1. Richard Armstrong Head of Primary Medical Care Contracting Department of Health

2. Practice-led Commissioning What is it ? Why Legal Framework Mechanics

3. Government Policy Themes Decentralisation STBoP Foundation Trusts Care/Children Trusts Systems Reform nGMS/nPMS Improving Performance Modernisation Agency/SHAs CHAI/Star ratings Improvement Plans

4. PCTs: The challenges Delivering the LDP Access NSFs Other National priorities (Health Inequalities, Drugs etc) System Reform Choice Payment by results Foundation Trusts Secondary to primary care shift Contracting for Primary Care provision Real clinical and public engagement

5. PCTs: The challenges The real challenge Matching demand with capacity, whilst meeting Need!

6. Practice-led Commissioning WHY? Empowering & engaging clinicians Choice, Access, Payment by Results Providing clear mechanisms for accountability Allows innovation – creating plurality of provision It works

7. Practice-led Commissioning WHY NOT Perverse incentives Distortions and gaming Transaction costs Alienating the profession

9. Practice-led Commissioning Legal framework Rights & Responsibilities - Clinical Team - PCT Down to PCT to determine - scope - range and - form of arrangements Not complete (or single) answer

10. Practice-led Commissioning Mechanics Setting budgets -Historic -Weighted Capitation -Something else Managing Risk -Over/Under spends -Stop Loss/over time Monitoring & Feedback mechanisms Contracting

11. Primary Medical Care – an update nGMS 99.8% signed Getting practices paid Managing disputes Superannuation (employers cont) PMS Quality points OOHs opt out price Contract variations PCTMS/APMS Guidance & Directions