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Do PCTs want real change or just good headlines?

Dr Nigel Watson offers the inside story on what the Hampshire model, lauded by ministers as a textbook example of PBC, has been like for those on the ground

Dr Nigel Watson offers the inside story on what the Hampshire model, lauded by ministers as a textbook example of PBC, has been like for those on the ground

Health minister Ben Bradshaw recently cited Hampshire as a PBC success story with the PCT having invested ‘several millions of pounds'. So what is the real story in Hampshire?

Hampshire PCT is the largest PCT in the country with a registered population of about 1.3 million, and 148 general practices.

To its great credit the trust worked closely with the LMC to ensure the investment and infrastructure were in place to ensure PBC expectations could be met.

The PCT did not want PBC to be a remote process and the LMC did not want it to be about a series of meetings that produced little in the way of change (though some might argue this is what has happened).

To begin with, DES money was used to ensure every practice had a PBC lead and to fund projects such as demand management through referral reviews, cutting hospital admission and redesigning pathways.

Then the real investment in PBC started. The PCT asked practices to form themselves into natural localities and invested an additional £1.46 per patient (£1.9m) to support the localities' infrastructures. Each locality now has managers, lead GPs, administrative support and information analysts. They work for the locality but also work closely with the PCT.

In addition the PCT invested £750,000 in a dedicated PBC lead manager and three PBC area managers and purchased a Dr Foster licence to enable every practice to be benchmarked.

This means we can measure activity and expenditure of our practice against the PCT average and find solutions if necessary. The PBC team works closely with the locality managers and PBC clinical leads to ensure that there is some cohesion between the trust's commissioning department and the PBC localities.

A major frustration for GPs involved with PBC is that although there is no shortage of good ideas for service redesign that would save money, there is often no funding available to set services up. With this in mind, the PCT identified £1.5m as ‘pump priming' funds to allow localities to bid for schemes that were effectively ‘spend to save'.

To date we have created models for ENT, gynaecology, rheumatology, flexible sigmoidoscopy, UTIs, cardiology and pulmonary rehabilitation. New pathways on their way include ones for heart failure, COPD and prostate cancer.

So models are being approved and the effects of the investment have been felt in my practice. We also now have a much greater understanding of the activity we generate on behalf of our patients and the subsequent costs this involves.

And we definitely have greater involvement with local issues, such as what services should be available in a new hospital and the future use of a local community hospital.

But I still feel the PCT needs to take its next leap of faith if PBC is to achieve its potential in Hampshire.

Of note is that the PCT commissioning department is still not closely aligned to PBC and commissioning new services is still a laborious and overly bureaucratic process given the values of the contracts.

The challenge for the trust now, having established a solid foundation, is to allow greater freedom and closer working to let PBC deliver change. Then there will be

more material for ministers to include in their speeches.

Dr Nigel Watson is a GP in Hampshire and chief executive of Wessex LMC – he is also chair of the GPC commissioning and service development subcommittee

Dr Nigel Watson

The PCT pumped £1.5m into spend to save schemes

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