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Missing the point of PBC

PBC needs to provide quality primary care – focusing on prevention rather than treatment – and the rest will follow, says Andrew Donald of Birmingham East and North PCT

PBC needs to provide quality primary care – focusing on prevention rather than treatment – and the rest will follow, says Andrew Donald of Birmingham East and North PCT

The current focus of PBC on resources, budgets and freed-up resources is missing the point.

The financial – and quality – challenge ahead requires the NHS to shift its emphasis from treatment to one of prevention.

This requires world-class primary care – the successful GP commissioner of tomorrow will be a high-quality provider of primary care today.

If GPs can change the pattern of patient care by using the community-based services available, thousands of patients will avoid being admitted to hospital or patients turning up at A&E. This in itself will save hundreds of thousands of pounds.

In NHS Birmingham East and North we followed Department of Health guidance on PBC and it didn't work. We devolved responsibilities as required but discovered that we retained full control. Our clinical engagement, as evidenced through World-Class Commissioning competencies, was good but the incentives for GPs to engage in PBC were limited, so there was no real transformation.

But we knew that if we could harness GPs' skills as providers in commissioning the pattern of care, real change and savings would follow.

So eight months ago we embarked with practices on setting up an alternative PBC scheme. We agreed to devolve all the management costs to localities and to develop a PBC business unit with PCT staff who would support the practices to enable successful commissioning. These two actions mean that some £2m in support costs has been devolved.

The next step in the scheme is to develop partnering agreements with practices that link the provision of primary care with commissioning. If practices achieve objectives under this arrangement, they will receive a reward payment. We describe this as a QOF Plus payment.

The key to the partnering arrangement is that the objectives are mutually agreed so they support the PCT in meeting its goals while ensuring the objectives also meet practice-based commissioners' requirements. If successful we believe this will reduce the costs of healthcare and the QOF Plus payment could grow year on year.

Practice-based commissioners often ask us what good commissioning looks like.

I always say good commissioning comes from excellent provision.

For example, our PCT developed Birmingham Own Health, a telephone-based service for people with long-term conditions. If all practice-based commissioners were to refer appropriate patients into this service we know that, based on current evidence, clinical outcomes would improve, unplanned visits to hospital would be reduced and over time costs of treatment would fall.

Looking at PBC in this way seems to have captured GPs' attention and focused minds differently. We don't talk about budgets or freed-up resources but we do talk about managing demand, using services appropriately and using primary care clinical leaders to change patterns of care.

This approach, we believe, demonstrates how world-class primary care can be achieved by reframing the objective, the rules and the relationship.

Andrew Donald is chief operating officer of Birmingham East and North PCT

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