SOUTH HAMS AND WEST DEVON PRIMARY CARE TRUST
PBC has been high on the agenda locally for several years now; from the early days there was a general recognition that the benefits of working in partnership with each other would reap rewards. The geographical size of the PCT area presented many challenges however; the PCT has always been approachable and receptive to practice views. As an example, practices have not been forced to either work in localities or in isolation, although both alternatives have been encouraged. This has seen cluster working develop organically, with several clusters now at different stages of development. Some clusters are working totally together, while others are banding only for certain services. Others, conversely, are currently content to develop services in isolation.
The PCT has put in place a PBC Team that acts as a resource for practices. The Team consists of a PBC Business Manager whose main responsibility is to support the practices business requirement, including the provision of monthly performance reports showing activity against indicative budget ; progress against our locally devised Incentive Scheme and adhoc requests. Many of these latter requests are to support the completion of business cases prior to submittal. This position is funded direct by the PCT. In addition, the PCT has appointed to two PBC Advisors whose main responsibility is supporting practices in service redesign. The Advisor role is funded through top-slicing the practices PBC budget.
The PCT has produced an Accountability and Governance Framework document which serves as a SLA between the practice and/or locality and the PCT describing the roles and responsibilities of all parties to the agreement. In addition, the PCT has devised a PBC business case template for the production of service proposals. Each practice has a comprehensive PBC Manual which comprises of these documents plus PbR guidance.
Overseeing the PBC work is the Strategic Commissioning PEC Sub-Group. This body is cross functional and includes PCT representatives, GPs, Practice Managers and a cross section of other health professionals. This group oversees the planning and delivery of the PBC initiative and ensures it meets both local direction and national policy. Business cases from the practices will be considered by this group, and the cross section of membership also means that it is often used as a resource for testing ideas.
Due to the levels of engagement achieved to date, the PCT has opted to continue with a locally agreed incentive scheme for 2006-07 as an alternative to the DES. This local scheme has been designed to reimburse practices for work done towards PBC, with the intention that the current financial year should be used to make a real step change in the ways in which services are provided. If applied fully, this scheme will allow new care pathways to become firmly embedded, which will deliver benefits in both patient care and financial resources in years to come. The scheme covers elements such as data validation and PBC planning, but also has a major focus on redesigning care pathways. Part of this is to encourage primary care clinicians to enter discussions with secondary care with the aim of agreeing and redefining care protocols, particularly with reference to ensuring that patients are discharged from outpatient care at the most appropriate points.
The range and scope of PBC in SH&WD has allowed for a high degree of innovation in the submission of PBC plans, over 50% of LDP submissions were from our practices. A number of schemes are worthy of highlighting. One of the most innovative involves a the commissioning of a practice to manage the operational and service development of a Community Hospital and services, including incorporating Social Services. This development is being run along the Kaiser Permanente principles of Self Care.
