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Gold, incentives and meh

Hampshire and the Isle of Wight - real PBC potential

Hamshire has invested millions in locality managers and in pump-priming new services, giving PBC a good start.

Hamshire has invested millions in locality managers and in pump-priming new services, giving PBC a good start.

Dr Nigel Watson is chief executive of Wessex LMCs covering, in the South Central SHA area, Hampshire – the largest PCT in the country – and the Isle of Wight. He says: ‘I believe PBC is on the verge of working well here. Intentions are good but the PCTs have to transform good intentions into practical outcomes. PBC has got a lot further to go. In my area there are very few new services available to us, yet there is lots of potential.'

Dr Watson feels relationships with the PCTs are pretty good generally and there is a focus on primary care. ‘Hampshire has invested a couple of million pounds to pay for locality managers to work with PBC leads and relate to the PCT commissioners. They've put money in to pump-prime new services on a spend-to-save scheme. So it's getting there, but it needs to be given a good kick to get it into the next stage', he says.

Each PCT has well-defined localities in which each practice is engaged and has a lead GP. The lead GP's influence on the PCT commissioners is variable, says Dr Watson, and the LMC is strongly encouraging a partnership between the two so they are working to a common agenda rather than conflicting with each other.

Practices are looking more effectively at the health needs of their population and looking to plan services, but Dr Watson says in some areas there isn't real data flowing from the PCT to PBC consortium. ‘There's work going on in most areas to reconfigure services but the frustration is there's a lot of talk about providing services in a different way but then it gets stuck with the contractors and two to three months down the line nothing much has changed.

‘If you ask the GPs on the ground, many would say they don't see much happening yet. Pathways have been developed, changes in services have been negotiated and agreed, but the problem is with pricing and contracting.'

There have been innovations – Dr Watson cites as an example a scheme in Southampton where a community-based ophthalmology service run by a GP screens all the cataract cases and stops unnecessary referrals going into secondary care. He says there are similar schemes with orthopaedics, ENT and dermatology, and a scheme involving a community-based diabetes consultant has been established in Southampton.

An incentive scheme aimed at examining referrals to see if they are appropriate has proved controversial. Hampshire PCT has funded a pilot project to discover the cause of a 20% rise in first consultant outpatients referrals in the first quarter of this year compared with last year by asking practices to look objectively at all referrals each week to see whether some could have been managed differently.

An incentive scheme rewards GPs if referrals have stayed the same or only increased a certain amount.

Dr Watson says: ‘New services have been started but they are patchy and I don't think they've gone anywhere near as far as they could do to have a real impact.'

Hampshire and Isle of Wight - real potential

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