Lessons and Challenges in Primary Health Care Financing: Insights from the UK

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