1. Sustaining Innovation through New PMS Arrangements Richard Armstrong

2. Quality in PMS (Chapter 4) Quality is equally important in PMS as in new GMS. Therefore: Patients expectations are for similar opportunities for improvement Quality delivery and quality framework in PMS should be broadly comparable to national QOF Equally, should be similar reward for similar effort between PMS and GMS

3. Quality in PMS BUT …. PMS not a one-size-fits-all model Some quality payments already in PMS practices baseline Therefore PMS can be different from National QOF

4. Quality in PMS PMS Quality Points Offset What is already in baseline covers: - Sustained Quality Allowance Chronic Disease Management Half of Cervical Cytology Screening Points Offset in 04/05 174 = £13,050 Reduces to 109 points in 05/06

5. Quality in PMS Issues in developing local schemes Schemes must be points-based -1050 More schemes depart from national QOF more difficult to provide management information No national information about relative prevalence in local schemes Local schemes must be subject to fair and thorough assessment of achievement

6. Quality in PMS Issues in developing local schemes Senior PCT clinician responsible for ensuring fairness between local and national quality framework. Ensuring local Quality schemes are: Rigorous Evidence based Monitored fairly Explicitly assessed against agreed criteria Paid at an appropriate and equitable rate

7. Quality in PMS Some options for local schemes National QOF plus local add-ons Different interventions Different indicators Fewer indicators Different evidence base Different approaches

8. Practice-led Commissioning Not fund-holding Not just about GPs or General Practice (about clinical teams) WHY? -Empowering & engaging clinicians -Choice, Access, Payment by Results - Allowing innovation - Providing clear mechanisms for accountability

9. Practice-led Commissioning Rights & Responsibilities - Clinical Team - PCT Down to PCT to determine - scope - range and - form of arrangements Not complete (or single) answer