Local Procurement under PBC

1
Local Procurement under PBC

• Katherine Sheerin Cheryl Mould
• Liverpool PCT
• October 2007

2
Aspirations for PBC

• Putting clinicians at the heart of decision
  making
• Continuously improve services for patients
• Achieve the best health outcomes with the
  investment made, help deliver financially
  sustainable local health economies

3
Position in Liverpool

• 4 Consortia covering 96/100 practices
• High degree of ownership by practices
• Inter-practice agreements
• Real focus on up-skilling primary care (not just
  swapping providers)
• Good balance between opportunities for innovation
  within consortia and shared-approach across the
  city

4
Relationship between PEC and PBC Consortia

• Strategic leadership
• Informed by active PBC clinicians
• Commonality of membership

5
Commissioning Plans 2007/08

• Service Change Plans
• All shaped around
• Achieving 18 week RTT
• Making more effective use of unplanned care
  services
• Making more effective use of prescribing resources

6
Incentives

• Practice incentive scheme action plans linked
  to consortium targets
• Opportunity to structure services in line with
  what is needed for practice patients
• Awareness of reality of funding issues can free
  up resources and invest more wisely
• FOCUSING ON COMMISSIONING!!!

7
Accountability Governance

• AG Framework
• Role of PEC
• Role of PBC Committee
• Procurement Principles

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Commissioning Dermatology Services

• PCT Direction of Travel
• Development of Consortium Model
• Decision to utilise the AWP Model

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Implementation of Dermatology ICATS Service

• ICATS Integrated Clinical Assessment
  Treatment service
• Key GPWSI/Consultant triage, Continuous
  feedback to GPs, Education Skill up of Primary
  Care
• Reduce referral follow up rates
• Process for AWP Model determined
• Timescales simplified resulting in 2 week
  application period
• PBC Committee approved recommendations made by
  interview panel
• Implementation plan drawn up!

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Implementation Plan

• Framework drawn up to include-
• Communication Plan
• Clinical Pathways/Management Plan
• Choose Book
• Information Systems
• Education Programme
• Minimum Data Set Monthly Monitoring
• SLA/Contract agreed

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What went well.

• Close working with providers proved crucial to
  successful implementation
• Links to other PCT teams extremely important i.e.
  CB Team, IMT, Pathology Prescribing
• Full understanding of what is needed to set up
  community based Primary Care Service
• Since service went live, only one area not
  covered in implementation plan travel for
  patients!!

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Key Issues/Challenges

• Information systems community based service.
  Complicated!
• Choose Book compatibility
• Choose Book processes to cover all
  eventualities.
• Setting up agreement with PPA Pathology
• Setting up processes in all 19 practices to
  ensure patient offered choice of provider
• Practices referring into incorrect service
• Working with 2 providers given the political
  issues

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Achievement

• PCT full support throughout whole process
• Excellent example of PBC
• We now have an alternative Dermatology Service
  available providing a quality service closer to
  patients homes
• Consultants based in the community
• Follow up rate has reduced considerably for e.g
  34 first appt NO follow ups
• Has the challenges been worth it.YES!!!

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Next Steps.

• Monthly monitoring feedback so far from
  patients/GPs has been excellent
• Education programme session to be held in
  January
• Evaluation Framework drawn up
• 6 Month evaluation of Dermatology Services across
  Liverpool
• Way forward agreed!!!

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Lessons Learnt

• Patient Public Involvement
• Management of conflicts of interest
• Working with private sector
• Media Interest
• Holding your nerve!!