GMS Update – PBC, NICE guidelines, new protocols

1. GMS Update – PBC, NICE guidelines, new protocols Meeting 11.5.07 Stephen Newell & Sue Neal

2. Topics for the meeting • Practice based commissioning • NICE guidance • New protocols

3. PRACTICE BASED COMMISSIONING What is the policy context?

5. 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)

6. 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

7. 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

8. 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 But……..PCT-led programme of change

9. 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

10. Practice Based Commissioning Key messages: • Level of engagement • Infra-structure • Shared agreements • Management costs • Indicative budgets • Data • IMT

11. What needs to be done • Engagement by GPs • Find some quick wins • Set indicative budgets • Consider what should be commissioned • Resource considerations

12. 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

13. 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

14. 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

15. Other providers of services • InHealth (diagnostics) • MRI • USS • New patient treatment centre at KGH

16. Challenges 1 • Patient services • Difficulty in registration • Population growth (new housing) • Patient satisfaction issues • Premises issues • Substandard premises • Cash limited resources for reimbursement

17. 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

18. 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

19. 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

20. 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

21. The Rationale • A belief that a pluralistic market will modernise/improve healthcare delivery • The assumptionthat 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

22. 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.

23. 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

24. Next steps • NSMC involved in PBC at a strategic level • Use of NICE and other guidelines • Protocols • Diagnostics • Referrals – already considered to some extent