Transcript Practice based commissioning in Sutton and Merton PCT

Practice based commissioning
in Sutton and Merton PCT
George Burns
Practice Based Commissioning
Development Manager
[email protected]
020 8251 0473
Introduction
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My role
Background to PBC
How PBC actually works
PBC in Sutton and Merton PCT
Providing new services
commissioned through PBC
Issues for discussion
My role
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I am the link between PBC consortia
and the PCT
Over the last year I have been
involved in developing the
framework for PBC in Sutton &
Merton and supporting consortia
Now PBC is firmly established the
focus of the role is how to develop
PBC
Background to PBC
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Practice based commissioning was
introduced by the Department of Health
in April 2005.
The 2007/8 Operating Framework for the
NHS states that ‘PBC is central to world
class commissioning and is here to
stay..PBC is our most powerful way of
reaching local communities, and so it is a
crucial part of how we expect PCTs to
address equality issues and reduce
inequalities’.
Background to PBC
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PBC is seen by the Department as
playing ‘a vital role in health
reform..[placing] primary care
professionals including GPs, nurses
and practice teams, working
alongside secondary care clinicians
and other primary and allied health
professionals, at the heart of
decision making to commission
services for their local population’.
Aims for PBC in Sutton & Merton
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The three aims for PBC are:
to put clinicians in charge of patient
pathways in order to develop services
which demonstrate high clinical quality,
are closer to home, more convenient for
patients and address health inequalities
to increase the the variety of services
available and type and number of
providers commissioned
to use services and resources efficiently
to maximise the health gain for patients
BUT, what exactly is practice based
commissioning?
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Practices or groups of practices
have the right to hold an indicative
budget covering the health care
delivered to their registered
populations
Practice based commissioners
receive information on this health
care, including levels of activity and
its cost, on a monthly basis
How PBC works….
How PBC works…
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If, at the end of the year, PBCs make
savings against their budget they can
reinvest them in other services for the
benefit of patients
PBCs can reinvest 70% of any savings.
30% is retained for investment across the
PCT.
Sutton and Merton PCT remains legally
responsible for the budgets and has a
statutory duty to break even every year
How PBC works…
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Practice based commissioners can make
savings against their budget by:
Re-designing health care services so that
they are more efficient and effective, and
providing more services in primary care
Reducing the demand for specialist care
by managing more conditions and
patients within primary care
Reducing health inequalities and focusing
on the prevention of ill health
How PBC works..
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Practice-based commissioners write
commissioning plans for each financial
year
These plans must be in line with the PCT’s
3 year Commissioning Strategy Plan
Plans must be signed off by the PCT
For each proposed service redesign or
change, practice based commissioners
must complete a service specification
This outlines the new service that they
wish to commission
How PBC works…
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The PCT, working with PBC consortia,
then procures the service
Providers are invited to submit business
cases for the provision of the service
Business cases are assessed by a subcommittee of the PCT’s Board
Successful providers deliver the service to
the specification and are monitored and
evaluated by the PCT and PBC consortia
PBC in Sutton and Merton
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53 out of 54 practices in Sutton and Merton
are practice based commissioners.
There are five PBC consortia across the
PCT:
Nelson Commissioning Group (150,00
patients)
Sutton Horizon (95,000)
Merton Healthcare (80,000)
Integrated Primary Care Commissioning
(50,000)
Sutton Commissioning Group (25,000)
PBC in Sutton and Merton
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Practices have been engaged with PBC
since the policy was introduced
Consortia are now well developed
The PCT supports PBC consortia by
funding managerial costs and providing
PCT staff to support PBC (eg service
improvement, finance, information)
Over the last 3 years, the PCT has also
provided a financial incentive for practices
to participate in PBC
PBC in Sutton and Merton
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PBC consortia are managing the following
indicative budgets for 2007/8:
Nelson Commissioning
£131.2m
Sutton Horizon
£91.4m
Sutton Commissioning
£24.7m
Merton Health Care Ltd
£70m
Integrated Primary Care
£48.7m
New or redesigned services so
far…
Diabetes
 Ophthalmology
 Gynaecology
 Anticoagulation
 Dermatology
AND PLANS FOR..
o End of Life care
o Urgent Care
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Providing new services
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GPs and practices involved in 3 of the PBC
consortia have set up separate provider
organisations.
It is the PCT’s responsibility to manage
potential conflicts of interest in PBC.
The PCT has responsibility for procuring
health care services and for ensuring best
value for the taxpayer.
PBC consortia cannot hold contracts with
providers; they must operate through
‘PCT-let contracts’.
Providing new services
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The PCT’s procurement process should be
non-discriminatory, open, objective and
proportionate.
The PCT should demonstrate that all
willing providers have had the opportunity
to bid to provide services.
The PCT should seek to encourage a
plurality of providers and increase patient
choice.
Providing new services
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The Department of Health has released
guidance on the ‘Principles and Rules for
Co-operation and Competition in the
NHS’.
The PCT’s processes for procuring
services, and the role of PBC consortia
within these, are evolving in line with
national guidance and policy.
There is a move to clearly separate the
functions of commissioning and providing.
Issues for discussion
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Do voluntary organisations have a
role to play in practice-based
commissioning?
How can voluntary organisations
become involved?
What role does the PCT have in
making this happen?
What about the provision of
services?