1. Personal Medical Services in North Bradford PCT
Primary Care Trust
Personal Medical Services in North Bradford PCT
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 subject
Julie Winterbottom
Assistant Director of Commissioning

2. Aims Provide an overview of PMS within North Bradford PCT
Show PMS in context with the overall performance framework
Look at our model of practice-led commissioning
Show potential Specialist PMS services

3. PCT Vision Self-care Preventative care Chronic disease management
Reduced hospitalisation
Targeted care for patients with complex needs
Can do culture

4. Profile of North Bradford PCT
12 multi-partner practices
Population size approx 93,000
High elderly population
Geographically small (20 minute drive radius)
Pockets of highly deprived areas and affluent areas
5% ethnicity

5. So what is Practice-led commissioning ?
The North Bradford model is to:
Devolve and align responsibility, accountability and authority at practice level

6. The current contract Practice-level PMS All 12 practices are PMS
2 practices went in Wave 1
9 practices went in Wave 3
1 practice went 1 April 2004
Wave 3 practices got £1m growth monies in total
Resulting in 15 Nurse Practitioner posts and 5 salaried GPs

7. PMS Performance Management
40 quality targets in PMS contract
Benchmarking data amongst practices
Quarterly practice reviews
Statistical analysis eg trend analysis, run charts
Regular reports to the Exec, PEC and Board
Monthly reporting and feedback to practices
Regular informal practice meetings with Chief Executive and Non-Executive Directors

8. PMS in context with the Performance Improvement Model
Mission
Performance Packages
Vision
Incentive Scheme
Perf. Fund
Patient Experience
Culture
PMS
Practice Manager leads
Support
Advisory Groups
PLT/PBE
Unit of Delivery
Education
Pursuing Perfection
Specialist Groups
Practice Review Meetings
Collaboratives
Optimising Hospital Utilisation
Patient/Consumer Involvement
Clinical leads
Information

9. In addition to core PMS – The Primary Care Incentive Scheme
Incentive Scheme Element
£ available to practice (based on list size of 10,000)
Prescribing Quality Markers
Payment is direct to GPs, no conditions on how money is spent.
Pick “n” mix
Rewards small improvements
Payments awarded on a matrix basis
£12,500 max
Hospital Services Quality Markers
£10,000 max
Financial Performance
(based on savings made against indicative practice budget)
Linked to quality – if no quality markers achieved then no savings retained.
Practice retains 50% of savings made for agreed investment in the practice.
Key objective is to encourage practices to achieve “value for money” and utilise alternative services to manage demand.
£20,000 max
Investment into Primary Care (maximum possible for a practice of 10,000 patients)
£42,500 max

10. In addition to core PMS – The Performance Fund
Investing in the infrastructure of Primary Care to support continuous improvement
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

11. In addition to core PMS – Locality Services
GPs with a Special Interest (GPwSI)
Consultant outreach clinics
Potential income to a practice = up to £70k plus

13. 2004/5 PMS contract
Choice of baseline for core general practices services
Plus payment for: - Enhanced services - GPwSI / locality services - Performance fund monies - Incentive Scheme monies - ‘Gold standards’ in chronic disease management - Agenda for Change - Patient involvement - True advanced access - E-booking / referral protocols - Pharmacist clinical time - IWL / IIP - Nursing Home pilot (Optional) (is this ‘Specialist PMS’ ?)

14. Out of hours A full package of out of hours services for practices to purchase (is this potentially a ‘Specialist PMS’ ?)
An out of hours service comprising:
GP Co-operative
Fast response
Salaried GPs
Nurse Practitioners
Paramedics
Crisis resolution
Telephone triage
Daytime home visits
Primary care walk-in centre at two sites

15. PMS - The 4 levels of service delivery
Core general practice
Enhanced services
Secondary to primary shift
Service developments – phase 1 & phase 2

16. A closer look at Core General Practice
Level 1 indicators = nGMS indicators
Level 2 indicators = improving quality further
No points system, money upfront, continuous development
More money for Chronic Disease Management
Includes, for example; - use of templates in relation to the Treatment Centre - practice-level Expert Patient Programmes

17. A closer look at Enhanced Services
Directed Enhanced Services (DES)
Examples: - Spirometry - Sexual Health - hysteroscopy workup - 24hr BP - Anticoagulation - Lithium monitoring
Practice’s own patients or other practices also

18. A closer look at Secondary to Primary Shift
More rigorous Clinical Governance
District-wide accreditation
Includes GPs with a Special Interest (GPwSI) - Urology Diabetes - Dermatology Musculo-skeletal - Neurology ENT - Cardiology and others
PCT-wide service

19. A closer look at Service Developments
Phase 1 & Phase 2
Need business case from practices
Examples; - Alternative therapies - Integrated community nurses - Minor injuries walk-in site

20. Key principles
Devolve and align responsibility, accountability and authority at practice level
Less bureaucratic
Flexibility
Money invested upfront
Clinical standards agreed locally
Collaborative approach to working
Different pace of change for each practice
Recognition of ‘High Achieving practices’ = more autonomy
Practices will not be disadvantaged compared to the new GMS contract
10% financial increase for the next 3 years