Transcript PILOT SCHEME AGREEMENTS

MARK WILSON
Director
020 7274 8813
[email protected]
Silverthorne Consulting
Contracting for Primary Care
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PCT Strategic Functions
• The general modernisation of primary care
• The expansion of the primary care sector and the resourced
shift of secondary to primary care work
• The recruitment and retention of the primary care workforce
• The management of demand for primary care services
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Patient Services Guarantee
PCTs will have a legal responsibility to ensure that:
‘patients will continue to be offered at least the range
of services that they currently enjoy under the
existing contract’
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Process
Develop
commissioning
strategy
Monitor
outcomes
Undertake
procurement
process
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Contracting Routes - Summary
CONTRACTING ROUTE
PROVIDERS
General Medical Services (GMS)
Practices with at least one GP provider
(single-handers, partnerships, or a certain
type of limited company)
Personal Medical Services (PMS)
Practices (single-handers, partnerships, or
a certain type of limited company)
Nurses and other clinicians
PCTs
Alternative Providers Medical Services (APMS)
Commercial providers
Voluntary sector
Not-for-profit organisations
NHS trusts and foundation trusts
Other PCTs
PCT Medical Services (PCTMS)
PCTs
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GMS Contractors
• A general medical practitioner
• Two or more individuals practising in partnership;
– At least one partner (who must not be a limited partner) must be a
general medical practitioner
– Other partners must be individuals from within the NHS family
• Company limited by shares
– At least one share must be legally and beneficially owned by a general
medical practitioner
– Other shares must be legally and beneficially owned by individuals
from within the NHS family
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PMS Contractors
Agreements can be made with one or more of the following:
•
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•
•
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An NHS Trust
A medical practitioner
A healthcare professional
An individual who is a GMS or PMS provider
An NHS employee or a PMS employee
A qualifying body (a company limited by shares, all of which
are legally and beneficially owned by persons identified
above)
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APMS Contractors
PCTs may make contractual arrangements with any person (for
the provision of primary medical services)
[Section 16CC(2)(b)of the National Health Service Act 1977]
Specific provisions for:
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Individuals
Companies
Partnerships
Industrial and provident societies, friendly societies, voluntary
organisations
ie. must be fit and proper persons.
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PCTMS
A PCT may provide primary medical services itself (whether
within or outside its area)
[Section 16CC(2)(a) of the National Health Service 1977
Act]
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PCTs as commissioner
Three routes:
Negotiation
GMS
National
PMS
Local
APMS
Local
Contractor
type
Prescribed, at least
one GP provider
Prescribed, but no
requirement for GP
provider
Completely flexible
Contract
terms
Min. requirements set
out in GMS Regs
Min. requirements set
out in PMS Regs
Min. requirements set
out in Directions
(based on PMS Regs)
Payment
Prescribed, as per
SFE
Flexible, but likely to
be linked to SFE eg
seniority, QOF
Flexible, may be
linked to SFE if
desired
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PCTs as provider
Two routes:
– PMS
– PCTMS
“ Under PMS, the PCT can be the contractor but this
involves the SHA acting as the commissioner. The SHA
commissioner role is increasingly anomalous given StBoP
and PCTs may ... wish to transfer such PMS contracts to
PCTMS arrangements where the PCT is the direct provider.”
[para 2.6 Delivering Investment in General Practice]
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PCT Provision
“ PCTs are encouraged to develop a minimum level of
(provision of essential) services....
If PCTs propose to become large-scale providers of primary
medical services, they are expected to discuss this first with
their SHA. They are also expected to consult with LMCs.”
[para 2.6 Delivering Investment in General Practice]
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Procurement Process
• Two stage process:
– First, competition between GMS and PMS practices
(which would have preferred provider status);
– Then, open competition.
[para 7.20 Investing in General Practice]
• Further Guidance ?
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