Key Principles:
White Paper – Our Health, our care, our say:
Four main goals:
Better prevention services and earlier interventions
More choice and a louder voice for people
Reduction on inequality and improving access to community services
More support for people with long-term needs
Methods for achieving this:
Shifting resources into prevention
More care undertaken outside hospitals and in the home
Better joining up of services at local level
Encouraging innovation
Allowing different providers to compete for services
How does Practice Based Commissioning fit into this?
PBC guidance
PBC supports all of these by acting as a driver for more responsive and innovative models of joined-up support within communities, delivering better health outcomes and well-being, including a focus on prevention. It is intended to:
Drive up quality
Improve patient experience
Reduce inequality
Deliver value for money
Under PBC guidance Practice Based Commissioners will be able to retain at least 70% of any released resources for investment in patient services.
This provides a minimum level to encourage engagement.
PBC in practice:
Practices should identify an area of healthcare provision that needs improving. This should be in keeping with the PCT local development plan and should involve discussion with other interested parties.
Practices can choose to provide the service, commission it from another provider or a combination of the two.
A business plan should be developed that outlines the proposed changes, the benefits of those changes and the new cost of delivering the service. This should be done in consultation with patients and other local health and social care organisations as appropriate.
As a provider the practice will need to identify the total cost of delivering the new service, including all costs: clinical, admin, managerial, disposables, room rental, service charges and other overheads. This will determine the cost of providing the service, as though it were being commissioned from a provider outside of the practice. The released resources would be the difference between the current acute provider tariff price multiplied by historical activity and the new proposed cost.
Practices are able to retain at least 70% of any released resources to re-invest in patient care. Practices are free to negotiate with the PCT on the use of the released resources above and beyond the guaranteed minimum 70% threshold.
The financial risk remains with the PCT and it is important to agree how this risk is going to be managed.
What about in areas where the PCT is in financial deficit?
The PCTs with the greatest financial pressures will need to achieve the greatest level of involvement of primary care practitioners in PBC if they are to achieve the necessary levels of service redesign to free up the required amount of resources necessary to achieve financial balance.
If practices are able to demonstrate significant cost reductions by delivering services differently then this will benefit all. Practices should still be able to negotiate with the PCT to determine the use of any released resources in partnership with the PCT. If the PCT removes this incentive practices are less likely to engage and therefore the service redesign necessary is less likely to take place and costs are less likely to be reduced therefore the deficit is less likely to diminish.
PBC outcomes
The outcome of this should be more work being carried out in the community which improves the patient experience and offers value for money therefore freeing an appropriate level of resource to assist the local NHS to move towards financial balance whilst encouraging innovative practice.
DES payment
The first DES payment will be used to encourage all practices to participate at the minimum level of engagement by reviewing their referral patterns and making some initial changes to their use of NHS resources through simple actions or a service redesign.
The second DES payment will ensure that they can benefit from some additional resource to invest in patient services in the absence of any resources being released from the process due to financial constraints within the PCT. However this should not constrain practices from negotiating with PCTs for the opportunity to determine the use of any released resources in partnership with the PCT.
Download Road Map
