My experience of clinical commissioning

One of the main aims of Connecting Care for Children (CC4C) is to ‘change the way childrens’ care is commissioned, delivered and experienced in London by making the experience of paediatricians in hospitals much more widely available’. I have been extremely lucky to be involved in a project which truly targets this goal.

Pulse oximetry is a non-invasive tool to measure oxygen levels in the blood that we use for almost every child seen in hospital. It is an indispensable piece of kit for any child coming in with breathing difficulties or fever, and helps doctors decide whether patients need oxygen therapy or other urgent treatment. Measurement of oxygen saturations features in most of the standard guidelines issued by NICE and the British Thoracic Society for acute respiratory conditions, and it is increasingly advocated that oxygen saturations should be measured in the community by GPs so as to help identify early those children who require urgent referral to hospital.

Despite these recommendations, most GP practices in the UK do not have a suitable pulse oximeter for children. Therefore, Hounslow Clinical Commissioning Group (CCG) has taken the initiative and is trying to introduce pulse oximeters into the GP surgeries in their area. Essentially, the busy people at the CCG had been looking to put together a business case to raise funding for the project. Their aim would be to provide pulse oximeters to all of their GP surgeries and to provide training in their use. For this, they needed some background medical information, guidelines and evidence behind the use of pulse oximetry in young children, in addition to some scoping of the different manufacturers and models (of which there are many) to find one suitable for use in GP practices and young children.

For adults, pulse oximetry involves placing a plastic probe on a warm finger or toe. In younger children, getting a reliable reading usually requires use of a different probe, which has to be wrapped around a toe, finger or foot in small babies. The adult-sized finger probe tends to fall off small fingers and often gives an erroneously high or low reading, therefore either giving false reassurance or causing unnecessary panic.

Throughout my Integrated Care fortnight, I kept in close contact with the CCG leads at Hounslow to ensure we were on the same page and not straying from the brief. I developed a ‘business case’ which detailed the background, aims and uses of pulse oximetry in primary care (asthma/wheeze, bronchiolitis, suspected lower respiratory tract infection, fever, upper airway obstruction) and pulse oximetry model recommendations.

At the end of the two weeks, a video conference with the involved CCG members cemented the plan of action: an official CCG business case based on my report would be drafted and submitted by the following week and presented to the finance board 15 days later. So much for my previous held views of a slow-moving commissioning group – this was so quick and efficient! Before we knew it, we’d sped through most of the stages of the clinical commissioning cycle!

I loved how the momentum was used to push everything forward, and it now seems likely that pulse oximeters may be available in GP practices in Hounslow by Christmas! Amazing news, and a great experience for me as a junior doctor, who so rarely gets involved in clinical governance. It also shows how working with a like-minded, forward-thinking group of people can really achieve a lot in a very short space of time.

Watch this space!

Image: the NHS commissioning cycle (