Personal Medical Services in North Bradford PCT

1. North Bradford Primary Care Trust Personal Medical Services in North Bradford PCT Julie Winterbottom Assistant Director of Commissioning

2. Aims • Provide an overview of PMS within North Bradford PCT • Show PMS in context with the overall performance framework • Look at our model of practice-led commissioning • Show potential Specialist PMS services

3. PCT Vision • Self-care • Preventative care • Chronic disease management • Reduced hospitalisation • Targeted care for patients with complex needs • Can do culture

4. Profile of North Bradford PCT • 12 multi-partner practices • Population size approx 93,000 • High elderly population • Geographically small (20 minute drive radius) • Pockets of highly deprived areas and affluent areas • 5% ethnicity

5. So what is Practice-led commissioning ? The North Bradford model is to: • Devolve and align responsibility, accountability and authority at practice level

6. The current contract • Practice-level PMS • All 12 practices are PMS • 2 practices went in Wave 1 • 9 practices went in Wave 3 • 1 practice went 1 April 2004 • Wave 3 practices got £1m growth monies in total • Resulting in 15Nurse Practitioner posts and 5 salaried GPs

7. PMS Performance Management • 40 quality targets in 2003-4 PMS contract • Benchmarking data amongst practices • Quarterly practice reviews • Statistical analysis eg trend analysis, run charts • Regular reports to the Exec, PEC and Board • Monthly reporting and feedback to practices • Regular informal practice meetings with Chief Executive and Non-Executive Directors

8. PMS in context with the Performance Improvement Model Mission Performance Packages Vision Incentive Scheme Perf. Fund Patient Experience Culture PMS Practice Manager leads Support Advisory Groups PLT/PBE Unit of Delivery Education Pursuing Perfection Specialist Groups Practice Review Meetings Collaboratives Optimising Hospital Utilisation Patient/Consumer Involvement Clinical leads Information

9. In addition to core PMS – The Primary Care Incentive Scheme

10. In addition to core PMS – The Performance Fund Investing in the infrastructure of Primary Care to support continuous improvement • Data collection /data quality • Attendance at key meetings / PLT / GP Advisory Group • Annual revised Practice Business Plans • Summarisation of medical records • Investors in People • Use of the electronic booking system/booked admissions £50,000 approx. (based on practice of list size 10,000) RECURRENT

11. In addition to core PMS – Locality Services • GPs with a Special Interest (GPwSI) • Consultant outreach clinics Potential income to a practice = up to £70k plus

13. 2004/5 PMS contract • Choice of baseline for core general practices services • Plus payment for:- Enhanced services- GPwSI / locality services- Performance fund monies- Incentive Scheme monies- ‘Gold standards’ in chronic disease management- Agenda for Change- Patient involvement- True advanced access- E-booking / referral protocols- Pharmacist clinical time- IWL / IIP - Nursing Home pilot (Optional) (is this ‘Specialist PMS’ ?)

14. Out of hoursA full package of out of hours services for practices to purchase(is this potentially a ‘Specialist PMS’ ?) An out of hours service comprising: • GP Co-operative • Fast response • Salaried GPs • Nurse Practitioners • Paramedics • Crisis resolution • Telephone triage • Daytime home visits • Primary care walk-in centre at two sites

15. PMS - The 4 levels of service delivery • Core general practice • Enhanced services • Secondary to primary shift • Service developments – phase 1 & phase 2

16. A closer look at Core General Practice • Level 1 indicators = nGMS indicators • Level 2 indicators = improving quality further • No points system, money upfront, continuous development • More money for Chronic Disease Management • Includes, for example;- use of templates in relation to the Treatment Centre - practice-level Expert Patient Programmes

17. A closer look at Enhanced Services • Directed Enhanced Services (DES) • Examples:- Spirometry- Sexual Health- hysteroscopy workup- 24hr BP- Anticoagulation- Lithium monitoring • Practice’s own patients or other practices also

18. A closer look atSecondary to Primary Shift • More rigorous Clinical Governance • District-wide accreditation • Includes GPs with a Special Interest (GPwSI)- Urology - Diabetes- Dermatology - Musculo-skeletal- Neurology - ENT- Cardiology - and others • PCT-wide service

19. A closer look at Service Developments • Phase 1 & Phase 2 • Need business case from practices • Examples;- Alternative therapies- Integrated community nurses- Minor injuries walk-in site

20. Key principles • Devolve and align responsibility, accountability and authority at practice level • Less bureaucratic • Flexibility • Money invested upfront • Clinical standards agreed locally • Collaborative approach to working • Different pace of change for each practice • Recognition of ‘High Achieving practices’ = more autonomy • Practices will not be disadvantaged compared to the new GMS contract • 10% financial increase for the next 3 years