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Contracting for Primary Care

Contracting for Primary Care. PCT Strategic Functions. The general modernisation of primary care The expansion of the primary care sector and the resourced shift of secondary to primary care work The recruitment and retention of the primary care workforce

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Contracting for Primary Care

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  1. Contracting for Primary Care

  2. PCT Strategic Functions • The general modernisation of primary care • The expansion of the primary care sector and the resourced shift of secondary to primary care work • The recruitment and retention of the primary care workforce • The management of demand for primary care services

  3. Patient Services Guarantee PCTs will have a legal responsibility to ensure that: ‘patients will continue to be offered at least the range of services that they currently enjoy under the existing contract’

  4. Process Develop commissioning strategy Undertake procurement process Monitor outcomes

  5. Contracting Routes - Summary

  6. GMS Contractors • A general medical practitioner • Two or more individuals practising in partnership; • At least one partner (who must not be a limited partner) must be a general medical practitioner • Other partners must be individuals from within the NHS family • Company limited by shares • At least one share must be legally and beneficially owned by a general medical practitioner • Other shares must be legally and beneficially owned by individuals from within the NHS family

  7. PMS Contractors Agreements can be made with one or more of the following: • An NHS Trust • A medical practitioner • A healthcare professional • An individual who is a GMS or PMS provider • An NHS employee or a PMS employee • A qualifying body (a company limited by shares, all of which are legally and beneficially owned by persons identified above)

  8. APMS Contractors PCTs may make contractual arrangements with any person (for the provision of primary medical services) [Section 16CC(2)(b)of the National Health Service Act 1977] Specific provisions for: • Individuals • Companies • Partnerships • Industrial and provident societies, friendly societies, voluntary organisations ie. must be fit and proper persons.

  9. PCTMS A PCT may provide primary medical services itself (whether within or outside its area) [Section 16CC(2)(a) of the National Health Service Act 1977]

  10. PCTs as commissioner Three routes:

  11. Why commission? Benefits • Transfer of clinical risk • Transfer of financial risk (to varying degrees) • Expansion of capacity/competition? but • Effective procurement process • Effective performance monitoring

  12. PCT Provision “ PCTs are encouraged to develop a minimum level of (provision of essential) services.... If PCTs propose to become large-scale providers of primary medical services, they are expected to discuss this first with their SHA. They are also expected to consult with LMCs.” [para 2.6 Delivering Investment in General Practice]

  13. PCTs as provider Two routes: • PMS • PCTMS “ Under PMS, the PCT can be the contractor but this involves the SHA acting as the commissioner. The SHA commissioner role is increasingly anomalous given StBoP and PCTs may ... wish to transfer such PMS contracts to PCTMS arrangements where the PCT is the direct provider.” [para 2.6 Delivering Investment in General Practice]

  14. What’s the difference? PMS • Requires contract between SHA and PCT that conforms to Regulations “Where the contractor is a PCT, the agreement must specify that its list of patients is open.” Para 11(4) NHS (PMS Agreements) Regulations 2004 PCTMS • No contract required • No requirement to maintain open list

  15. Why provide? Provision is not an easy option: • No transfer of clinical risk (capacity?) • No transfer of financial risk (equity?) • Performance (measuring quality?) but • Control • Inject competition/capacity?

  16. Procurement Process • For greenfield sites, two stage process: • First, competition between GMS and PMS practices (which would have preferred provider status); • Then, open competition. [para 7.20 Investing in General Practice] • For brownfield sites, could go straight to tender or choose PCTMS

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