Primary Health Care Financing Lessons from the UK Beverly Sibthorpe Deputy Director Australian Primary Health Care Research Institute

Problems Facing NHS in 2000  Under-invested system  Lack of national standards  Demarcations between staff  Lack of clear incentives  Barriers between services  Lack of support  Over centralisation  Dis-empowered patients

PCTs and Fund-holding  Primary Care Trusts (PCTs)  Regional fund-holder for all NHS services  Negotiate and purchase services for registered population expanding range of public and private providers  Carry financial risk

nGMS Contract  new General Medical Services contract  Practice not GP  Basic package of services  Minimum Practice Income Guarantee  Quality and Outcomes Framework (QoF) 146 indicators / targets  Additional money for reaching targets

Information and Review  Information - Single unique identifier - Massive investment in IT - Collation of information from general practices  Review - Healthcare Commission

Forecast Changes – System  Hospital ~ primary health care interface  Participation of private providers, including US HMOs  Greater emphasis on promotion and prevention  Nurse-based immediate care clinics  Prescribing rights for non-medical clinicians  Better links with social services  Specialist ambulatory services and clinics

Forecast changes – general practices  Practice cooperatives pooling management, financial and IT resources  Practices working jointly  Practice nurses, physicians assistants, health care assistants  Practice nurse management of people with chronic diseases  Allied health professionals

Forecast changes - GPs  GP focus on diagnosis and management of complexity  GP specialisation  Alternative career pathways in management, policy, strategic planning and public health  Growth in salaried general practice

Forecast changes - IT  Internet-based decision support  consulting  NHS Direct for telephone and internet access to home-based care and advice  TV-based access to health advice

Sweeteners for general practices & GPs?  Additional practice income  New money for premises and workforce  New career opportunities  Improved working conditions: after hours locum support retirement pensions education and training

Threats?  Focus on what’s measured; neglect of what’s not measured  Increased fragmentation  Erosion of doctor-patient relationship  Erosion of continuity of care  Erosion of comprehensive care  Gaming and rhorting

Immediate challenges  PCT restructure  Diversion of care/costs from hospital sector  Practice-based commissioning  Clinician re-engagement  PCTs as service providers?

Bold Plan !  Need for system change  Care and resources out of hospitals  Focused on performance  Underpinned by information  Consumer focused  Concerned with equity  General practice support

Lessons for Australia  Health resources finite  Regional approach to resource management  Re-orientation to primary health care  Sophisticated and flexible commissioning  General practice as entity  Rich information driving change