Transcript Document
GMS Update – PBC, NICE
guidelines, new protocols
Meeting 11.5.07
Stephen Newell & Sue Neal
Topics for the meeting
Practice based commissioning
NICE guidance
New protocols
PRACTICE BASED COMMISSIONING
What is the policy context?
The policy context
Commissioning a patient-led NHS
Dealing with the whole person (health and
health services)
Local convenient modern services
New systems, choices, payment by
results
More local decision making
Diversity of providers
National standards (supported by
inspection)
Objectives
Deliver health targets
Smoking
Drugs/alcohol
Sexual health
Childhood obesity
System Reform
Creating the patient-led culture
Re-focus commissioning to
community/primary care
Organisational Change and
Development
SHA reconfiguration in London
Formation of NHS London
32 Borough based PCTs retained
All co-terminous with London
Government regional office
But……..PCT-led programme of
change
Provision
Strategic
commissioning
Primary care
commissioning
Practice-based
commissioning
Finance
Public Health
Social care
partnership with
local government
Governance
Support services
Communication
Organisational
development
Human resources
What’s in it for patients? The vision
Commissioning by those best placed
to know their real choices
Likelihood of more services closer to
home
Reduced chance of service
fragmentation
More chance of their practice
surviving
Practice Based Commissioning
Key messages:
Level of engagement
Infra-structure
Shared agreements
Management costs
Indicative budgets
Data
IMT
What needs to be done
Engagement by GPs
Find some quick wins
Set indicative budgets
Consider what should be
commissioned
Resource considerations
Service redesign
Reconfiguration of Unscheduled care
services (A&E / OOH)
Management of Long term
conditions
Savings should be generated by
transferring care into a community
setting
Reviewing Consultant referrals
Competition, change and challenge
GPs will face increased competition
from alternative providers
PBC is a vehicle for helping practices
to work together
PCTs may be merged
Community services will not be
provided by PCTs
Practices working in isolation or poor
premises will face major changes
Competition
Alternative Providers of Medical
Services (APMS)
APMS can be used instead of
PMS/GMS or PCT services or they
can run in parallel or in addition to
them
Other providers of services
InHealth (diagnostics)
MRI
USS
New patient treatment centre at
KGH
Challenges 1
Patient services
•
Difficulty in registration
Population growth (new housing)
Patient satisfaction issues
Premises issues
Substandard premises
Cash limited resources for
reimbursement
Challenges 2
Practice issues:
Partnership splits
Retirement of GPs especially single-handed
Non-viable small lists
PCT managed issues
Performance issues:
Practices not providing services such as
cytology and immunisations
Access targets
QOF underachievement
Clinical governance compliance
Meeting the challenges 1
Practices can help meet the
challenges by:
Collaborating
with neighbouring
practices
Forming groupings or partnerships
Establishing GP co-operatives
Creating PBC consortia
Working with the PCT
Meeting the challenges 2
PCTs can help meet the challenge
by addressing the concerns:
Pace
of change
Financial deficits
Lack of clarity about management
costs
Insufficient scope for savings
Poor data quality
What may be achieved
Real savings possible by:
Managing
referrals to secondary care
Preventing admissions by targeting
management of long term conditions
Facilitated and supported early discharge
Service redesign involving alternative
(cheaper!) provision in primary care
The Rationale
A belief that a pluralistic market will
modernise/improve healthcare delivery
The assumption that rollout of PBC and
opening up health care to the private
sector will result in more choices for
patients and the more cost-effective
provision of services
The assumption it will release 15%
saving on management and admin
costs
Pluralistic Health Economy
There will be a progressive move
towards greater use of other providers
including those from the independent
sector
There will be no commissioner loyalty
towards existing GP/other local
providers
GP contracts may be put out to tender
Economies of scale favour alternative
providers especially if they take over
community services.
Key Messages
Practices working together can deliver the
service redesign which has eluded PCTs and
PCGs
Individual practices need to safeguard
themselves by joining forces with other
practices
GPs should take on commissioning or
someone else will do it for them
GPs should consider COLLECTIVELY taking
over some of the provider functions or risk
someone else doing it for them to their
detriment
Next steps
NSMC involved in PBC at a
strategic level
Use of NICE and other
guidelines
Protocols
Diagnostics
Referrals – already
considered to some extent