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PEC Summary

• Fit for purpose process should ensure that PCTs will become more powerful commissioning bodies who will act as agents for change.

• Clinical involvement in decision making brings clinical expertise and adds clinical credibility to decisions

• PEC clinicians need to be capable of performing a management role, of thinking outside of the traditional NHS box and of providing clinical leadership in the PCT’s role as an agent for change.

• To have credibility the clinicians will need a knowledge and understanding of the different roles and organisations that clinicians work in primary care, including variations in the different types of General Practice. Care will be needed in ensuring that the importance of General Practice currently both as being responsible for NHS costs and as in instigator in the reform of the NHS is recognised in the makeup of the PEC.

• Whilst the PEC is best concentrating most of its time on issues to which clinical expertise is relevant The Chair of the PEC will need a detailed knowledge of and involvement in all of the PCTs responsibilities.

• PCTs should decide themselves, after assessing local conditions and problems, how many clinicians are required on the PEC. They should take into account the need to both involve clinicians and to provide clinical credibility to their decisions in pursuit of their agenda for change.

• In order to ensure that the PEC clinicians possess the qualities required they are best appointed. There must be an active process to ensure that the qualities mentioned already are present. Credibility can also be developed by the PEC having regular meetings with a council of practices or with groups of practices.

• PCTs must also ensure that they have good relationships with individual practices or groups of practices if they have legally binding relationships with each other. Credibility has to be worked for but should both ensure higher quality services and make easier the reform of health care.

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Primary Care Contracting Routes

It should be noted that delivery of primary care has become far wider than just traditional general practice. This trend is set to continue with general practice from the minority of delivery in some practices already.
The term ‘practice’ also covers a wide range of different models, developed to meet the needs of the local population.

 

 Contract/mechanism

 

 
Key features

 

New General Medical Services
nGMS 

 • ‘New GP contract’
• Nationally negotiated
• Contract with PCT held at practice level
• Greater skill mix possible than in previous contract
• Some local flexibilities
• Good income for ‘mainstream’
• Business model does not encourage innovation
• Still allows large list size/poor service
• Concentrating growth into QOF may have curtailed PMS workforce schemes
• Performance indicators limited to national QOF
• Can deliver wider range of services through local enhanced services

Personal Medical Services
PMS

 • Local contract between PCT and primary care provider
• Introduced to pilot locally negotiated practice based contract with flexibility to include new models such as wider skill mix and salaried GPs
• Scheme must deliver services equivalent to GMS
• Must include a GP
• Now may be lower income for new entrants PMS than nGMS
• Alternative QOF permitted but discouraged
• Additional performance indicators can be used
• Potentially the NHS ‘APMS equivalent’
• Flexibility being used for practice takeovers
• ‘PMS plus’ used to deliver very much wider range of services in primary care
• Could deliver same benefits as APMS if used creatively

Specialist Personal Medical Services
SPMS

 • Initially introduced as subset of PMS to allow greater flexibility through:
• Not having to offer full range of services equivalent to GMS
• Not having to include a GP
• Allowing individuals or multidisciplinary team to offer a service that covers specific elements of primary care
• All services must be covered by NHS contracts
• Relatively little uptake , now being explored as a mechanism for delivery of a wider range of services e.g. commissioning
• Also ‘APMS equivalent’
• NHS contracts only

Alternative Provider Medical Services
APMS

 • Permits a wide range of providers, including private and voluntary sector providers to deliver primary care (see below) under a contract with a PCT
• Introduced to allow co-ops to contract within NHS framework
• Can be used to deliver nGMS equivalent
• Not restricted to GMS therefore can contract for e.g. extended opening hours, extended key performance indicators, greater ‘value for money’, extended services
• Has produced large new wave of entrants
• Some large players including Care UK, Four Seasons, Mercury Health and UnitedHealth Europe
• Tendency for ‘more of same’ or transformational?
• Poorly funded services tend to remain poorly funded
• Investment to achieve and transform failing practices
• Has already created a strong market for provision of primary care in deprived areas
• Biggest issue is private providers delivering same contract in same place as independent contractor GP within the NHS does not have access to NHS superannuation scheme

 PCT Medical Services

• Generally used by PCTs to deliver services where no interest from other GPs – often in deprived areas
• Not as efficient as other routes
• PCTs tending now to divest themselves of PCTMS practices
• Divestment has created the strengthening primary care provider market

Social Enterprise Provision

 • Very early days!
• "A social enterprise is a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners’.
• Delivery of primary care services by social enterprises referred to in ‘Our Health Our Care, Our Say’
• Covers the ‘third’ sector. Includes voluntary and community sector as well as ‘values driven’ groups such as co-operatives
• Set up funding being offered
• ‘Pathfinder’ schemes being selected
• Suggestion that this group may have access to NHS Pensions, but not clear how this sits with no access for other independent providers




 

 

 

 

 

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The Effective Resource Manager

This course will enable health & social care
managers and budget holders to identify the
considerable cost savings that can be made by
using the 'toolbox' of skills provided which
enable the elimination of waste, the reduction
of costs and thus, improved patient/client care
and satisfaction.

The foundation of the course is a comprehensive programme
of practical financial and resource management skills.
Participants will be required to complete a mentored 'resource
review' of a specific area of their work, with a view to making
real savings and improving resource efficiency.
Participants will be guided and mentored through the course
by the academic tutor and his colleagues.

To download the full programme click on the following link

Download Programme

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NHS Institute Projects in Primary Care

Established in 2005, the NHS Institute for Innovation and Improvement was set up to support the transformation of the NHS. Its mission is to improve health outcomes and raise the quality of delivery in the NHS by accelerating the uptake of proven innovation and improvements in healthcare delivery models and processes, medical products and devices and healthcare leadership.

One of the NHS Institute’s Priority Programmes involves improving the provision of care for people with long-term conditions. The programme particularly focuses on patient care in primary care settings.

To deliver this we need to see a significant “shift” in the way care is delivered, away from the “one size fits all” reactive approach, usually delivered in hospital settings, to community based-responsive adaptable services.

The NHS Institute is working with a range of field sites to establish how far this vision has been adopted locally and is currently monitoring pilot projects that are due to be rolled out nationally in 2007.
 
Of the pilots, a number are taking place in primary care settings.

For example, one project in Birmingham provides a  “One Stop Shop for Pain” for patients with low back pain. Patients can see a multidisciplinary team, including a General Practitioner with Special Interest (GpwSI), physiotherapist and psychologist in a single visit, reducing the stress and inconvenience of having to make multiple visits for treatment.

In Christchurch, hypertension patients are being educated to monitor their condition, saving them from the unnecessary stress of attending appointments with the practice nurses twice a year. Patients are provided with literature and are put in touch with other patients via a “buddying scheme”, empowering them to take control.

For further information about the schemes, visit www.institute.nhs.uk/PriorityProgrammes/LongTermConditions. Further information about the NHS institute can be found at www.institute.nhs.uk

 
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