Personal Medical Services in North Bradford PCT Primary Care Trust Personal Medical Services in North Bradford PCT Introduce self Presentation on GP Specialists services Don’t want to talk the whole session, hope is to give presentation and then have a debate around the subject 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 Look at our model of practice-led commissioning Show potential Specialist PMS services

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

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

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

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 15 Nurse Practitioner posts and 5 salaried GPs

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

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

In addition to core PMS – The Primary Care Incentive Scheme Incentive Scheme Element £ available to practice (based on list size of 10,000) Prescribing Quality Markers Payment is direct to GPs, no conditions on how money is spent. Pick “n” mix Rewards small improvements Payments awarded on a matrix basis £12,500 max Hospital Services Quality Markers £10,000 max Financial Performance (based on savings made against indicative practice budget) Linked to quality – if no quality markers achieved then no savings retained. Practice retains 50% of savings made for agreed investment in the practice. Key objective is to encourage practices to achieve “value for money” and utilise alternative services to manage demand. £20,000 max Investment into Primary Care (maximum possible for a practice of 10,000 patients) £42,500 max

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

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

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’ ?)

Out of hours A 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

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

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

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

A closer look at Secondary 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

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

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