• Choice and contestability; any willing provider
• Incentives to provide clinically effective services
• Investment in primary care
• Minimise risk of “disenrollment”
• Professionalism and public sector values
• Patients and public: “NHS Local, leadership and influence, partnership
with professionals
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

5. Nuffield Trust Breakfast Seminar:
GP commissioning and public engagement
Profile and Governance
Origins
Impact
Patient and Questions
Public
Involvement
in Principia
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

6. Principia: lay governance arrangements
Practice Critical All constituent GP practices are required by
Articles of Association to develop a Critical
Friends Groups Friends Group
Network > 1000 interested local people includes
Principia Health forums (cancer , diabetes, MH , stroke) that
Network participate in commissioning & service redesign
Patient Reference Group(s): (elected) Lay
Patient Reference Advisers, Disabilities Adviser, Practice Manager,
Group(s) Principia PPE Lead, Voluntary Services, COO
Principia Lay Chair, 6 Lay Directors, 3 GPs 3 Community
Staff, Non-voting co-optees: COO, Clinical Chair,
Board LA Representative
Principia Beneficiaries 122,000 All groups chaired by lay people but supported by professions
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

7. Nuffield Trust Breakfast Seminar:
GP commissioning and public engagement
Profile and Governance
Origins
Impact
Patient and Questions
Public
Involvement
in Principia
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

8. Principia: operating arrangements
Clinical Commissioning Forum:
Lay Chair, GPs, Community Staff,
Practice Managers, PRG and Lay
Board members, COO
Practice Critical
Friends Groups
Principia Health
Network Lay-
Multi-professional
Task & Finish
Patient Reference Groups
Group(s)
Principia
Board
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

9. Principia: examples of impact of patient and public
Clinical Commissioning • Strategy development
Forum: Lay Chair, GPs, • Performance management
Community Staff, • Development and presentation of business
Practice Managers, PRG, cases (e.g. 7/7 community diagnostics clinic)
Lay Board member, COO • Pathway development (e.g. community
COPD, Diabetes pathways and virtual
Practice Critical community wards)
Friends Groups • Procurement decisions (AWP community
physiotherapy pathway, TCS)
• Development and decision making around
decommissioning and rationing decisions
Principia Health • Management of Conflicts of Interest (e.g.
Network Lay- “Articles”, GP and Success Scheme
Multi-professional payments)
Task & Finish • Management of GP commissioner
Patient Reference Groups performance
• Management of GP provider performance
Group(s) • Practice surveys (DNA , GP and PN
satisfaction, extended Hours, surveys)
• Appointment of COO and GP Chair
Principia • Design and QA content of health promotion
Board materials and Principia website e.g. 50+
Health Group “Your Medicines Your Safety”
• External representation at national, regional
and local events
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

10. Principia: examples of impact of patient and public
Clinical Commissioning • Strategy development
Forum: Lay Chair, GPs, • Performance management
Community Staff, • Development and presentation of business
Practice Managers, PRG, cases (e.g. 7/7 community diagnostics clinic)
Lay Board member, COO • Pathway development (e.g. community
COPD, Diabetes pathways and virtual
Practice Critical community wards)
Friends Groups • Procurement decisions (AWP community
physiotherapy pathway, TCS)
• Development and decision making around
decommissioning and rationing decisions
Principia Health • Management of Conflicts of Interest (e.g.
Network Lay- “Articles”, GP and Success Scheme
Multi-professional payments)
Task & Finish • Management of GP commissioner
Patient Reference Groups performance
• Management of GP provider performance
Group(s) • Practice surveys (DNA , GP and PN
satisfaction, extended Hours, surveys)
• Appointment of COO and GP Chair
Principia • Design and QA content of health promotion
Board materials and Principia website e.g. 50+
Health Group “Your Medicines Your Safety”
Culture of accountability,
commitment and pride • External representation at national, regional
and local events
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk

11. Nuffield Trust Breakfast Seminar:
GP commissioning and public engagement
Profile and Governance
Origins
Impact
Patient and Questions
Public
Involvement
in Principia
stephen.shortt@gp-c84005.nhs.uk www.principia.nhs.uk