1. Sustaining Innovation through New PMS Arrangements Richard Armstrong

2. Sustaining Innovation through PMS Plenary to cover Operational Issues (Chapter 2) New Flexibilities (Chapter 3) Quality in PMS (Chapter 4) PMS Finance (Chapter 6) In Workshop to cover New Innovations -Specialist PMS -Practice-led Commissioning

3. Sustaining Innovation through PMS Purpose of PMS Provide greater freedom to address the primary care needs of patients Enable flexible and innovative ways of working Address recruitment problems Tackle issues of under-resourcing

5. Sustaining Innovation through PMS Ideas that underpin new PMS Choice Equity & Fairness Value Decentralisation Sustaining Innovation

6. Sustaining Innovation through PMS Operational Issues (chapter 2) Commissioning Primary Care Permanence Roles & Responsibilities Developing new Contracts Dispute Resolution Movement between GMS <> PMS

7. Sustaining Innovation through PMS New Flexibilities Chapter 3 Out-of-Hours Opt Out Seniority Pay Improved changes to pension benefits Human Resource improvements Increased investment in IM&T Premises flexibilities

8. Sustaining Innovation through PMS Quality in PMS (Chapter 4) Quality is equally important in PMS as in new GMS. Patients have the right to similar opportunities for improvement Quality delivery and quality framework should be broadly comparable Equally, should be similar reward for similar effort between PMS and GMS

9. Quality in PMS (Cont) BUT …. Some quality payments already in PMS practices baseline PMS not a one-size-fits-all model Therefore can be difference from National QOF

10. Adjusting QOF for PMS Current estimated deduction = £14,700 (equivalent to 196 points in 04/05) Calculation of deduction is value of what is in PMS baseline covering payments for: -CDM -SQA -Higher Cervical Screening target Points value reduce in future years as value (£s) of each point increases Quality in PMS (Cont)

11. Issues in developing local schemes Schemes must be points-based No national information about relative prevalence in local schemes Local schemes must be subject to fair and thorough assessment of achievement More schemes depart from national QOF more difficult to provide management information

12. Quality in PMS (Cont) Issues in developing local schemes Senior PCT clinician responsible for ensuring fairness between local and national quality framework. Ensuring local Quality schemes are: Rigorous Evidence based Monitored fairly Explicitly assessed against agreed criteria Paid at an appropriate and equitable rate

13. Quality in PMS (Cont) Some options for local schemes National QOF plus local add-ons Different interventions Different indicators Fewer indicators Different evidence base Different approaches

14. Sustaining Innovation through PMS PMS Finance Existing PMS funds form part of PCTprimary care allocation (not ring-fenced to PMS) Some elements of Primary Care allocation cover GMS and PMS PCTs need to demonstrate funding decisions between GMS and PMS are fair, equitable and transparent No central pot to bid for growth No future in-year claw backs

15. PMS Finance (cont) PMS allocation include All waves to 5b, adjusted for inflation and full-year effect Contract variations Additional funding for rent increase One-off adjustments And excludes 03-04 PMS quality preparation funding, Allocations for flu, pneumococcal and HIB immunisation PA and dispensing

16. PMS Finance (cont) Premises IM&T PMS Quality Allocations -QuIP is a DES funded from PCTs UB -QPREP for 04-05 will be allocated to PCTs in April on same basis as 03-04 (unweighted patient list size) -Aspiration resources -Achievement payments held by NHS bank Calculating MPIG for transfer to GMS OOHs Opt Out Price

17. Sustaining Innovation through PMS Further PMS Guidance (end January) Managing Closed list in PMS Practice led Commissioning Contractor Budget spreadsheets Confirmation of -Quality Points deduction -OOHs Opt Out Price Plus Piloting Patient Choice opportunities in PMS

18. EXPLORING NEW FRONTIERS