Primary Health Care Financing Lessons from the UK Beverly Sibthorpe Deputy Director Australian Primary Health Care Re

1. Primary Health Care Financing Lessons from the UK Beverly Sibthorpe Deputy Director Australian Primary Health Care Research Institute

2. Problems Facing NHS in 2000 Under-invested system Lack of national standards Demarcations between staff Lack of clear incentives Barriers between services Lack of support Over centralisation Dis-empowered patients

3. PCTs and Fund-holding Primary Care Trusts (PCTs) Regional fund-holder for all NHS services Negotiate and purchase services for registered population expanding range of public and private providers Carry financial risk

4. nGMS Contract new General Medical Services contract Practice not GP Basic package of services Minimum Practice Income Guarantee Quality and Outcomes Framework (QoF) 146 indicators / targets Additional money for reaching targets

5. Information and Review Information - Single unique identifier - Massive investment in IT - Collation of information from general practices Review - Healthcare Commission

6. Forecast Changes � System Hospital ~ primary health care interface Participation of private providers, including US HMOs Greater emphasis on promotion and prevention Nurse-based immediate care clinics Prescribing rights for non-medical clinicians Better links with social services Specialist ambulatory services and clinics

7. Forecast changes � general practices Practice cooperatives pooling management, financial and IT resources Practices working jointly Practice nurses, physicians assistants, health care assistants Practice nurse management of people with chronic diseases Allied health professionals

8. Forecast changes - GPs GP focus on diagnosis and management of complexity GP specialisation Alternative career pathways in management, policy, strategic planning and public health Growth in salaried general practice

9. Forecast changes - IT Internet-based decision support Email consulting NHS Direct for telephone and internet access to home-based care and advice TV-based access to health advice

10. Sweeteners for general practices & GPs? Additional practice income New money for premises and workforce New career opportunities Improved working conditions: after hours locum support retirement pensions education and training

11. Threats? Focus on what�s measured; neglect of what�s not measured Increased fragmentation Erosion of doctor-patient relationship Erosion of continuity of care Erosion of comprehensive care Gaming and rhorting

12. Immediate challenges PCT restructure Diversion of care/costs from hospital sector Practice-based commissioning Clinician re-engagement PCTs as service providers?

13. Bold Plan ! Need for system change Care and resources out of hospitals Focused on performance Underpinned by information Consumer focused Concerned with equity General practice support

14. Lessons for Australia Health resources finite Regional approach to resource management Re-orientation to primary health care Sophisticated and flexible commissioning General practice as entity Rich information driving change