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A cash budget to commission social care

Iain Stewart, chief Officer of Wallasey Health Alliance LLP explains how a hard cash budget for social care interventions has focused minds on commissioning.

Iain Stewart, chief Officer of Wallasey Health Alliance LLP explains how a hard cash budget for social care interventions has focused minds on commissioning.

Eighteen months ago, NHS Wirral gave each practice in our area a hard cash budget for low level social care interventions. The experience of being handed real money with which to purchase services for patients has really helped focus our minds on what resources are available and whether they are being used in the most efficient way.

The PCT had become aware that many of the reasons for patients' long hospital stays were social rather than medical ones. So in April 2008 the PCT offered a one-off, non-recurring allocation of funding from their development money to every practice on Wirral for use on low level social care interventions. This was real money, physically transferred into each practice's bank account.

For the first 6-9 months not much happened as many practices were unsure about what they were supposed to spend the money on.

But in September 2008 12 local practices formed Wallasey Health alliance and we pooled our allocations, which totalled around £175,000. This gave us a corporate approach about how we were going to use the social care fund to help patients.

Originally the money was for use over the financial year 08/09 but because it took such a long time for practices to start using it, it has been rolled over into the second year.

We were given a fair amount of freedom about how the money was spent though the PCT were clear it was for low level social care intervention, for example paying for an occupational therapist rather than more GP time in the practice. The PCT retains the right to audit a practice's accounts to see how they've used the money.

Focusing minds

Having real money has made GPs think much more carefully about where the money goes. The ability to control where and when physical cash is deployed has made GPs look more closely at the issues for their patients, and what low level intervention could help them.

Because the PCT let go of the reins the guidelines were more about the spirit of what a social care intervention would be, rather than dictating what the money had to be spent on. This meant that PBC has had to better understand the problems and seek out what services were available that could be commissioned for patients.

For example, one practice has bought a stair lift for a very frail couple to prevent avoidable falls. If more GPs started thinking in this way it would make a real difference for patients.

I see this as an opportunity to prove ourselves, but I don't think it's so much about the PCT giving us more trust and responsibility as those of us in the alliance seizing the opportunity we've been given to show we can be trusted with hard budgets.

GPs are not automatically entitled to have the public's money given to them. They need to prove they can manage public money. Even on this relatively small scale we must show the PCT that we can safely be given resources, and are responsible and accountable for what we do with that money, and this is a start.

Commissioners in the vanguard of PBC have been encouraged by being given the chance to prove to the PCT they can manage public funds, and we have seen a bit of a shift in the 09/10 indicative PBC budgets. The PCT will now consider business cases for areas which last year were completely off-limits in terms of GP involvement and influencing. They are slowly opening up the budget areas PBC can influence.

Having hard money in the bank has meant GPs have wanted to deliver better services and get better value for money. Giving GPs real money focuses their attention on commissioning. If they had more money it would focus them more.

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