PeckppointohpEPPCT Conf 1

1
Reconfiguring PCTsInfluences and options

• Professor Edward Peck, Health Services Management
  Centre
• 6 October 2005

2
Some initial thoughts

• NHS as pendulum
• NHS as shanty town
• NHS as commissioner

3
Primary care-led commissioning - what does the
evidence tell us?

• Little evidence that shows PCLC (or any other
  approach) to have made a significant or strategic
  impact on secondary care
• PCLC, where clinicians have influence over
  budgets, can improve responsiveness
• PCLC has made most impact in primary and
  intermediate care

4
Primary care-led commissioning - what does the
evidence tell us?

• Given a sustained opportunity to innovate, highly
  determined PCL commissioners can achieve
  innovation in working practices
• Primary care-led commissioning increases
  transaction costs in commissioning

5
Primary care-led commissioning - what does the
evidence tell us?

• No ideal size for a commissioning organisation
• A single organisational solution is neither
  appropriate nor possible
• Meaningful clinical engagement is key
• Balance to be struck with public and management
  accountability
• PCLC organisations have struggled with public
  engagement

6
Can form follow function?

• Commissioning referral and demand management at
  around 30-50k
• Public Health joint projects suggest LA
  co-terminosity 200k-1m
• Independent contractors ?
• Provision ?

7
What do we know about mergers?

• No evidence that increases in size beyond 100,00
  generate significant cost savings or performance
  improvements
• Numerous studies point to tendency of mergers not
  to make promised savings
• Many other costs in terms of loss or morale and
  productivity
• Most managers fail due to cultural differences

8
Provider changes for more profound

• Contestability demands a contest?
• Contestability demands variety of propositions?
• Contestability demands range of organisational
  forms?

9
The plethora of options

• Private sector platforms and pensions?
• Voluntary sector perspectives and pensions?
• Public/Community Interest companies
  legislation?
• Public Benefit corporations governance
  arrangements?

10
The plethora of options (contd)

• Vertical integration monopoly and evidence?
• Horizontal integration LA relationships?
• Care Trust commissioner or provider (or both)?
• SPMS/APMS GMS?
• Local Authority history?
• GP Partner business growth culture?

11
The plethora of options (contd)

• Enthusiasm of DH to support innovation?
• Enthusiasm of NHS managers for entrepreneurial
  approaches?
• Enthusiasm of staff for the disruption and risk
  involved?

12
The plethora of options need to balance

• The views of commissioners (NHS and LA)
• The views of provider managers (and elected
  members)
• The views of clinical staff

13
The plethora of options adopt a joint venture as
holding position

• Purpose
• Identity
• Senior Executive and Management Team

14
A plethora of options adopt a joint venture

• Simple to establish
• Focus on short-term
• Process for deciding long-term future