1. GMS Update – PBC, NICE guidelines, new protocols Meeting 11.5.07 Stephen Newell & Sue Neal

2. Topics for the meeting  Practice based commissioning  NICE guidance  New protocols

3. PRACTICE BASED COMMISSIONING What is the policy context?

5. The policy context  Commissioning a patient-led NHS  Dealing with the whole person (health and health services)  Local convenient modern services  New systems, choices, payment by results  More local decision making  Diversity of providers  National standards (supported by inspection)

6. Objectives Deliver health targets  Smoking  Drugs/alcohol  Sexual health  Childhood obesity System Reform  Creating the patient-led culture  Re-focus commissioning to community/primary care

7. Organisational Change and Development  SHA reconfiguration in London  Formation of NHS London  32 Borough based PCTs retained  All co-terminous with London Government regional office

8. But……..PCT-led programme of change  Provision  Strategic commissioning  Primary care commissioning  Practice-based commissioning  Finance  Public Health  Social care partnership with local government  Governance  Support services  Communication  Organisational development  Human resources

9. What’s in it for patients? The vision Commissioning by those best placed to know their real choices Likelihood of more services closer to home Reduced chance of service fragmentation More chance of their practice surviving

10. Practice Based Commissioning Key messages:  Level of engagement  Infra-structure  Shared agreements  Management costs  Indicative budgets  Data  IMT

11. What needs to be done  Engagement by GPs  Find some quick wins  Set indicative budgets  Consider what should be commissioned  Resource considerations

12. Service redesign  Reconfiguration of Unscheduled care services (A&E / OOH)  Management of Long term conditions  Savings should be generated by transferring care into a community setting  Reviewing Consultant referrals

13. Competition, change and challenge  GPs will face increased competition from alternative providers  PBC is a vehicle for helping practices to work together  PCTs may be merged  Community services will not be provided by PCTs  Practices working in isolation or poor premises will face major changes

14. Competition  Alternative Providers of Medical Services (APMS)  APMS can be used instead of PMS/GMS or PCT services or they can run in parallel or in addition to them

15. Other providers of services  InHealth (diagnostics) MRI USS  New patient treatment centre at KGH

16. Challenges 1  Patient services  Difficulty in registration  Population growth (new housing)  Patient satisfaction issues Premises issues  Substandard premises  Cash limited resources for reimbursement

17. Challenges 2  Practice issues:  Partnership splits  Retirement of GPs especially single-handed  Non-viable small lists  PCT managed issues  Performance issues:  Practices not providing services such as cytology and immunisations  Access targets  QOF underachievement  Clinical governance compliance

18. Meeting the challenges 1  Practices can help meet the challenges by:  Collaborating with neighbouring practices  Forming groupings or partnerships  Establishing GP co-operatives  Creating PBC consortia  Working with the PCT

19. Meeting the challenges 2  PCTs can help meet the challenge by addressing the concerns:  Pace of change  Financial deficits  Lack of clarity about management costs  Insufficient scope for savings  Poor data quality

20. What may be achieved  Real savings possible by:  Managing referrals to secondary care  Preventing admissions by targeting management of long term conditions  Facilitated and supported early discharge  Service redesign involving alternative (cheaper!) provision in primary care

21. The Rationale  A belief that a pluralistic market will modernise/improve healthcare delivery  The assumption that rollout of PBC and opening up health care to the private sector will result in more choices for patients and the more cost-effective provision of services  The assumption it will release 15% saving on management and admin costs

22. Pluralistic Health Economy  There will be a progressive move towards greater use of other providers including those from the independent sector  There will be no commissioner loyalty towards existing GP/other local providers  GP contracts may be put out to tender  Economies of scale favour alternative providers especially if they take over community services.

23. Key Messages  Practices working together can deliver the service redesign which has eluded PCTs and PCGs  Individual practices need to safeguard themselves by joining forces with other practices  GPs should take on commissioning or someone else will do it for them  GPs should consider COLLECTIVELY taking over some of the provider functions or risk someone else doing it for them to their detriment

24. Next steps  NSMC involved in PBC at a strategic level  Use of NICE and other guidelines  Protocols  Diagnostics  Referrals – already considered to some extent