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This insightful piece explores the importance of practice-based commissioning (PBC) in the healthcare landscape, emphasizing the need for courage, conviction, and cultural change. It discusses the shift in financial responsibility, where PCTs have spent significant resources without proper patient-centered commissioning. The document highlights strategies for engaging GPs, the critical role of clinical leadership, and how to reshape spending to align with patient care needs. Case studies from Sheffield illustrate successful initiatives in community care, elderly support, and redesigning pathways—all aimed at improving patient outcomes.
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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
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
“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
How you might persuade and influence PBC clinicians Creating a clear vision for your patients journey and the pathway they take Ensure congruency between the people and the delivery mechanism • Knowing and being passionate about the patient journey • Understanding the context in which PBC takes place
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 email 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
Contact details • Agnes.mcAuley@sheffieldpct.co.uk • Eithne.cummins@gp-c88034.nhs.uk