Sustaining Innovation through New PMS Arrangements

1
Sustaining Innovation through New PMS Arrangements

• Richard Armstrong

2
Quality in PMS (Chapter 4)

• Quality is equally important in PMS as in
• new GMS. Therefore
• Patients expectations are for similar
  opportunities for improvement
• Quality delivery and quality framework in
• PMS should be broadly comparable to
• national QOF
• Equally, should be similar reward for
• similar effort between PMS and GMS

3
Quality in PMS

• BUT .
• PMS not a one-size-fits-all model
• Some quality payments already in
• PMS practices baseline
• Therefore PMS can be different from
• National QOF

4
Quality in PMS

• PMS Quality Points Offset
• What is already in baseline covers -
• Sustained Quality Allowance
• Chronic Disease Management
• Half of Cervical Cytology Screening
• Points Offset in 04/05 174 13,050
• Reduces to 109 points in 05/06

5
Quality in PMS

• Issues in developing local schemes
• Schemes must be points-based -1050
• More schemes depart from national QOF
• more difficult to provide management information
• No national information about relative prevalence
  in local schemes
• Local schemes must be subject to fair
• and thorough assessment of achievement

6
Quality in PMS

• Issues in developing local schemes
• Senior PCT clinician responsible for
• ensuring fairness between local and
• national quality framework. Ensuring local
• Quality schemes are
• Rigorous
• Evidence based
• Monitored fairly
• Explicitly assessed against agreed criteria
• Paid at an appropriate and equitable rate

7
Quality in PMS

• Some options for local schemes
• National QOF plus local add-ons
• Different interventions
• Different indicators
• Fewer indicators
• Different evidence base
• Different approaches

8
Practice-led Commissioning

• Not fund-holding
• Not just about GPs or General
• Practice (about clinical teams)
• WHY?
• Empowering engaging clinicians
• Choice, Access, Payment by Results
• - Allowing innovation
• - Providing clear mechanisms for accountability

9
Practice-led Commissioning

• Rights Responsibilities
• - Clinical Team
• - PCT
• Down to PCT to determine
• - scope
• - range and
• - form of arrangements
• Not complete (or single) answer