Practice-based commissioning Courage, conviction and culture

What’s PBC about PCTs have paid bills - not commissioned PBC ‘handed’ GPs 50%+ of PCT spend – in Sheffield over £500 million! PBC gives GPs and PCTs finance/activity data so can see where patients and money going Spend not matched to need - Wanless says focus on long-term care of elderly/ LTCs GP-led redesign to help realign spend

Courage

From a PBC Manager view… Barriers How do I engage busy GPs? What I found works Ask GPs to help you improve quality of patient care – not save money. But show them where the spend is now. Find your lead GPs. Back them to the hilt practically. Get business cases for redesign approved – its why GPs do PBC.

From a GP Point of View- Barriers -Time -Relationships -Organisational culture -Organisational boundaries -Lack of support -Poor data

From a GP point of view - Enablers PBC Lis PBC Support Patient support Knowing your stakeholders Organisational relationships Clinical Leadership

Conviction

“You don’t need an engine when you have wind in your sails” Paul Bate, 2004

Over 75yrs 7.4% population £106 million on Emergency admissions 43% of which was on over 75yrs age group Falls = £6million 1/10 over 85yrs

Crisis

How you might persuade and influence PBC clinicians Knowing and being passionate about the patient journey Understanding the context in which PBC takes place Creating a clear vision for your patients journey and the pathway they take Ensure congruency between the people and the delivery mechanism

Culture

Framing Infection Control Bad frame?Good frame? DoctorsHalving MRSA rates is a Government Target Focus on the basics of excellent clinical care (peer to peer) NursesYou must balance the need for beds with infection control Patients’ safety and dignity come first Infection Control Staff Changing staff behaviour is your responsibility You have CEO/Board support to do what needs to be done to eradicate infections The BoardIt will be mandatory for a senior nurse to report rates at every Board meeting Preventing avoidable infections tops the Boards’ strategic objectives and supports the achievement of other objectives The PublicAvoidable infections are caused by visitors and the public Help us, help you

Send the message 10 times in 10 different ways 10

What have we done to date in Sheffield Lis Unscheduled Care Les Care Homes Women's Continence Pathway Falls Dementia pathway Community Nursing for the over 75years

Direction Prevention Early identification Working with Community and Hospital Geriatricians

A Citywide Strategy High Level buy in Across the Health Economy Project management support

How PBC can help you Back in your constituency find out who your consortia leads are and talk to them If you don’t know who they are your PEC Chair Tell them what can be fixed. If you have data even better! Get consortia leads to champion reform and put business case/pathways into PCT

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