David Colin-Thome National Clinical Director for Primary Care GP, Castlefields, Runcorn Honorary Professor, M.C.H.M, Manchester University Honorary Professor, School of Health, University of Durham

The P.M.s Principles for the Public sector National Framework of Standards and Accountability Devolution to the Local Level Improved Rewards and Conditions of Employment (Flexibility, Incentives, Rewarding Success, Shedding Bureaucracy) More Choice, More Contestability

PCT Manager of the local NHS

COMMISSIONING Service Delivery and Service Re-Design. Contract Management and Monitoring.

PPF Improving Access-Emergency Care, Waiting, Booking, More Choice Clinical Priorities & Improving life chances for children Improving patients experience Reducing Health Inequalities X Government Drug Misuse programme

Policy Developing a Wider Range of Services in Primary Care GPs with Special Interests – 2004 Target At least 1 million outpatient appointments to be delivered in the community by 2006

Commissioning Primary Care nGMS nPMS nCommunity Pharmacy LPS, PDS Liberating the talents Community Dentistry Options for Change PwSI Secondary to Primary care Self care and self management

National ES PCTs may establish; Monitor anti-coagulation Care of the homeless Intra partum care IUCD fittings Minor injury service More specialised services for patients with Multiple Sclerosis. More specialised sexual health services Services for alcohol misusers Services for drug misusers Near patient testing Immediate and first response care Specialised care for depression

Local ES PCTs may establish any number of LES. Pricing and specification will be negotiated locally. LES may not provide for funding in respect of any service provided as Essential,Additional,DES or NES unless that service is to a higher standard or different specification.

Clinical Resource Management Practice based incentives and budgets Case Management Assertive outreach Secondary to Ambulatory shift including PwSI Clinical Appropriateness Expert Patient

General practitioners with special interests supplement their important generalist role by delivering a high quality, improved access service to meet the needs of a single PCT or group of PCTs. They may deliver a clinical service beyond the normal scope of general practice, undertake advanced procedures, or develop services. They will work as partners in a managed service not under direct supervision, keeping within their competencies. They do not offer a full consultant service and will not replace consultants or interfere with access to consultants by local general practitioners. DH / RCGP Definition

PwSI Work Completed 1250 GPwSI Frameworks Step by step advice document for PCT NwSI National Development Group

Initial Frameworks ENT Coronary Heart Disease Echocardiography Drug misuse specialinterests

Modernising the Primary Care Workforce - ENT services provided by GPsWI 30-40% of ENT patients can be seen by a GPwSI. Up to 20% of ENT patients seen by GPwSI are referred onwards to a consultant or surgical waiting list. DNA rates for GPwSI clinics are typically 1-2%. One GPwSI, holding a weekly clinic, can manage the relevant ENT workload generated by a population of 75,000. An established GPwSI, holding a weekly clinic, can perform 500 consultations per annum.

2003 frameworks produced Child protection Dermatology Drug misuse(revised) Emergency care Epilepsy Headaches Palliative care Respiratory medicine Mental health Sexual health Diabetes Care of older people Musculo-skeletal conditions(?soon)

Future Frameworks Public Health CAMH Genetics ?Pain specialinterests

Work in Progress AHPwSI ? Scientists ?Pharmacists ?Dentists ?Optometrists ?Midwives ?Practice Managers