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Richard Armstrong

This overview explores the principles and mechanics of Practice-Led Commissioning within the context of primary medical care. It discusses the legal frameworks, government policies, and the importance of decentralisation in healthcare delivery. Key themes include empowering clinicians, managing risk, and ensuring accountability in contracting primary care services. The document also addresses challenges such as matching demand with capacity and the implications of payment by results. An informative resource for healthcare professionals and policymakers looking to navigate the complexities of modern healthcare systems.

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Richard Armstrong

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  1. Richard Armstrong Head of Primary Medical Care Contracting Department of Health

  2. Practice-led Commissioning What is it ? Why Legal Framework Mechanics

  3. Government Policy Themes Decentralisation • STBoP • Foundation Trusts • Care/Children Trusts • Systems Reform • nGMS/nPMS • Improving Performance • Modernisation Agency/SHAs • CHAI/Star ratings • Improvement Plans

  4. PCTs: The challenges • Delivering the LDP • Access • NSFs • Other National priorities (Health Inequalities, Drugs etc) • System Reform • Choice • Payment by results • Foundation Trusts • Secondary to primary care shift • Contracting for Primary Care provision • Real clinical and public engagement

  5. PCTs: The challenges The real challenge Matching demand with capacity, whilst meeting Need!

  6. Practice-led Commissioning WHY? • Empowering & engaging clinicians • Choice, Access, Payment by Results • Providing clear mechanisms for accountability • Allows innovation – creating plurality of provision • It works

  7. Practice-led Commissioning WHY NOT • Perverse incentives • Distortions and gaming • Transaction costs • Alienating the profession

  8. Practice-led Commissioning • Legal framework • Rights & Responsibilities - Clinical Team - PCT • Down to PCT to determine - scope - range and - form of arrangements • Not complete (or single) answer

  9. Practice-led Commissioning Mechanics • Setting budgets • Historic • Weighted Capitation • Something else • Managing Risk • Over/Under spends • Stop Loss/over time • Monitoring & Feedback mechanisms • Contracting

  10. Primary Medical Care – an update nGMS • 99.8% signed • Getting practices paid • Managing disputes • Superannuation (employers cont) PMS • Quality points • OOHs opt out price • Contract variations PCTMS/APMS • Guidance & Directions

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