Practice based commissioning in Sutton and Merton PCT George Burns Practice Based Commissioning Development Manager

Introduction  My role  Background to PBC  How PBC actually works  PBC in Sutton and Merton PCT  Providing new services commissioned through PBC  Issues for discussion

My role  I am the link between PBC consortia and the PCT  Over the last year I have been involved in developing the framework for PBC in Sutton & Merton and supporting consortia  Now PBC is firmly established the focus of the role is how to develop PBC

Background to PBC  Practice based commissioning was introduced by the Department of Health in April  The 2007/8 Operating Framework for the NHS states that ‘PBC is central to world class commissioning and is here to stay..PBC is our most powerful way of reaching local communities, and so it is a crucial part of how we expect PCTs to address equality issues and reduce inequalities’.

Background to PBC  PBC is seen by the Department as playing ‘a vital role in health reform..[placing] primary care professionals including GPs, nurses and practice teams, working alongside secondary care clinicians and other primary and allied health professionals, at the heart of decision making to commission services for their local population’.

Aims for PBC in Sutton & Merton o The three aims for PBC are: - to put clinicians in charge of patient pathways in order to develop services which demonstrate high clinical quality, are closer to home, more convenient for patients and address health inequalities - to increase the the variety of services available and type and number of providers commissioned - to use services and resources efficiently to maximise the health gain for patients

BUT, what exactly is practice based commissioning?  Practices or groups of practices have the right to hold an indicative budget covering the health care delivered to their registered populations  Practice based commissioners receive information on this health care, including levels of activity and its cost, on a monthly basis

How PBC works….

How PBC works…  If, at the end of the year, PBCs make savings against their budget they can reinvest them in other services for the benefit of patients  PBCs can reinvest 70% of any savings. 30% is retained for investment across the PCT.  Sutton and Merton PCT remains legally responsible for the budgets and has a statutory duty to break even every year

How PBC works…  Practice based commissioners can make savings against their budget by: Re-designing health care services so that they are more efficient and effective, and providing more services in primary care Reducing the demand for specialist care by managing more conditions and patients within primary care Reducing health inequalities and focusing on the prevention of ill health

How PBC works..  Practice-based commissioners write commissioning plans for each financial year  These plans must be in line with the PCT’s 3 year Commissioning Strategy Plan  Plans must be signed off by the PCT  For each proposed service redesign or change, practice based commissioners must complete a service specification  This outlines the new service that they wish to commission

How PBC works… o The PCT, working with PBC consortia, then procures the service o Providers are invited to submit business cases for the provision of the service o Business cases are assessed by a sub- committee of the PCT’s Board o Successful providers deliver the service to the specification and are monitored and evaluated by the PCT and PBC consortia

PBC in Sutton and Merton  53 out of 54 practices in Sutton and Merton are practice based commissioners.  There are five PBC consortia across the PCT: - Nelson Commissioning Group (150,00 patients) - Sutton Horizon (95,000) - Merton Healthcare (80,000) - Integrated Primary Care Commissioning (50,000) - Sutton Commissioning Group (25,000)

PBC in Sutton and Merton  Practices have been engaged with PBC since the policy was introduced  Consortia are now well developed  The PCT supports PBC consortia by funding managerial costs and providing PCT staff to support PBC (eg service improvement, finance, information)  Over the last 3 years, the PCT has also provided a financial incentive for practices to participate in PBC

PBC in Sutton and Merton  PBC consortia are managing the following indicative budgets for 2007/8:  Nelson Commissioning £131.2m  Sutton Horizon £91.4m  Sutton Commissioning £24.7m  Merton Health Care Ltd £70m  Integrated Primary Care £48.7m

New or redesigned services so far…  Diabetes  Ophthalmology  Gynaecology  Anticoagulation  Dermatology AND PLANS FOR.. o End of Life care o Urgent Care

Providing new services  GPs and practices involved in 3 of the PBC consortia have set up separate provider organisations.  It is the PCT’s responsibility to manage potential conflicts of interest in PBC.  The PCT has responsibility for procuring health care services and for ensuring best value for the taxpayer.  PBC consortia cannot hold contracts with providers; they must operate through ‘PCT-let contracts’.

Providing new services  The PCT’s procurement process should be non-discriminatory, open, objective and proportionate.  The PCT should demonstrate that all willing providers have had the opportunity to bid to provide services.  The PCT should seek to encourage a plurality of providers and increase patient choice.

Providing new services  The Department of Health has released guidance on the ‘Principles and Rules for Co-operation and Competition in the NHS’.  The PCT’s processes for procuring services, and the role of PBC consortia within these, are evolving in line with national guidance and policy.  There is a move to clearly separate the functions of commissioning and providing.

Issues for discussion  Do voluntary organisations have a role to play in practice-based commissioning?  How can voluntary organisations become involved?  What role does the PCT have in making this happen?  What about the provision of services?