Understanding Practice based commissioning

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UnderstandingPractice based commissioning

• Bev Norton
• Primary Care Development
• Birmingham
• The Black Country SHA

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What is Practice Based Commissioning?

• It is a vehicle to enable PCT to meet its
  commissioning targets by engaging practices or
  groups of practices or other primary care
  professionals in the commissioning of services

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Five key aims of PBC

• Give PCTs and practices an opportunity to
  redesign service to meet the demographic
  challenges of the local population
• Move the focus to Primary Care delivery
• Ensure greater levels of clinical engagement
• Facilitate greater equity in the overall
  deployment of NHS resources
• Meet the demands of a Patient Led NHS

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PBC does not represent

• A return to any previous scheme
• A general NHS management reorganisation
• An explicit opportunity to increase practice
  profits

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Joined up policy?
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Budgets

• From April 2005 every practice is entitled to
  hold an indicative budget
• The PEC and PCT board recommend and decide on the
  rules of engagement
• The budget will initially be historic. John
  Hutton Move to fair share may take longer than 3
  years
• Management costs, including reasonable practice
  costs, should come from the savings in the
  budget
• Practices can choose which services they want to
  take the budget for but this needs to be for
  all services by 2008
• Practices need to balance budget over 3 years (
  but any deficit falls back to the PCT)

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Accountability arrangements

• There are shared agreements- between PCT and
  practices- practice to practice
• PCT has the Right of intervention
• Must be linked to choose and book
• Conflict of interests-commissioner and provider
  roles - need for governance arrangements

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Risk Management

• Overspends
• Fluctuation rates in services required
• Impact of Payment by Results
• Top sliced contingency fund suggested
• Agreed trigger points for monitoring
• The Public Health agenda

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Savings

• Efficiency gains governed by PEC and PCT boards
  and can be used for
• Patient services only
• Capital developments

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Competencies PCTs may require from practices

• Good record of data quality and understanding of
  IT
• Recognised as performing well
• No outstanding disputes
• Good clinical governance and risk management
  systems

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What might PCTs require from practitioners?

• Good understanding of PCT agenda and the
  commissioning cycle
• Practice LDPs identifying patient and service
  needs
• Ability to influence local decision-making
• Commitment to service redesign
• Committed to Patient and Public Involvement
• Ability to work well with other practices

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Practice Based Commissioning

• Development of patient care
• Increasing the secondary to primary care shift
• Providing services and settings that are closer
  to home and more convenient to patients.
• Developing patient pathways
• Vertical integration

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Practice Based Commissioning

• Could ensure greater choice?
• With greater variety of services.
• More contestability
• Plurality of providers

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Practice Based Commissioning

• Could impact on demand and resource management?
• Referral control
• Providing alternatives for patients with long
  term conditions who are regular service users
• Alternative pathways eg orthopaedic triage
• Balancing PbR

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What could it mean for you?

• Use your power of local knowledge to
• Influence the use of savings
• Develop the services for your patients health
  needs
• Develop the culture to prevent your population
  having health needs!!

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• Bev Norton
• Birmingham The Black Country SHA