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Practice Based Commissioning - FAQ
A: PBC is about engaging practices and other primary care professionals in the commissioning of services. Through PBC, front line clinicians are being provided with the resources and support to become more involved in commissioning decisions. Under PBC, practices receive information on how their patients use health services. This information can be used for the redesign of services by front line clinicians for the benefit of patients.
A: Practice based commissioning gives clinicians greater freedoms and flexibilities to tailor services to the needs of the local community. Through this, the quality and choice of services will improve. Patients will benefit from more services being provided with greater convenience in the community. In particular, patients with long-term conditions will be able to benefit from more personalised care. PBC is also good for taxpayers. The accountability and support we are putting in place will ensure the best use of public resources. Q: Where can I find examples of how PBC works in practice? A: The Department has just published Practice based commissioning: early wins and top tips, a document containing tips, case studies and service redeisgn ideas. It is specifically designed for clincians looking to see how PBC can be utilised. Q: How is PBC different to GP fund-holding? A: PBC is not fund-holding. The 1997 NHS White Paper made it clear that we wanted to "extend to all patients, the benefits, but not the disadvantages of GP fund-holding." Subsequently, there are key differences between PBC and fund holding. i. PBC is less bureaucratic. Fund-holding was bureaucratic. PCTs will continue to deal with the administration ie. contracting, payments etc which should mean limited additional bureaucracy. ii. PBC is centred on improving patient care. Savings from fund-holding did not have to be spent directly on patient care. Under PBC all proposals for savings must be agreed at the outset and must be spend on patient services. iii. PBC is more equitable. Fund-holding practices received more funding than non-fund-holding practices, leading to an inequitable distribution of resources. Under PBC, practices not taking up PBC will not receive proportionally less funds. iv. PBC is focused on quality, not price. Fund-holding GPs could negotiate the cheapest price for acute services. With tariffs there is no longer any incentive to bargain on price. Q: What does PBC mean PCTs have to do? A: By the end of December, PCTs are responsible for ensuring that the following arrangements are in place. This is laid out in Practice based commissioning: achieving universal coverage. 1. All practices are receiving information that will allow them to understand their clinical and financial activity compared with local and national indicators. 2. All practices have received an indicative budget covering an agreed scope of services. 3. All practices are receiving support from the PCT and the offer of an incentive payment (the DES or locally agreed payment) to support practice based commissioning. 4. Governance arrangements for practice based commissioning are in place. These will be agreed in partnership between the practice and the PCT. Q: What is universal coverage? A: Universal coverage will be achieved when all PCTs have put in place the arrangements to facilitate PBC. We expect all PCTs to do so by 31st December 2006. This will involve all practices receiving information about their referrals, information on their allocation of the PCT budget, the offer of support from their PCT, and details of the local governance arrangements. The arrangements will mean that all practices will be significantly engaged in PBC by the end of December 2006. Q: Will universal coverage mean all GPs will be completely involved in PBC? A: PBC remains voluntary for practices. As PBC contains numerous benefits to patients –a greater range of services, more services provided closer to home, increased investment in primary care – we expect GP practices will want to get involved in PBC. By ensuring the right environment will exist for PBC, we are removing the obstacles for GP practices to get involved. It is important to remember that recent health reforms have changed the way that healthcare is commissioned. Under reforms such as payment by results and patient choice, clinical decisions are now direct drivers of financial resources. Primary care professionals commit NHS resources as a matter of course through their clinical decisions. In this way, all practices are already in some form, such as in their decision to refer patients, engaging in commissioning.
A: No. PBC is about those in the best place to make commissioning decisions, making those decisions. Often this is likely to be GPs, but it can also include other primary care professionals such as nurses, pharmacists, optometrists amongst others. Q: Is the government backing up PBC with any money? A: Yes. As announced in December, the new GMS contract contains a directed enhanced service (DES) for PBC. The DES for PBC will enable practices to access resources to support practice based commissioning. The DES has two components; the first is payable to practices on the production of a plan which sets out how services will be redesigned. The plan will be agreed with the PCT. The first component amounts to 95 pence per patient. The second component is available for reinvestment in redesigned services for patients. It is made available once practices have delivered the objectives set out in the plan. Practices will agree with the PCT how the component two resource will be reinvested in patient services. As a minimum, component two will amount to 95 pence per patient, but where practices free up resources above this amount, they will agree with the PCT a greater value of freed up resources to be reinvested in patient care. Q: How is the January 2006 guidance different to previous guidance published? A: Practice based commissioning: achieving universal coverage sets out the expectations and responsibilities and the freedoms and flexibilities that PCTs and practices can expect in 2006/07. It supersedes the Technical guidance that was published in February 2005. The guidance sets practice based commissioning in terms of the wider health reforms and explains why we are expecting universal coverage by the end of this year and what PCTs need to do to have this in place. Source: Department of Health, 2006 |
