Richard Alsop

1
Implementing Practice Based Commissioning

• Richard Alsop
• Director of Service Improvement Performance
• Northamptonshire Heartlands PCT

2
Some Background

• Large PCT (in old money) 280,000
• 4 previous PCGs
• Locality structure retained with devolution
• Clinical engagement 6 years in the making
• Good relationships with general practice LMC
• Contract implementation used to mutual benefit
• Honest conversations
• Now merging with 2 other PCTs
• 1st Wave PBC Collaborative Site

3
The Right Climate for Change?

• The Merger
• Concern about loss of Heartlands ethos
• Concern about loss of trusted managers
• The Money
• 37 Million deficit across county
• Disinvestment decisions
• The Motivation
• The contract is paying well, why bother?
• Not obvious WIIFM

4
Sometimes, it makes you feel, well like ..
5
So what have we done?
6
Structures

• Transformed previous locality structures in to
  Locality Commissioning Groups
• Previous locality staff now focused on
  commissioning PBC
• Replaced the PEC
• With a Commissioning Clinical Executive
• 8 GPs (2 per locality) Executive members
• Influencing 100 of spend, not just freed up
  resources

7
Information

• Were significantly behind the pace
• Limited support to contract management
• No provision of regular practice level data
• Invested in new web based system Executive
  Viewer
• Budget / contract variance reporting
• Inter practice benchmark comparisons
• Budgets
• Interesting when in deficit
• 05/06 outturn
• Contingency reserve top slice

8
The DES

• Endless conversations about 95p
• National DES didnt fit with what we were trying
  to achieve
• But agreed
• Countywide
• Second 95p guaranteed in return for commitment to
  prescribing recovery plan - 5 Million
  potentially
• Validation Enhanced Service
• Prescribing reward scheme
• Opens the door to invest to save developments
• Detailed Practice Plans soon
• Pooling of resources at locality / network level

9
PBC Developments

• General Surgery Clinical Assessment Service (CAS)
• Expanding Orthopaedic Triage
• Low back pain service
• Nursing home support
• Oral Surgery transfer to primary care
• Varicose Veins CAS
• Limiting Follow Up out patients in contracts
• Heart Failure Nurse
• LTC / Intermediate Care Developments
• Locality Based Projects to reflect local need

10
The Difficult Decisions

• Sterilisations gone
• IVF criteria tightened, but service suspended
• Increased list of low priority treatments
• Excluded from contract
• Validate waiting list and remove
• Return future referrals
• Reduce NRT to 4 weeks prescribed
• Anti-obesity drugs significantly reduce
• Gluten free foods, fungal nail treatments, etc,
  stopped
• Challenging role of Health Visiting
• MUCH OF THIS LIST STILL BEING WORKED THROUGH !!!!

11
Where Next?

• Invest to save proposals
• Confirm, challenge, try!!
• Incentive / reward arrangements for work done on
  prescribing changes
• Acute trust data validated (and challenged!)
• Increased Transfer / tendering of services
• Community nursing ???
• Take the best bits of what we have done in to
  Northamptonshire PCT on 1 October 2006