Primary Health Care Financing

1

• Primary Health Care Financing
• Lessons from the UK
• Beverly Sibthorpe
• Deputy Director
• Australian Primary Health Care Research Institute

2
Problems Facing NHS in 2000

• Under-invested system
• Lack of national standards
• Demarcations between staff
• Lack of clear incentives
• Barriers between services
• Lack of support
• Over centralisation
• Dis-empowered patients

3
PCTs and Fund-holding

• Primary Care Trusts (PCTs)
• Regional fund-holder for all NHS services
• Negotiate and purchase services for registered
  population
• expanding range of public and private providers
• Carry financial risk

4
nGMS Contract

• new General Medical Services contract
• Practice not GP
• Basic package of services
• Minimum Practice Income Guarantee
• Quality and Outcomes Framework (QoF)
• 146 indicators / targets
• Additional money for reaching targets

5
Information and Review

• Information
• - Single unique identifier
• - Massive investment in IT
• - Collation of information from general
  practices
• Review
• - Healthcare Commission

6
Forecast Changes System

• Hospital primary health care interface
• Participation of private providers, including US
  HMOs
• Greater emphasis on promotion and prevention
• Nurse-based immediate care clinics
• Prescribing rights for non-medical clinicians
• Better links with social services
• Specialist ambulatory services and clinics

7
Forecast changes general practices

• Practice cooperatives pooling management,
  financial and IT resources
• Practices working jointly
• Practice nurses, physicians assistants, health
  care assistants
• Practice nurse management of people with chronic
  diseases
• Allied health professionals

8
Forecast changes - GPs

• GP focus on diagnosis and management of
  complexity
• GP specialisation
• Alternative career pathways in management,
  policy, strategic planning and public health
• Growth in salaried general practice

9
Forecast changes - IT

• Internet-based decision support
• Email consulting
• NHS Direct for telephone and internet access to
  home-based care and advice
• TV-based access to health advice

10
Sweeteners for general practices GPs?

• Additional practice income
• New money for premises and workforce
• New career opportunities
• Improved working conditions
• after hours
• locum support
• retirement pensions
• education and training

11
Threats?

• Focus on whats measured neglect of whats not
  measured
• Increased fragmentation
• Erosion of doctor-patient relationship
• Erosion of continuity of care
• Erosion of comprehensive care
• Gaming and rhorting

12
Immediate challenges

• PCT restructure
• Diversion of care/costs from hospital sector
• Practice-based commissioning
• Clinician re-engagement
• PCTs as service providers?

13
Bold Plan !

• Need for system change
• Care and resources out of hospitals
• Focused on performance
• Underpinned by information
• Consumer focused
• Concerned with equity
• General practice support

14
Lessons for Australia

• Health resources finite
• Regional approach to resource management
• Re-orientation to primary health care
• Sophisticated and flexible commissioning
• General practice as entity
• Rich information driving change