PBC is here to stay AND moving forward

I will be brief to allow plenty of time for questions and I’m delighted to be joined by Mark Britnell – our Director General for Commissioning and System Management and David Colin-Thome, our National Director for Primary Care, who led the work on the Primary and Community Care Strategy.

Its launch on 3rd July was the culmination of many months work. David and the rest of the Advisory Board, which included your own Mike Dixon (Mike, thank you) spoke to many patients, the public and healthcare professionals around the country who have been developing regional visions as part of the review, and to GPs, community nurses and others about how we can get the very best from GP and community services.

Around the country we have heard of countless examples of fantastic, high qualty services, delivered by dedicated NHS staff.

The challenge for all of us is to make these examples the norm.

There is still, as the latest GP survey published yesterday showed, too much variation in quality and access – with people in some of our most deprived communities generally faring worst.

People should expect to receive services that are easy to access, of high quality, personal and designed around their needs and their lifestyles.

People also want care that is more integrated and flexible. No one wants to have to make three visits to the same place or, even worse, three visits to different places when one would do, or constantly repeat the same information to everyone they see about the care and services they need.

The Primary and Community Care Strategy tries to address these challenges with three main themes.

Firstly, People shaping services. This means giving people more choice and control over their health and healthcare, including real choice of GP, more information to help them make these choices, better information, and a greater say in judging the quality of local services. It means providing better rewards and recognition for GPs and other health professionals who provide the most convenient and responsive services for their patients.

Secondly, Promoting healthy lives. Boosting the role played by Primary Care in public health. This means focusing on prevention as much as cure – from health checks at the local pharmacy to helping people give up smoking and become more active, and devoting a greater proportion of the incentives paid to primary care providers, including GPs, for public health work.

Continuously improving quality. This means better systems to tackle poor performance, including registration of GPs, up-to-date information about the quality of care, and doing more to ask patients about the service and care they receive from their GP practice and other local health services and the commissioning assurance system for primary care trusts.

David will be covering the strategy in more detail in his session. However I do want to mention that we will be setting up a national Clinical Advisory Group, to be led by David, to review progress in implementing the strategy, on which the NHS Alliance will be represented.

So moving on to commissioning. I think that we are all clear that achieving these goals of improved services and better outcomes will require strong commissioning, but also an acknowledgement that this is an area in need of further development.

Our programme of world class commissioning is now advancing rapidly and provides a framework to enhance the role of Primary Care Trusts as strategic commissioners. However, Primary Care Trusts cannot work in isolation.

Clinical engagement is at the heart of world class commissioning. Commissioning will only be at its strongest and most effective when it is the product of a partnership between local clinicians and health service managers working in tandem.

Practice-based commissioning provides the key vehicle for this partnership. With 300 million consultations a year in general practice, GPs and other primary care clinicians are best placed to know the needs of their populations. This intelligence together with their insight into the clinical performance of local providers, is vital for world class commissioning to work.

The Primary and Community Care Strategy commits to reinvigorating the implementation of practice based commissioning.

Firstly, we need to be clearer about exactly what we mean by practice based commissioning to ensure there is a shared and consistent understanding of its role and contribution. We will more firmly position PBC as providing the clinical leadership that must be at the heart of world class commissioning – ensuring a focus on high quality services and on better health outcomes.

Secondly, to support and reinvigorate implementation, we will introduce a package of measures to focus on both getting the existing arrangements working better and incentivising high-performing practice-based commissioners to go as far as their ambition takes them. This will include:

Distinguishing more clearly between practice based commissioning and the role of practices in actual service provision – experience of PBC so far has shown that many practices get involved in practice-based commissioning in order to improve the way that they provide services within their practice, rather than actually working with the PCT to commission services beyond the practice. For example by providing a phlebotomy service in the practice so patients don’t have to go to outpatients, or by employing an extra nurse to provide proactive care in the community in order to reduce the number of emergency referrals. Both are legitimate, but we want to do still more to engage clinicians in the commissioning of services.

Setting out different levels of engagement with PBC - recognising that there are differences within general practice and that a ‘one-size-fits-all’ model for PBC is unrealistic. PBC for the future needs to be flexible enough to allow practices to engage at different levels depending on where their interests and ambitions lie. Some practices may want to influence aspects of care in relation to two or three care pathways, where as others may want to influence the larger picture of all care provided by the local provider and beyond.

In the future, high performing PBC groups will be entitled to increased freedoms in managing resources and designing services. Officials will be working with the NHS Alliance and others in developing these arrangements.

Perhaps of most importance, requiring PCTs to provide improved information and management and financial support to PBC groups - practices who are prepared to invest their time and effort into PBC will have an entitlement to receive from their PCT their ‘fair share’ of the budget, accurate and timely information on referrals and budgets, and sufficient management resources to drive change, and

Providing incentives for a broader range of clinicians to engage in PBC – for example we will look at broadening the focus of the local incentive schemes that PCTs have in place to encourage practices to participate in PBC, to reward greater collaboration with other community clinicians and specialists in developing more integrated care for their patients. In addition we will ensure that the level of management resources provided by the PCT is sufficient for practice-based commissioners to develop the capacity of their organisations to properly engage with other frontline health and care professionals. Many PCTs are doing this already.

Hampshire PCT, for instance, has invested several millions in support of their practice-based commissioners, and their communities will reap the benefits of a close commissioning partnership between clinicians and managers. It is our challenge to make such examples become the norm.
We will be holding PCTs to account through the world class commissioning assurance system for doing so. As a consequence, I firmly expect PCTs to change their behaviour and give PBC the proper attention and investment it requires to succeed.

However, we also recognise that some localities may need support to do this. That is why David will lead a National PBC Improvement Team to:
highlight the importance we attach to PBC
provide clarity about exactly what we mean by practice-based commissioning, to develop the shared and consistent understanding of its role and contribution, and
work with SHAs, PCT and PBC consortia to offer focused support and advice in improving the implementation of PBC locally.

The Team will share information on the features key to implementing PBC successfully. It will also collect information to establish best practice from practice based commissioners and PCTs in order that we can share leading edge activity across the country.

In addition, and alongside the work of David’s team, I am pleased to announce that, by the end of July, the Department will be issuing an invitation to tender to provide support for PCTs and PBCs in developing arrangements locally. The programme will draw from best practice and focus on governance, organisation and board development. It will be available to PCTs and practice-based commissioners from early autumn. It will provide the support to help PBC take off on the ground and help turn our ambition for PBC to provide the clinical engagement into world class commissioning from policy into reality.

I am sure that the NHS Alliance and others here today will wish to consider putting themselves forward for this opportunity to support implementation.

CONCLUSION

In this year, the 60th anniversary of the NHS, we have set out through the NHS Next Stage Review a clear statement of intent for PBC. It is here to stay. It is an integral part of how PCTs approach their role as world class commissioners providing the clinical engagement that needs to be at the heart of this. We all know that practice based commissioning has a huge potential to transform care services, allowing doctors and clinicians to develop better services for patients in local communities and most importantly improved health for patients.

I hope what we outlined in the Next Stage Review and what I have announced today will be welcome to all of you and boost Practice Based Commissioning, as has long been needed.

Thank you.