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Personal Medical Services in North Bradford PCT

North Bradford Primary Care Trust. Personal Medical Services in North Bradford PCT. Julie Winterbottom Assistant Director of Commissioning. Aims. Provide an overview of PMS within North Bradford PCT Show PMS in context with the overall performance framework

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Personal Medical Services in North Bradford PCT

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  1. North Bradford Primary Care Trust Personal Medical Services in North Bradford PCT Julie Winterbottom Assistant Director of Commissioning

  2. Aims • Provide an overview of PMS within North Bradford PCT • Show PMS in context with the overall performance framework • Look at our model of practice-led commissioning • Show potential Specialist PMS services

  3. PCT Vision • Self-care • Preventative care • Chronic disease management • Reduced hospitalisation • Targeted care for patients with complex needs • Can do culture

  4. Profile of North Bradford PCT • 12 multi-partner practices • Population size approx 93,000 • High elderly population • Geographically small (20 minute drive radius) • Pockets of highly deprived areas and affluent areas • 5% ethnicity

  5. So what is Practice-led commissioning ? The North Bradford model is to: • Devolve and align responsibility, accountability and authority at practice level

  6. The current contract • Practice-level PMS • All 12 practices are PMS • 2 practices went in Wave 1 • 9 practices went in Wave 3 • 1 practice went 1 April 2004 • Wave 3 practices got £1m growth monies in total • Resulting in 15Nurse Practitioner posts and 5 salaried GPs

  7. PMS Performance Management • 40 quality targets in 2003-4 PMS contract • Benchmarking data amongst practices • Quarterly practice reviews • Statistical analysis eg trend analysis, run charts • Regular reports to the Exec, PEC and Board • Monthly reporting and feedback to practices • Regular informal practice meetings with Chief Executive and Non-Executive Directors

  8. PMS in context with the Performance Improvement Model Mission Performance Packages Vision Incentive Scheme Perf. Fund Patient Experience Culture PMS Practice Manager leads Support Advisory Groups PLT/PBE Unit of Delivery Education Pursuing Perfection Specialist Groups Practice Review Meetings Collaboratives Optimising Hospital Utilisation Patient/Consumer Involvement Clinical leads Information

  9. In addition to core PMS – The Primary Care Incentive Scheme

  10. In addition to core PMS – The Performance Fund Investing in the infrastructure of Primary Care to support continuous improvement • Data collection /data quality • Attendance at key meetings / PLT / GP Advisory Group • Annual revised Practice Business Plans • Summarisation of medical records • Investors in People • Use of the electronic booking system/booked admissions £50,000 approx. (based on practice of list size 10,000) RECURRENT

  11. In addition to core PMS – Locality Services • GPs with a Special Interest (GPwSI) • Consultant outreach clinics Potential income to a practice = up to £70k plus

  12. 2004/5 PMS contract • Choice of baseline for core general practices services • Plus payment for:- Enhanced services- GPwSI / locality services- Performance fund monies- Incentive Scheme monies- ‘Gold standards’ in chronic disease management- Agenda for Change- Patient involvement- True advanced access- E-booking / referral protocols- Pharmacist clinical time- IWL / IIP - Nursing Home pilot (Optional) (is this ‘Specialist PMS’ ?)

  13. Out of hoursA full package of out of hours services for practices to purchase(is this potentially a ‘Specialist PMS’ ?) An out of hours service comprising: • GP Co-operative • Fast response • Salaried GPs • Nurse Practitioners • Paramedics • Crisis resolution • Telephone triage • Daytime home visits • Primary care walk-in centre at two sites

  14. PMS - The 4 levels of service delivery • Core general practice • Enhanced services • Secondary to primary shift • Service developments – phase 1 & phase 2

  15. A closer look at Core General Practice • Level 1 indicators = nGMS indicators • Level 2 indicators = improving quality further • No points system, money upfront, continuous development • More money for Chronic Disease Management • Includes, for example;- use of templates in relation to the Treatment Centre - practice-level Expert Patient Programmes

  16. A closer look at Enhanced Services • Directed Enhanced Services (DES) • Examples:- Spirometry- Sexual Health- hysteroscopy workup- 24hr BP- Anticoagulation- Lithium monitoring • Practice’s own patients or other practices also

  17. A closer look atSecondary to Primary Shift • More rigorous Clinical Governance • District-wide accreditation • Includes GPs with a Special Interest (GPwSI)- Urology - Diabetes- Dermatology - Musculo-skeletal- Neurology - ENT- Cardiology - and others • PCT-wide service

  18. A closer look at Service Developments • Phase 1 & Phase 2 • Need business case from practices • Examples;- Alternative therapies- Integrated community nurses- Minor injuries walk-in site

  19. Key principles • Devolve and align responsibility, accountability and authority at practice level • Less bureaucratic • Flexibility • Money invested upfront • Clinical standards agreed locally • Collaborative approach to working • Different pace of change for each practice • Recognition of ‘High Achieving practices’ = more autonomy • Practices will not be disadvantaged compared to the new GMS contract • 10% financial increase for the next 3 years

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