Practice Based Commissioning

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Practice Based Commissioning
Tarun Sharma 01.04.09.
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What is PBC?
E-portfolio GP curriculum MSF/PSQ/COT/CBD etc
etc etc and now PBC .......
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At its simplest ....
One of the many reforms/measures introduced by
the government along with PbR , CB and Rx
Centres
Whereby practices ( either alone or in
combination with other practices / primary care
professionals) can use allocated funds to
directly commission services for their patients.
Any savings made in the process, can be used by
the practice to fund new services for themselves.
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Is it that simple ....... ?
Not quite...
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Origins of PBC
1990s GP fund holding was implemented by the
Conservatives.
1997 Abolished by the labour govt ( 2 tier
care).
The New NHS Modern, dependable( DoH 1997). This
white paper believed there was some merit in the
idea of devolving commissioning to GPs.
2004 7 yrs later Practice Level
Commissioning
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Why PBC ?
1. Better service for pts, closer to home.
2. Making GPs feel responsible for sec care
budgets.
3. Envisaged to Develop innovative pathways for
patients outside hospital Secure long term
savings by reduced hsp referrals and admissions.
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What exactly is the PBC recipe ?
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GP Commissioning group.
Indicative budget / Fair share budget.
PBC plan Commissioning Providing.
FURS Money to spend on the practices.
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Commissioning or Provider Groups
GPs and hospital consultants.
Nurses
Pharmacists
Optometrists
Any primary care professional
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Indicative budget.
Not real budgets ( ? ).
Includes historic expenditure incurred on
managing the practice's patients in sec care
e.g. attending AE or hsp inpt stay.
Also includes comparisons with local national
figures.
Still held by the PCT.
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Fair share budget.
Differences between GP practices.
National formula by including Age Illness
data Deprivation levels
Capped at 1 p.a.
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PBC PLAN
Assess needs
Review current service provision and prioritise
needs
Design service
Ensure access to service
Manage performance
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Therefore now the Commissioning Group has
that was spent on a service e.g. single
admission due to Stroke.
Can the Commissioning group make savings or
provide a better service?
AF screening at Flu clinics by Colchester PBC Gr.
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Freed up Resources - FURS
If the service can be provided, via PBC plan,
cheaper than before, savings are made.
70 of these freed up resources can be used by
the commissioning group on improving its services
e.g.
Fund TENS machines Light boxes for SAD.
Fund training as a GPwSI.
Commission a new service such as local Derm /ENT
clinic DVT testing service etc.
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Community Dermatology

• Tariff price for OP 115 or 58 follow up
• GPSI service sees 6 new and 6 follow ups per
  session
• c1k of activity
• Charge this at 80 tariff to others
• Allow 200 for heat, light and consumables
• 600 left (cost GPSI session 250)
• 350 left as profit!

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Lastly...
Voluntary scheme.
No targets !!
Incentives( DES) from PCT to practices to engage
0.95p / pt to develop implement a plan.
0.95p / pt on achieving objective of the
above plan.
Total 1.90 / pt registered at the practice
which is a part of the PBC group.
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Some examples of services developed
1. Community based musculoskeletal service.
2. F/u of Coeliac patients in the community
3. Initiation management of IDDM patients in
the community.
4. Community COPD management service.
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GP Curriculum Being a GP
www.primarycarecontracting.nhs.uk www.dh.gov.uk ww
w.kingsfund.org.uk www.improvementfoundation.org w
ww.rcgp.org.uk
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Any questions ?
THANK YOU !