Q what is practice based commissioning?
A Commissioning is the process by which the health needs of the population are assessed, the responsibility is taken for ensuring that appropriate services are available which meet the needs and the accountability for associated healthcare outcomes. Practice based commissioning transfers these responsibilities, along with the associated budget from the PCT to primary care clinicians.
Q what are the main principles of practice based commissioning?
A (a) a working partnership between the PCT and practices to improve health care of the local population.
(b) engagement of primary and community care clinicians in commissioning
(c) creates an environment for innovation
(d) supporting a shift from secondary to primary care
(e) empowering clinicians to develop services and care packages that meet the needs of their population
(f) improved patient care through service redesign
(g) optimise patient choice by providing more services closer to the patient.
Q do practices have to accept a budget and agree to commission?
A a practice can not be forced to hold a budget or take responsibility for commissioning services for their patients, however practices will be encouraged to consider the advantages of commissioning. The guidance states that all practices will be holding budgets by 2008.
Q can a practices choose when to hold a budget?
A a practice or group of practices may opt to take responsibility for commissioning and the related budget at any time, after the 1st April 2005, with the agreement of the Professional Executive Committee (PEC).
Q how will the budget be calculated?
A the baseline budget will be calculated by using 2003 – 04 hospital activity data which is then converted into HRGs and spells then costed at national tariff to give a financial baseline. All individual practice budgets will then be added together ensuring that they are no greater that the total PCT resources.
Q can a budget be set by not using 2003 – 04 HES data
A the DH guidance states that 2003 – 04 HES data should be used to set an indicative budget for 2005 – 06. PCTs should use this data as the baseline and make adjustments for local variation on activity and cost for 2005 – 2006
Q can practices choose to manage part of the allocated budget?
A yes - practices can apply their PCT to hold all or part of the commissioning budget.
Q what is meant by payment by results?
A the aim of the new financial reforms being introduced across the NHS is to create a transparent system for paying NHS hospitals and other NHS providers. Payment by Results (PbR) will end the relying on historical budgets and locally negotiated settlements as payments for services will be directly linked to activity and results. PbR will therefore reward efficiency and quality and encourage the better management of demand and risk.
Q will a practice be paid to manage the budget and monitor activity?
A the guidance suggests that an adequate level of management support should be available to ensure effective commissioning and that clinical time should be support financially. Management costs will vary according to local circumstances i.e. size of budget devolved, practice involvement .
Q what is an indicative budget?
A an indicative budget means that legal responsibility for performance against the budget remains with the PCT to which the practice belongs. In simple terms an indicative budget may simply be the amount that was spent historically on referrals to a provider.
Q will budgets move to a fair shares model?
A yes - there is a plan nationally to move all budgets to fair shares in 2006. Further guidance is awaited from the DH.
Q can practices join together to manage a larger budget?
A yes - practices will be encouraged to join together and collectively commission services to improve efficiencies, recognise economies of scale therefore reducing some of the financial risks.
Q do practices have to work together?
A no - working together across practices or in localities can not be imposed on practices. Practices and PCTs should be working together to agree economies of scale for the development of services.
Q what support can a practice of group of practices expect to get from their PCT?
A the PCT is responsibility for and will continue to monitor service level agreements with the acute hospital providers and any other contracts that the PCTs hold. This information will then be attributed to individual practices and groups of practices on either a monthly or quarterly basis. PCT contract teams should support practices in managing their budgets and monitoring contracts
Q who will responsible if the budget is overspent?
A the PCT is ultimately responsible for financial balance. The PCT and practice or group of practices will need to develop clear rules about how the budget is spent and how financial risk is managed.
Q how can a practice develop new services or transfer services from secondary care?
A practices wishing to develop new services for their patients or other patients locally will be asked to submit a business plan. A business plan should clearly state the reasons for the new service, identify all potential risks, expected clinical outcomes and improvement in patient care. The plan should then be submitted to the PEC for approval.
Q is practice based commissioning link to other NHS targets?
A PBC is a tool that will enable a number of other national and local targets to be delivered. PCTs should ensure that they communicate with practices what must be delivered and where there is local flexibility.
Q could practice based commissioning be linked to enhanced services?
A there is no reason why PCTs should not use the same process for setting up new service in the way that enhanced services have been set up and agreed. However caution should be taken not to mix PBC activity with current enhanced services agreements
Q will the activity data for all practices be shared?
A the PCT and their practices should agreed as part of the local compact how information is shared and with whom.
Q how will PBC be monitored?
A further work will need to be carried out to ensure that changes in commissioning can be identified. PCT Information analysists and contract managers will be asked to develop reports showing changes in commissioning trend and efficiency gains. The develop of these reports should as part of the compact be agreed with practices.
Q could PBC be monitored in the same way as prescribing?
A GPs and practice managers are used to looking at PPA data and reports. PCTs will be encouraged to develop a similar type of reporting to support commissioning decisions.
Q how can a practice sign up to PBC?
A PCTs should be asking their practices for a formal commitment to PBC. This should be based on a local agreement between the PCT and individual practices or groups of practices.
Q what is meant by “compact” or “PBC Agreement between PCTs and practices” ?
A so that all parties are clear about their responsibilities for implementing PBC and delivering service redesign there should be a very clear agreement. This agreement could form part of a contractual arrangement with objectives and timescales. The NHS confederation and NAPC have drawn up a guide which may assist PCTs in developing a local agreement.
Q what happens if a practice or group of practices and the PCT can not agree on budgets, setting up of services?
A the essence of successful PBC will be when PCTs and practices work in partnership to achieve common aims and objectives. However, there is likely to be occasions where PCTs and practices cannot agree or practices and practices connot agree then some form of arbitration process will be required. If PCTs are unable to resolve local differences then the strategic health authority will be called upon to arbitrate.
Q what are the direct benefits to patients?
A patients will be offered more choice and practices will be able to construct “care packages” for patients that reflect the need of each patient. Over time patients will be offered more convenient, more appropriate, closer to home treatment. Over time PBC will provide the opportunity for GPs to shift emphasis from treatment to improving health and well being of the local population.
