Practice-based Commissioning

Practice-based Commissioning PowerPoint PPT Presentation


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Aim of the presentation. To provide an overview of the North Bradford model of practice-based commissioning with a focus on devolved secondary care budgets Have a look at where we've been and where we are going with practice-based commissioning. Profile of North Bradford PCT. 12 multi-partner practices

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Practice-based Commissioning

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1. Practice-based Commissioning Julie Winterbottom Associate Director of Commissioning Introduce self Presentation on GP Specialists services Don’t want to talk the whole session, hope is to give presentation and then have a debate around the subjectIntroduce self Presentation on GP Specialists services Don’t want to talk the whole session, hope is to give presentation and then have a debate around the subject

2. Aim of the presentation To provide an overview of the North Bradford model of practice-based commissioning with a focus on devolved secondary care budgets Have a look at where we’ve been and where we are going with practice-based commissioning

3. Profile of North Bradford PCT 12 multi-partner practices – all PMS Population size approx 93,000 High elderly population 5% ethnicity Geographically small (20 minute drive radius) Pockets of highly deprived areas and affluent areas 1 main acute provider (Foundation Trust) 3 Star PCT for 2 consecutive years

4. Self-care Preventative care Proactive management of long term illness Reduced hospitalisation Targeted care for patients with complex needs Clinical leadership Can do culture PCT Vision

5. Practice-based Commissioning The North Bradford model is to: Devolve and align responsibility, accountability and authority at practice level

6. Practice-based Commissioning The North Bradford model pre-April 2005 ‘Establishing the infrastructure in primary care’

7. Performance Improvement Model

8. The Hospital Services Incentive Scheme

9. Hospital Services Quality Incentive Scheme markers Examples of 2002-3 & 2003-4 markers - 60% dermatology referrals to GPwSI - 97% usage of the hip and knee joint replacement scoring system - Reduction in A&E attendances Examples of 2004-5 markers - Reduction in acute admissions from COPD, falls - Achieving true advanced access - Complete all 6 options on patient involvement - Patients referred for retinopathy screening - Establish patient self-care focus in the practice

12. The Performance Fund Data collection /data quality Attendance at key meetings / PLT / GP Advisory Group Annual revised Practice Business Plans Summarisation of medical records Investors in People Use of the electronic booking system/booked admissions £50,000 approx. (based on practice of list size 10,000) RECURRENT

13. Core general practice Enhanced services Secondary to primary shift Specialist PMS Managing demand in 1° Care 4 levels of service delivery

14. Dentists with a Special Interest Opticians with a Special Interest Pharmacists with a Special Interest Nurses with a Specialist Interest GPs with a Special Interest

17. Practice-based Commissioning The North Bradford model April 2005 and beyond Currently out for consultation within the PCT ‘Establishing the infrastructure in primary care’

18. North Bradford PCT Commissioning Pyramid

19. Practice-based Commissioning Options for practices Option 1 Monitored against a notional PCT devolved budget Management information packs provided Discretion of practice as to level of engagement Reports on performance to the Board Ability to make ‘unplanned’ savings Practice retains 25% of savings at year end Practice can opt into Option 2 at any time

20. Practice-based Commissioning Options for practices Option 2 Live indicative PCT devolved budget Management information packs provided Business Plan produced pre-empting how resources will be recycled to improve quality of patient care Ability to make ‘planned’ and ‘unplanned’ savings Practice retains 50% of unplanned savings Practice retains 80% of planned savings 25% of savings released each quarter Year end payment settles the balance No sanctions for overspending other than not reaped the rewards of underspending

21. Live Hospital Services budgets covering - Secondary care (elective care) - Locality services - Independent Sector Treatment Centre - Out of hours - Pathology - Direct Access - Community Nursing (ring fenced) - Primary Care Mental Health - Prescribing Acute on an incentive scheme for 2005-6 Based on historic usage (HRGs converted to spells with 2004-5 tariffs applied) Move to weighted capitation PCT devolved budget elements

22. Support packages for practices Practice allowance (£50k per 10k patients) Quality Incentive Scheme (£30k per 10k patients) Urgent Care Nurse - Case Manager (F/T/E per 10k pats) Management Information PCT Manager half a day per week Implementation handbook Workshops, PLTs, PBE, training Development of clinical pathways PCT-level contracting process

23. Payment by Results (PbR) Provides flexibility to shift finances and scope where and how activity is provided Same level of secondary care activity under PbR costs the PCT far more money Build service specifications into contracts Data quality improvement

24. Contact details Email: [email protected] Tel: 01274 366253

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