GMS Update – PBC, NICE guidelines, new protocols

Meeting 11.5.07Stephen Newell & Sue Neal

Topics for the meeting

Practice based commissioning

NICE guidance

New protocols

PRACTICE BASED COMMISSIONING

What is the policy context?

The policy context

Commissioning a patient-led NHS

Dealing with the whole person (health and health services) Local convenient modern services New systems, choices, payment by

results More local decision making Diversity of providers National standards (supported by

inspection)

Objectives

Deliver health targets Smoking Drugs/alcohol Sexual health Childhood obesity

System Reform Creating the patient-led culture Re-focus commissioning to

community/primary care

Organisational Change and Development

SHA reconfiguration in London

Formation of NHS London

32 Borough based PCTs retained

All co-terminous with London Government regional office

But……..PCT-led programme of change

Provision Strategic

commissioning Primary care

commissioning Practice-based

commissioning Finance Public Health

Social care partnership with local government

Governance Support services Communication Organisational

development Human resources

What’s in it for patients? The vision

Commissioning by those best placed to know their real choices

Likelihood of more services closer to home

Reduced chance of service fragmentation

More chance of their practice surviving

Practice Based Commissioning

Key messages: Level of engagement Infra-structure Shared agreements Management costs Indicative budgets Data IMT

What needs to be done

Engagement by GPs Find some quick wins Set indicative budgets Consider what should be

commissioned Resource considerations

Service redesign

Reconfiguration of Unscheduled care services (A&E / OOH)

Management of Long term conditions

Savings should be generated by transferring care into a community setting

Reviewing Consultant referrals

Competition, change and challenge

GPs will face increased competition from alternative providers

PBC is a vehicle for helping practices to work together

PCTs may be merged Community services will not be

provided by PCTs Practices working in isolation or poor

premises will face major changes

Competition

Alternative Providers of Medical Services (APMS)

APMS can be used instead of PMS/GMS or PCT services or they can run in parallel or in addition to them

Other providers of services

InHealth (diagnostics)MRIUSS

New patient treatment centre at KGH

Challenges 1

Patient services Difficulty in registration Population growth (new housing) Patient satisfaction issues

• Premises issues Substandard premises Cash limited resources for

reimbursement

Challenges 2

Practice issues: Partnership splits Retirement of GPs especially single-handed Non-viable small lists PCT managed issues

Performance issues: Practices not providing services such as

cytology and immunisations Access targets QOF underachievement Clinical governance compliance

Meeting the challenges 1

Practices can help meet the challenges by:

Collaborating with neighbouring practices

Forming groupings or partnerships Establishing GP co-operatives Creating PBC consortia Working with the PCT

Meeting the challenges 2

PCTs can help meet the challenge by addressing the concerns:

Pace of change Financial deficits Lack of clarity about management

costs Insufficient scope for savings Poor data quality

What may be achieved

Real savings possible by: Managing referrals to secondary care Preventing admissions by targeting

management of long term conditions Facilitated and supported early discharge Service redesign involving alternative

(cheaper!) provision in primary care

The Rationale

A belief that a pluralistic market will modernise/improve healthcare delivery

The assumption that rollout of PBC and opening up health care to the private sector will result in more choices for patients and the more cost-effective provision of services

The assumption it will release 15% saving on management and admin costs

Pluralistic Health Economy

There will be a progressive move towards greater use of other providers including those from the independent sector

There will be no commissioner loyalty towards existing GP/other local providers

GP contracts may be put out to tender Economies of scale favour alternative

providers especially if they take over community services.

Key Messages

Practices working together can deliver the service redesign which has eluded PCTs and PCGs

Individual practices need to safeguard themselves by joining forces with other practices

GPs should take on commissioning or someone else will do it for them

GPs should consider COLLECTIVELY taking over some of the provider functions or risk someone else doing it for them to their detriment

Next steps

NSMC involved in PBC at a strategic level

Use of NICE and other guidelines

Protocols Diagnostics Referrals – already considered to some extent