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Re-invigorating Practice Based Commissioning

Re-invigorating Practice Based Commissioning

1. Background

1.1 Following the recent DH Accelerated Solutions Environment (ASE) event facilitated by Capgemini, the following issues became clear during the two study days.
In areas where problems remain with the implementation of PBC;

• The service has a variable understanding about why PBC was developed and therefore becomes confused about its main aspirations.
• Commissioning relationships between those particular PCTs and PBC groups remain immature due to misinterpretation of the policy. Clinicians and managers do not comprehend each others language resulting in misunderstandings. This poor communication is the consistent process by which relationships break down.
• PCT managers, in those areas, who are in local PBC leadership positions, have often joined the NHS after the policy was developed, and therefore have a restricted organisational memory.

1.2 Partnership working and the PCT’s perceived (and actual) need for clinicians to be central to commissioning remains underdeveloped in too many areas – and as that great icon of modern medicine, Sir William Osler stated, “The greater the ignorance, the greater the dogmatism” which is a cause for clinical disengagement.

1.3 Whilst many barriers and their solutions were identified at the ASE, what is central to re-invigorating PBC is to articulate its aims and objectives to the service in a coherent, cogent and consistent manner.

1.4 Where this has happened and where there is strong local leadership and commissioning capability and in particular PCT CEO support – then PBC flourishes.

1.5 As two PCT managers with whom I was discussing the provision/commissioning potential conflict debate stated at the end of the two days, “For the first time, we really understand PBC. We can now make it work”.

1.6 The draft narrative slides already produced to support the event, and beyond, may help improve understanding, but there are still some gaps, particularly in the key messages for clinicians.

1.7 As fundholding ended, the energy, expertise and clinician involvement in managing NHS resource became rapidly depleted and disengaged.
There needs to be as much a revisiting of the best elements of fundholding in understanding how this model captured the hearts, minds and imagination of clinicians and liberated the entrepreneurial spirit. This needs to also be used to re-invigorate PBC.
 

Position Paper - Urgent Care

Following our members’ forum meeting on urgent care I wanted to try and pull together a headline position statement as to where NAPC stands on this.

From the meeting I picked up the following:

There is a belief that primary care, GPs in particular, are willing and interested in taking a greater role in the organisation and coordination of “Out of Hours” services.

The way forward in developing the quality of urgent care services is greater integration between existing providers developed at a local level with the local community.

It should be made much clearer to patients how they access the appropriate urgent care service to meet their need locally but the Association is concerned that
the suggested introduction of a new three digit telephone number might prove to be confusing for some patients and believes that any such proposal should be fully evaluated before being introduced.

Patient needs that could be met by primary care should be met by a primary care service rather than an A+E service. Primary care providers delivering such care would then retain responsibility for the quality of that care.

Existing models of service provision should be better understood to share the patient benefits of good practice more widely.

Practices, through PBC, should be integral to the design of local solutions and models of urgent care with involvement as both commissioners and providers, within their existing primary care contractual arrangements.

Dr Johnny Marshall
Chairman, NAPC
November  2008
 
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