Singapore

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Singapore
AAH Pharmaceuticals Convention
2007
understanding tomorrow today
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Michelle Webster
PBC The Road Ahead

• Assistant DirectorPBC Development Programme

Singapore
2007
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The Organising Framework for the Health Reforms
Money following the patients, rewarding the best
and most efficient providers, giving others the
incentive to improve
Better care Better patient experience Better
value for money
More choice and a much stronger voice for
patients, connected to strong commissioning by
practices and PCTs
More diverse providers, with more freedom to
innovate and improve services
A framework of system management, regulation and
decision making which guarantees safety and
quality, equity value for money
Singapore
2007
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Practice Based Commissioning

• Practice based commissioning gives practices and
  professionals the freedom to develop innovative,
  high quality services for patients.

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PBC History

• Provider led NHS
• Advent of PbR
• Importance of Commissioning
• Commissioning / Contracting / Procurement
• Who Should be the Commissioner

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Aim

• In partnership with SHAs and PCTs, maximise the
• number of PCTs and practices operating PBC
• in order to develop and improve services for
  patients, and
• to embed a residual local skill base in
  commissioning for future development

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The Challenges

• Enthusiasm from GPs
• Reconfiguration
• Pace of Reform
• Getting Good Useful Information
• Budgets deficits save to invest rather
  than invest to save
• Provision versus Commissioning
• Risk Averse Mentality Stifling Innovation
  e.g. Tendering
  Contestability Rules
• Collusion with Secondary Care

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The Successes

• Improved Working Relationships
• Shared Understanding and Vision between Practices
  and PCTs
• Shared Responsibility
• Good Systems in place to Collect Data and Monitor
  Budgets and Outcomes
• Practices have Welcomed the Opportunity to Lead
  Change

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Roles Responsibilities

• The Practice
• Patient/Practice Based Control
• Reshaping Care
• Chronic Disease Management
• Unscheduled Care

• The PCT
• Strategic Commissioning
• Contract setting
• Coordination of Practice needs
• Market management
• Urgent care integration
• Tackling health inequalities

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Partnership Working

• Partners in Care
• Pharmacists
• Social Services
• Voluntary Sector
• Charities
• Patients
• Community Members

• New ways of working
• Unique Care/Care Case Management
• Sexual Health Services
• Mental Health Services
• Healthy Communities Collaborative

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Practice based commissioning

• 3.16 Efforts in 2006/07 have focused on putting
  in place the building blocks for PBC to support
  practices. Good progress has been made. In
  2007/08, the emphasis must be on practical
  implementation so that it makes a real difference
  to peoples lives

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Any Willing Provider

• Excerpt from Practice Based commissioning
  Practical Implementation DoH November 2006
• PCTs should seek to establish a range of
  providers (such as GP limited companies, third
  sector organisations that are values-driven,
  community pharmacies and private companies) from
  which patients can choose, driving up quality
  through contestability.

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Service Re-design

• Crucial ingredient of PBC
• Where the real changes will be made
• Real improvements in service delivery
• All inclusive - engagement of all stakeholders,
  including the most important of all

Patients
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Case Studies

• North Sheffield Testing and treatment for H
  Plylori
• Initially a pilot in North Sheffield
• Pilot showed a saving of over 16,000 on avoided
  gastroscopies giving a net saving of nearly
  13,000
• The pharmacy will carry out H. pylori breath
  tests on patients referred to them via a written
  direction from a GP
• The pharmacist will subsequently treat H. pylori
  positive patients with eradication therapy under
  a Patient Group Direction (PGD)
• The pharmacist will offer advice on the
  management of
  dyspepsia to patients
• The pharmacy will communicate the results to the
  GP practice
• This service has been extended across the
  whole of
  the city and commissioned as an enhanced service

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Case Studies

• Hillingdon PCT Diabetes management in primary
  care
• This service is delivered through community
  pharmacies in
  Hillingdon PCT
• Available to all adults, taking medication for
  their diabetes, residing within Hillingdon PCT
• Each patient has a consultation with the
  pharmacist on at least 6 occasions in a 12-month
  period
• Pharmacists measure each patients blood glucose,
  blood pressure, HbA1c and cholesterol level
• Pharmacists use agreed referral criteria and
  refer patients to GP when monitoring parameters
  fall outside the target range
• The programme is now being adapted to incorporate
  supplementary prescribing.

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Singapore
AAH Pharmaceuticals Convention
2007
understanding tomorrow today