Practice based commissioning: practical implementation

1
Practice based commissioningpractical
implementation

• Rebecca Dallmeyer
• Southwark PCT
• January 2007

2
PCT responsibilities

• Locally agreed incentive scheme offered to all
  practices
• Provide timely and clear information at practice
  level
• Provide tools and support for PBC groups to
  commission effectively

3
DH ethos for PBC

• Balance public accountability with minimum
  bureaucracy and maximum clinical freedom to
  innovate for real improvements for patients

4
Governance and accountabilityPCT committee

• Set up committee of the PCT to
• Develop clear local framework ensuring probity
  between commissioning and providing services
  (based on national guidance)
• Provide advice on governance arrangements,
  including scope and detail
• Approve PBC business cases
• PEC and Board membership

5
Governance and accountabilityPractice based
commissioning plans (to buy services)

• Each practice must agree commissioning plan with
  PCT detailing
• Response to health needs of practice population
• Contribution to national priorities (18 wks and
  health improvement) through service redesign and
  freeing up resources
• Areas for the PCT to coordinate a collective
  approach and prioritise local needs
• Practices need to
• Work with all relevant clinical professionals
  (including DNs, HVs and community pharmacists)
• Include acute trust care staff when moving
  services

6
Governance and accountabilityPBC business cases
(to provide Services

• Need business case to provide service through PBC
  that includes
• service to be provided
• benefits for patients
• expected improvements in efficiency and
  effectiveness
• management resources
• costs of proposals and when recovered

7
Governance and accountabilityPBC accountability

• PCT
• Balance the books
• Provide fair realistic budgets
• Agree use of freed-up resource
• Monitor and discuss progress
• Ensure clinical governance
• Lead implementation of policy
• Ensure patient choice

• PBC
• Manage in budget
• Agree indicative budget
• Agree use of freed-up resource
• Monitor and discuss progress
• Provide quality service
• Implement of policy
• Dont create monopolies

8
Governance and accountabilityPBC accountability

• PCT
• Involve practices in developing local strategy
• Ensure patient involvement
• Ensure PBC plans are available to public
  Overview and Scrutiny committee
• Ensure complaint and PALs met

• PBC
• Be involved in developing local strategy
• Involve patients
• Ensure PBC plan is available to practice
  population
• Ensure complaint and PALs met

9
PBC finance indicative budgets

• Move towards fair share of budget (due 08/09)-
  focus on outliers and maximum of 1 movement
  towards fair share
• New fair share based on prevalence
• Includes prescribing, management costs, community
  and MH
• Reviewed quarterly to take account of changes
• Methodology is simple, consistent ,fair and
  transparent

10
PBC finance freed-up resources

• Minimum of 70/30 rule freeing up resources for
  re- investment in patient care focussed on
  national and local priorities
• Planned OR unplanned
• PCTs and PBC need to agree on use of freed up
  resource

11
PBC finance risk management

• Freed up resource and risk management linked
• No patient disadvantaged due to high cost care
• Plan for in year variation
• Risk pool can be held by PCT or PBC group 3-5
  of indicative budget
• Need to agree access thresholds to risk pool

12
Support Incentives

• DES 06/07, Local Inventive Scheme(LIS)
• Payable only when on or under budget
• LIS should be focussed on achievement of national
  and local priorities
• PCT support available includes management lead,
  project management,analytical and IT systems
  support
• Blocking back of finances and formal agreement
  between practices and PCT re support

13
PBC finance - Procurement

• Tendering ONLY required when likely monopoly
• Any willing provider to ensure choice and
  contestability (quality and choice see
  3.38/3.4)
• Develop range of providers
• Providers must meet national quality criteria
• Value for money
• Prices outside PbR(eg GP led OP services)will be
  based on benchmarking at PCT, SHA and national
  level
• Contracts based on throughput, no income
  guarantees