Practice-led Commissioning

1. PRIMIS Practice-led Commissioning Dr David Colin-Thomé National Clinical Director for Primary Care Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future

2. David Colin-Thomé • National Clinical Director for Primary Care • GP, Castlefields, Runcorn • Honorary Visiting Professor,CPPM, Manchester University • Honorary Visiting Professor, School of Health, University of Durham

3. Benefits of a first contact in primary care.(Starfield) • Higher patient satisfaction with health services • Lower overall HS expenditure • Better population health indicators • Fewer drugs prescribed per head of population • The higher the number of family physicians the lower the hospitalisation rate.

4. …then General Practitioners as Purchasers Fund Holders then multi-funds, total purchasers and commissioning ‘‘A GP with a budget is worth 10 GPs on a committee’’

5. Fast, convenient access Extended range of services Consistently high quality services Delivered locally Modernised premises Appropriately trained and motivated staff Integrated IT Responsive Based on needs of informed patients Quality based care in least invasive ways Multi-disciplinary teams Operating across organisational boundaries Vision for Primary Care

6. Commissioning Primary Care • nGMS • nPMS • ‘Liberating the talents’ • Agenda for Change • nCommunity Pharmacy • (LPS, PDS) • Community Dentistry ‘Options for Change’ • Secondary to Primary care-PwSI, PBR • LTC- NSFs, QOF, EPP, Community Matrons • ...and Practice based commissioning

7. NHS FTs Independent Sector Choice Practice Budgets PbR

8. The Registered List What use is it and should it remain? • Starfield’s work • The public’s health • Population management • Budgets for work traditionally based in hospital • -but not for purchasing • The practice as the local micro yet strategic health organisation

9. Key issues • Encouraging commissioning at both a practice, and at a locality, level. • PCTs and practices to work in equal partnership- a meeting of experts • Scope of budget to be determined by the Practice and the PCT. • Size of practice no bar • Clear role for small practices • Not just for GPs

10. Key lessons from past experience Commissioning often does little more than replicate existing service arrangements and service models Degeling

11. Policy Outcomes • Services that are more local, more varied and from more providers. • Increased clinical engagement in service development • A lever for demand management.

12. Strategic fit of PBC • Fits with devolution agenda. • Local delivery Facilitates Choice. • Secondary to Primary shift. • Encourages Plurality • Links to new primary care contracts for supporting people with LTCs.

13. 1. treat day surgery (rather than in-patient surgery) as the norm for elective surgery 2. improve patient flow across the NHS system by improving access to key diagnostic tests 3. manage variation in patient discharge thereby reducing length of stay 4. manage variation in the patient admission process 5. avoid unnecessary follow-ups for patients, providing necessary follow-ups in the right care setting 6. increase the reliability of therapeutic interventions through a "care bundle" approach 7. apply a systematic approach to care for people with chronic conditions 8. improve patient access by reducing the number of queues 9. optimise patient flow through service bottlenecks using process templates. 10 redesign and extend roles in line with efficient patient pathways to attract and retain an effective workforce Ten high impact change principles for service redesign

14. The NHS and Social Care Long Term Conditions Model Delivery System Better outcomes Infrastructure Case Management Community Resources Empowered and informed patients Decision support tools and clinical information system (NPfIT) Disease Management Creating Supporting Prepared and proactive health and social care teams Supported Self care Health and social system environment Promoting Better Health

15. Personal health services have a relatively greater impact on severity (including death) than on incidence. As inequities in severity of health problems (including disability, death, and co-morbidity) are even greater than are inequities in incidence of health problems, appropriate health services have a major role to play in reducing inequities in health. Starfield 12/03 03-385

16. PHCT AND PUBLIC HEALTH • Health Needs Assessment • Anticipatory Care - primary - secondary - tertiary • Inter Agency Working • Community Facilitation / Development • Clinical Governance

17. Castlefields CDM • Older People: • 97% assessed within 1 working day • 48 patients(4%) of >65 were ‘high risk’ • 1000 bed days ‘saved’ = > £300k pa • SS also within budget cf rest of Runcorn • No increased GP workload

18. Castlefields • MH: • 25% (of 38.7%) of SMI admitted • 20% bed occupancy • 50% decrease in OP referrals • HONOS improvement in 28/30 • Total ‘saving’ £0.5m bed days pa

19. General Practice • First Contact Where Patient Chooses • Continuity of Care for Episodic Illness • Chronic Disease Management • Final Repository (“Their Doctor”)