PBC view from Leicester County & Rutland PCT Dr Nick Pulman

LCR PCT Population 635k 7 localities Strong PBC management team (18 managers 2 GPs) Inherited 45m overspend… risk averse 7 clusters in different stages of development 150 schemes live (+40 in next 6m) PBC schemes with focus on primary care engagement

LCR PBC scheme Budget fair share, combined Rx and PBC Management allowance £2.50 pp Incentive scheme 20% FUR for practice 1m for wcc outcomes Tight deadlines for approvals panel Emergency incentive scheme Twinning Off the shelf schemes PBC website

LCR Donut website 11,103 hits last week PBC issues guides and services, but also: Clinical support pathways and guidance Nursing support Locality meetings Clinical forums

Off the shelf PBC schemes Beauty parade 20 schemes Two schemes chosen: COPD and Diabetes Offset costs of strengthening primary care services including prevalence and training expenses …. …. with reduced secondary care spend as a result of the improved practice

COPD scheme Vs 10% unscheduled admissions, 1.2% prevalence (1.4% national 1.7% neighbours) 20p x list size (approx 1% population screen) £500 training/audit £16.67 x COPD list Spirometer + pulse oximeter Bolt ons

Elements of PBC scheme to manage COPD EMIS LV protocol Excel application sheet PREVALENCE Ongoing process to review patients over 35 on inhalers SPIROMETRY SCREENING FEV1 less than 80% predicted and FEV1/FVC less than 0.7 PRACTICE LEARNING Spirometry accreditation Optimum patient care toolkit ESTABLISHED COPD PRIMARY CARE ASSESSMENT INTERMEDIATE CARE NURSES PULMONARY REHABILITATION SEVERITYMRC dyspnoea scale Spirometry Pulse oximetry ASSESS RISKS CVD/CCF cancer nutrition depression hospital admission SMOKING CESSATION VACCINATION OXYGEN THERAPY TREATMENT PLAN 3 to 5 REVERSIBILITY

COPD (spend to save) scheme Vs 10% unscheduled admissions, 1.2% prevalence (1.4% national 1.7% neighbours) 20p x list size (approx 1% population screen) £500 training/audit £16.67 x COPD list Spirometer + pulse oximeter Bolt ons

DM (outcome) scheme Vs Poor tariff specificity for DM, nationally under diagnosed (3% males over 35s) + no recall for IGT. 20p x list size (approx 2.5% population screen) £500 training/audit £200 insulin start £100 complex patient £100 structured education package for newly diagnosed diabetics Bolt ons

Patient Primary care services screening routine monitoring insulin starts complex patients DSN podiatry dietician counseling Patient web space Advice reqresultsRX req Appointment booking Secondary care advice & guidance mentoring Secondary care outpatient & inpatient services Local DESMOND Local DAPHNE Patient led “network board” Map of medicine Leics Guidelines Education & accreditation

Uptake of “off the shelf” schemes 84 Practices in LCR Diabetes scheme 48 practices COPD scheme 64 practices

Future “off the shelf” schemes? Practice/locality based targeted nursing services Salaried GPs Out of hours hand over scheme Nursing home schemes