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Appraisals, commissioning and the new NHS

Appraisals, commissioning and the new NHS. Dr Nigel Watson. Dr Nigel Watson. GP Had 9 appraisals CEO Wessex LMCs Has 8 performance reviews GPC – Represent Hants and IoW (1996 – to date) Chair – Commissioning Sub-committee of GPC (BMA) DoH committees GP strategic commissioning

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Appraisals, commissioning and the new NHS

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  1. Appraisals, commissioning and the new NHS Dr Nigel Watson

  2. Dr Nigel Watson • GP • Had 9 appraisals • CEO Wessex LMCs • Has 8 performance reviews • GPC – Represent Hants and IoW (1996 – to date) • Chair – Commissioning Sub-committee of GPC (BMA) • DoH committees • GP strategic commissioning • GP working group • Centre for workforce Intelligence • General Practice Advisor

  3. Quality Individual • Appraisal • Revalidation Practice • QoF – Quality performance • Quality premium • CCG contract – benchmarking/peer pressure

  4. How do we define quality in the NHS?

  5. What is quality? • Upper quartile performance? • Value for money - VFM? • Financial balance? • Technical care? • Customer service? • Improved process measures? • Improved clinical outcomes?

  6. Countries whose health systems are more oriented towards primary care achieve • better health levels • higher life expectancy • better health outcomes • higher satisfaction with health care among their populations • lower overall health care costs • lower medication use

  7. Some facts • GP consultation £20 • Walk in Centre £24 • NHS Direct telephone call £15 • A&E attendance £74 • OPD £100 – 300

  8. NHS Budget in billions

  9. Challenges • Flat cash • Aging population • 17 million people with long term conditions and rising • New drugs and technologies • Reduce bureaucracy • Improve decision making

  10. Issues to resolved • Outcomes • Patient choice • Targets • Bureaucracy • Lack of clinical involvement in healthcare planning • Clinicians – responsibility, accountability • Lack of close working with Local Authority • Money

  11. Commissioning • GPs commission services for the individual patient • Prescribe • Refer • Admit • Co-ordinate care • Proposals will ensure that GPs are involved in commissioning for a population

  12. Clinical challenge • GPs • Improve quality • Align clinical behaviour with financial accountability • Commissioning for individual vs population • Reduce variability • Greater peer review and peer pressure

  13. Clinical challenge • Consultants • Work with commissioners • Contribute to reform • Understand care outside hospital • Stop silo working • Understand the financial future of the NHS • Integration of primary and secondary care

  14. Appraisal The purpose of the appraisal will enable all General Practitioners to participate in continuous quality improvement of the quality of their practice. Although not it’s primary purpose, aspects of appraisal may assist in the early identification of doctors in difficulty so that they can be offered appropriate support.

  15. Quality improvement • Reduce the unacceptable variability • GP • Appraisal – who will commission? • Revalidation • Procedures for GPs whose performance causes concern –PCT/LMC – the future? • Performers list – registration – PCT – NHSCB • CSU, CCG, sub-national NHSCB

  16. Quality improvement • Reduce the unacceptable variability • General Practice • QoF • CCG • Quality Premium

  17. QoF • Quality improvement • 96.5 points • Average practice £12,500 • Prescribing • Referrals • Emergency care • Quality & VFM • Data, information, peer review • Contribute to commissioning process • Design, develop and utilise clinical pathways

  18. Clinical Commissioning Groups • Improve quality of general practice • Peer review and peer pressure • Devolved leadership • Commissioning Group Lead • Board • Locality lead • Practice lead

  19. Quality premium • How much? • 5-10% of current GP funding • Who will decide on achievement? • CCG or Health and Well Being Board • How will quality be measured?

  20. Performance of practices • Mirror the GP performance procedures • What happens to a failing practice? • Where will practice contracts be held?

  21. Accountability and Probity • All practices part of a Clinical Commissioning Group • CCG accountable to NHSCB • Practice accountability • All GPs in every practice engaged • Conflict of interest • GP/patient • GP role in CCG • Role of GP provider companies

  22. Any questions?

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