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The PBC diaries: Staying Afloat

This month, our diarist considers the options to keep the PCT’s head above stormy financial waters. Could PBC be the essential lifeboat?

This month, our diarist considers the options to keep the PCT's head above stormy financial waters. Could PBC be the essential lifeboat?

The story so far

Dr Peter Weaving is a GP in Cumbria and a locality lead for Cumbria PCT. PBC has previously helped the PCT out of financial deficit and is now forging ahead with ambitious integrated care pilots. But like the rest of the country, lean times are ahead and tough decisions have to be made...

‘If you don't produce an acceptable plan we will pull the £6m transitional funding and then the SHA will pull its £4m support.'

Our PEC chair is engaging our consultant colleagues in meaningful clinical dialogue.

‘Your trust will not survive the loss of £10m from a total budget of £186m.'

I sigh inwardly – this is neither clinical nor engaging.

My mind wanders as I look around the panelled boardroom. This is the first of a series of weekly evening meetings scheduled to continue until we come up with the right answer – the one that keeps us all afloat financially. The proposal under consideration is a structured downsizing plan, in which the trust cost-base is cut significantly by reducing beds.

I look along the serious faces of the assembled clinicians – GPs and consultants, the medical directors and leaders from primary and secondary care, opposing each other in here but going to dinner parties, taking each other's children to school and sitting side-by-side on worthy cause committees out there. Blimey, that consultant has operated on two of my children and I see his partner at the surgery all the time. Why are we fighting about this?

Realistically we are beating up a trust for performing as it's meant to under PBC rules – by being successful in attracting business, coding the work it does effectively (award-winning department in the acute trust) and maximising its financial gains under Payment by Results (in the top quartile of trusts for length of stay). The solution to the problem lies outside in the community but the focus of this meeting is about the acute trust.

I drift off as the usual rhetoric continues in the background – a familiar if irritating rhythm – and begin pondering.

We have recently looked at a very simple measure for our practices – spend per practice per patient per year for PBC and prescribing. What's yours? It'll be about £600 per patient per year. As I look across the practices in the patch I find it varies from a minimum of £420 a head to nearly £900. As the battery of PCT performance measures confirms, high spend may not always be a reflection of high-quality care. If the practices all worked toward the performance of the best, the financial issues would be solved overnight.


Ah, the meeting.

‘What are your thoughts on what the acute trust needs to do?' asks the PEC chair, returning me to frosty reality.

I get to my feet slowly, walk down the length of the room and stand behind him, looking at my weary colleagues. I put my hands on his shoulders and look over his head at them.

‘It's not your fault, guys,' I say. ‘It's his – him and all the other GPs. They're the ones prescribing the drugs, referring the outpatients and admitting the emergencies. But they need your help to change.'

staying afloat staying afloat

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