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An update on PBC lingo

With more and more terms and acronyms arriving on the PBC scene, Helen Mooney puts together a helpful jargon buster

With more and more terms and acronyms arriving on the PBC scene, Helen Mooney puts together a helpful jargon buster

PBC framework

This term has been heard a lot in recent months and refers to the five organisations the Department of Health has selected to be in a PBC development framework.

This is essentially a shortlist of suppliers that PCTs can turn to for high-quality support to improve their PBC capability and skills. The framework means PCTs can rapidly buy in such services from the five organisations rather than have a drawn-out tendering process.

Although the DH has funded the setting up of the framework, individual PCTs, SHAs and PBC groups will have to pay for any services they seek from the five organisations.

The organisations on the list are:

• Aetna Health Services (UK) in partnership with the RCGP and PricewaterhouseCoopers

• Catch On Group

• Centre for Innovation in Health Management at Leeds University Business School

• Humana Europe in partnership with NHS Alliance and Dr Foster Intelligence

• Tribal Group in partnership with Quest4Quality.

Any willing provider

This is a procurement model that PCTs use.

The thinking behind the AWP model is that free choice of providers should not be constrained by commissioners and heavy-going tendering processes.

Rather, patients should have a list of providers to choose from and their choices will ‘drive up quality through contestibility'.

So, the role of the PCT is to draw up the list of AWPs and to vet those who want to go on it, which includes ensuring they meet the national minimum quality criteria as set out by the Healthcare Commission.

There is no guarantee to the providers about how much work they will get as a result of being on the list.

Providers are paid either a locally agreed tariff or a price agreed in advance with the provider, but there is no guaranteed income.

The Government has instructed PCTs to adopt the AWP model when tendering for routine elective services and this applies to those developed through PBC. No tendering is required.

Joint commissioning

Joint commissioning between the NHS and local authorities is set to grow this year. To date, such partnerships have usually been between PCTs and local authorities rather than with, or driven by, PBC consortiums. This is because there are strategic arrangements in place for PCTs and LAs to work together – through, for example, joint strategic needs assessment (JSNA) and local joint planning such as Children and Young People Partnership Boards.

The Government white paper Our Health, Our Care, Our Say raised the prospect of more use of pooled budgets by PBC groups working with their PCT and LAs. This built upon the notion that GPs are on the ground and in touch with patient needs so would be best placed to work with local authorities to build better services for the populations they serve.

Increasingly, with the help of PBC indicative budgets, PCTs are engaging their PBC groups to inform decisions about LA partnerships so the PCT has access to a general practice view. However, this is not a uniform approach.

The Our Health, Our Care, Our Say white paper, the operating framework for the NHS in England and the commissioning framework for health and wellbeing all mention the importance of joint commissioning.

Personalised care

Both health minister Lord Darzi and health secretary Alan Johnson have stated their determination to introduce personalised patient care for users of NHS services. In Lord Darzi's Next Stage Review, he summarised such care as ‘tailored to the needs and wants of each individual, especially the most vulnerable and those in greatest need, providing access to services at the time and place of their choice'.

Patients with long-term conditions will be given even greater control over their care and the Government plans to introduce personal budgets and care plans nationwide under the banner of patient choice, to ‘empower' individual patients and enable them to ‘use their personal knowledge, time and energy in solving their own health problems'. Its aim is that within two years, all 15 million people living with long-term conditions in the UK will be offered a personalised care plan. GPs are likely to take a key role.

Patients will also be offered personal health budgets in a national pilot that is about to begin.

Subsidiarity

This is a term originally coined by EU mandarins when talking about devolving power and decision-making being done at the most appropriate level.

The NHS Operating Framework for 2009/10 introduced the term subsidiarity into the NHS and in this context it means devolving power to the patient. PCTs will be expected to strengthen their focus on subsidiarity while still delivering national priorities in the current three-year comprehensive spending round. How they do it is up to each PCT.

As the DH puts it: ‘Patient experience is the final arbiter of success.'

Co-production

This is the new buzzword for describing breaking down organisational barriers where key partners work together for a common aim.

The thinking behind the phrase is that all parties have to work together to ‘co-produce' their common goal. In health and the NHS, the Government hopes that the patient can be engaged as a co-producer of their own healthcare. It wants to see the public viewing the NHS as a partner, adviser and co-manager for health rather than someone to go to in an emergency.

System alignment

This refers to local health services working collectively to improve population health. The NHS Next Stage Review and the NHS Constitution have clarified that the NHS is a system, not an organisation, and that therefore the wider system needs to be aligned around the same goal to drive up quality.

According to the NHS Operating Framework 2009/10, ‘system alignment' is a key factor in making quality happen in NHS services. It puts a particular emphasis on joint planning and partnership working with local authorities. System alignment will also be about the NHS and local authority partnerships working across several areas, including commissioning ‘comprehensive health and wellbeing services' according to local needs and the Prevention Package for Older People. This has a particular focus on maximising health and independence through telecare, falls prevention services and other services.

HRG4 – the new tariff system

Due to start on 1 April, Healthcare Resource Group version 4 is seen as a double-edged sword.

HRG is the set of codes hospitals use to label an episode of patient care and a tariff is applied to each code to allow a cost to be worked out for each hospital visit or stay.

Hospitals currently use HRG version 3.5, which has 650 codes – the new version 4 will have 2,500 codes.

Its introduction will be key to unbundling tariffs for the following nine services – radiology, rehabilitation, chemotherapy, radiotherapy, renal dialysis, critical care, high-cost drugs, specific palliative care and interventional radiology – and so more care will be delivered in community settings for these.

However HRG4 is not without its critics. There were rumours at the end of 2007 that the DH was getting cold feet about the switch, when finance directors raised concerns over its robustness.

Vertical ICO

The final 20 successful integrated care organisations pilots will be announced at the end of this month.

Although only a fraction of GPs will be involved in these pilots, the models will be a blueprint for how PBC develops long term.

Vertical ICOs will aim to promote integration between primary and specialist care providers.

Whereas GPs are used to taking responsibility for providing primary care for registered populations, integrated care organisations will extend that responsibility to a wider range of care. In some cases this could include most care required by the population.

Horizontal ICO

Horizontal ICOs will work by attempting to knit together primary, community and, increasingly, social care.

In theory, ensuring a single point of responsibility backed with a firm budget will give providers a stronger incentive to develop services that fit around the patient rather than the requirements of disconnected providers. Moreover, by giving such an integrated organisation a single budget to cover care normally delivered by different providers, a better balance between investment in treatment and in prevention should be achieved.

Fair shares budget

The current indicative budget-setting process has produced winners and losers among practices because of a failure to take full account of local factors such as ethnic minorities, student populations, people in sheltered housing and asylum seekers.

Using historical expenditure as the basis for setting budgets has also meant practices who have limited referrals and been effective gatekeepers can be losers whereas those practices that have referred lots of patients have been winners.

A fair shares budget is one that addresses such imbalances. The Government's aim is for PCTs to bridge the gap between an indicative budget and a fair shares budget to within a range of 10% in the coming year. It has published a fair shares budget toolkit to help advise PCTs on how to do this.

Provider arm

In a drive to ensure there is no conflict of interest and competition prevails, PCTs are moving to divorce from their provider functions and become solely commissioning organisations.

So services traditionally provided by PCTs directly to the populations they serve are having to be hived off into a provider arm.

The options for the PCT to create the provider arm range from forming services into a completely separate stand-alone trust through to keeping the provider arm in-house. The DH is to set a deadline for PCTs to decide on the future of their provider arm services in the coming months.

Decommissioning

Decommissioning means the termination of a service from a provider.

This usually happens because the PCT wants a different service introduced to better suit local patients' needs.

A service can also be decommissioned if a provider is in breach of contract or there are quality concerns.

There were reports last year that two thirds of PCTs failed to decommission any services in 2007.

The DH's World Class Commissioning drive with its focus on scrutiny of contracts and existing services means decommissioning is set to intensify over the next couple of years.

Helen Mooney is a freelance journalist

Getting to grips with PBC lingo

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