PRACTICE BASED COMMISSIONING

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PRACTICE BASED COMMISSIONING

• CHRD PCT APPROACH

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• INSERT PCT MAP

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Facts and figures

• More than 200,000 people spread over more than
  200,000 square kilometres
• 205m budget
• 26 practices
• Complex range of acute care
• Going Local

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Why do it?

• Inability to change care pathways
• Over allocation by 10m
• Flow of resources short waits,PbR,FTrusts,
  growing demand
• Clinical engagement
• Future proofing
• PCT locality arrangements
• Impact of nGMS, NHS Plan

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Going Local Strategic Service Framework
Proportion of money currently spent
20 million
107 million
Secondary
Community/Locality level across practices
10 million
52 million
Practice level
Self managed care
The PCT has devised a simple approach to express
the framework within which it seeks to commission
and develop all services. We aim to develop more
and better primary and community services.
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How we set about it

• PBC steering group
• Membership LMC link
• Practice managers
• PCT Directors group project board
• 1 April and after
• PCT letting go and supporting strategic change

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Our model

• Any practice can apply to hold a budget
• PCT prefers consortia or whole localities to
  promote broader based commissioning, more
  financial influence, more significant service
  change, easier to support
• Practices already opting for locality or
  sub-locality approach

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Our model

• PCT will devolve LDP and achievement of national
  and local targets to practices/consortia and
  localities
• All budgets devolved by Y3
• Practice and locality business plans approved
  by PEC
• Participation at locality level approval of
  plans
• SSD involvement at locality level joint
  commissioning
• Locality will commission for non-participating
  practices

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Our model

• PCT support to PBC
• As much as possible! - financial accountability
  remains with PCT and major benefits to PCT
• Not GPFH focus on clinical engagement
• We will provide
• Referral, health needs and activity information
• Budget and contract monitoring
• Contracting negotiation, documentation,
  monitoring
• Expertise on national requirements and targets
• Training

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Our model

• How will we provide the support?
• Providing a framework for practices to work in
• Business planning cycle and governance
• Planning for service change
• Dedicated named link people for practices
• Centralised contracting support function
• Multi- agency and multi-professional locality
  groups
• Service change implementation

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Our model

• Year 1
• Prescribing and prescribing incentive scheme
• July 2005 at Practice Level
•        - Six main surgical specialties
•        - (Gen Surg, Orthopaeds, Urology, Oral
  Surg,
• Ophthalmology, ENT)
•        - and General Medicine, Elderly Care
  Medicine
•        - Other secondary care services if
  practices want
• and are ready

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Our model

• Year 1 (continued)
• Other secondary care services at locality level
• October 2005 Community Nursing and Mental Health
  Services at locality level

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Our model

• Years 2 and 3
• Other secondary care services at practice level
• Possibly community and mental health services at
  practice level
• Enhanced Services at locality level

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Commissioning Allowance

• What is it for?
• Clinical Engagement
• Work with PCT to develop and implement PBC
• Service Change
• Incentive to make change work

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Commissioning AllowanceHow much?

• 5k recurrent per practice
• 3k non recurrent to work with PCT from April
  (1.5k from October)
• Service Change Allowance (2 of service budget)
• Incentive Payment (20 of service change
  allowance)

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5k recurrent money

• Holding indicative budgets
• Participate in localities
• Take on devolved responsibility for delivery on
  targets
• Participation in the annual planning cycle

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3k start up fee

• Work with PCT to agree approach for PBC
• Agree budgets
• Help develop locality and PBC structures
• Help develop risk and contingency arrangements
• Help develop annual cycle

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Service Change Allowance

• Identify potential changes to service delivery
  and create new service models
• Participating in the service change process
• - Criteria/protocol development
• - Clinical discussions with secondary care

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Incentive Payment

• For continued use of the service change
• Referral target etc will need developing

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Savings

• One pot of money
• 100 savings
• Code of conduct

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