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Top tips on...Learning to speak the PBC lingo

Need help understanding the many PBC terms and abbreviations? Gerry McLean has put together a jargon-buster to get you started

Need help understanding the many PBC terms and abbreviations? Gerry McLean has put together a jargon-buster to get you started

Freed-up resources

This refers to the money saved by effective commissioning. It means the freeing up of resources for other uses, which can include patient services, premises development and management costs. This in turn will result in a wider range of services being available to patients.

There will be a written agreement between the PCT and the commissioner about the use of these resources and your professional executive committee (PEC) will be responsible for recommending approval.

Give some thought, right at the beginning of your PBC journey, to how you will use any freed-up resources. Note that PBC is a not-for-profit activity. The benefit, if you like, is that you can ‘charge' costs for servicing the activity and benefit from freed-up resources by investing them in your membership partnership.

Secondary Uses Services (SUS)

This anonymous data system reflects both the patient and the care the patient is getting. Or to put it another way, it is about getting data on the total costs involved in treating a patient – not just the clinical care bits.

It provides a consistent environment for the linkage and management of data, allowing better comparison across the care sector, together with associated analysis and reporting tools. IT obviously plays a big part, and SUS is the NHS Information Centre's baby.

It is important for two reasons. First, it enables practices to analyse variations in service use across their patch. Second, in time it could be used by the independent sector to cover all aspects of NHS-commissioned care provided to all sectors.

However, before you start thinking what a wonderful thing SUS is, be warned. Many observers believe the central SUS data system is not fit for purpose and needs radical reform because some acute trusts have failed to enter all relevant data or to ensure accuracy.

Payment by Results (PbR)

Historically, hospitals and other providers relied on block contracts for commissioning purposes. But this produced a perverse system where the more work a hospital had to do the more money it received so there was little incentive to bring workload, particularly waiting lists, down.

Under the new PbR system, hospitals are reimbursed for the activity they carry out using a tariff of fixed prices that reflect national average costs. Trusts are paid for a number of individual treatments they provide, based on a system of coding.

It is believed that a fixed pricing policy will encourage trusts to manage their budgets effectively by holding their figures up against a national tariff.

Likeminded GPs

Often used in connection with commissioning groups, this is where individual GPs share a set of common values, including unity of purpose, a unified agenda and a common understanding of the benefits they wish to realise from becoming involved in the PBC process.

Remember you do not have to be in a commissioning group, but you may wish to consider the value of working with others to realise the benefits of the clout you get working in a larger group.

If you are considering establishing a commissioning group, do not waste time on membership issues if not all of the practices share your likeminded GP agenda. Move on to working with the ones that do!

Fair shares budget

The fair shares formula is about addressing the imbalances between those practices that are doing well out of the current historical spend situation and those that are not.

It is vital in negotiating your indicative budget with your PCT that you carry out

a review of your practice's use of resources (see below for more on this term) to understand why your budget may have to take account of any variances you may have – practice population, for example – that affect your local needs.

As the Department of Health is currently reviewing this whole area, it is important that you begin discussions with your PCT sooner rather than later.

World-class commissioning

This is what the Department of Health wants to implement – a commissioning process that is the envy of the world. It is not just a fancy term – the department has actually got a plan on how it will achieve this.

The DH believes such a programme is timely because in the 21st century people are living longer and their expectations are changing.

World-class commissioning will be the key driver in enabling the NHS to meet these challenges, with commissioners and healthcare professionals working together in a way that is patient-centred, clinically driven and able to respond to local patient needs.

Indicative budgets

This is a big issue for those starting their PBC journey. Since April 2005, practices have been able to receive an indicative budget that they can use to commission hospital and community services.

You first need to talk to your PCT to find out the practice's share of the unified PCT allocation. This indicative budget will include secondary care services covered by the national tariff (elective, non-elective, outpatients) and primary care prescribing activity. PCTs remain legally responsible for: managing finances; negotiating and managing all provider contracts; the

overall commissioning strategy; and the implementation of PBC. What is important to grasp is that practices are managing this indicative budget – accountability still rests with the PCT.

You must ensure that you understand the figures you are presented with – this budget allocation is the amount of ‘cash' that you will have influence over and is the basis of your freed-up resources.

Framework for procuring External Support for Commissioners (FESC)

The function of this is to provide PCTs with access to expert suppliers, for example BUPA, that can help them with their commissioning function.

It is designed to streamline the procurement function by giving the PCT access to a wide range of solutions. It is believed this approach will offer a reduction in cost and legal implications that are met when PCTs want to use external support.

It is important for commissioners to note that one of the criteria deployed in this area is that suppliers are encouraged to offer innovative and efficient approaches to commissioning.

Care and resource utilisation (CRU)

This is about examining whether the right care is given, in the right place, and at the right time. The result of this examination in your area may mean:

• providing more care than at present

• changing the location of care

• changing the patient pathway.

For PBC this issue is important because you will need to identify local priorities, not only for care but for the use of resources. This is also of relevance to the 18-week rule.

Resource utilisation information gives you the opportunity to target those areas where you can prove significant inappropriate use of resource and where you have identified clear alternatives.

Self care

You cannot have failed to notice in recent years the messages on your television that say enjoy alcohol sensibly, stop smoking and exercise more.

Self care refers to the actions that individuals take to promote their own health and wellbeing through their individual lifestyle choices. When you couple this with how our society has changed in the way it accesses information on self care, it becomes a hotspot in terms of your potential commissioning agenda.

Research indicates that patients and the public in general believe that they need to take responsibility for aspects of their health rather than leaving it all to their GP.

Therefore it is particularly important to reflect patients' views in your PBC commissioning plans. The patient's input is a vital requirement, so give some thought as to how patients will provide input to your commissioning plans.

Data validation

Information is, without doubt, the foremost single issue that affects more PBC practices and groups than any other. Without robust and timely information from the PCT, you will encounter great difficulties in assessing the commissioning agenda. Data validation is the process to identify errors in providers' information or the PCT's interpretation.

The process needs to ask: did the activity take place, has it been correctly recorded, is the information appropriate, and what can be learned from this information?

An example of a data error would be a pregnancy counted as lasting for 12 months.

It is vital you start a dialogue with your PCT now to ensure you have access to the information you need, and that when it is supplied, it is in a form you can understand. Your PCT has the responsibility of providing the data that practices need, and where it cannot, is expected to develop it as rapidly as possible to meet PBC requirements.

Social Enterprise

Commissioning and provider organisations come in a variety of forms including: the limited liability company, community interest company (CIC), limited liability partnership (LLP),charitable incorporated organisation (CIO).

A social enterprise is another organisation that can be a provider or commissioner. It is a business-like organisation but rather than being profit-driven it is designed to reinvest any surpluses back into the business or the community. They are a business with a social purpose.

Whatever commissioning organisation you choose to form, it is a good idea to make things legal from the outset and to ensure the governance arrangements you put in place offer the maximum protection.

The legal indentity you chose should reflect the long-term strategy of your organisation.

Gerry McLean is executive chair of MAC2 Consulting and has a particular interest in practice audit and collaboration. His work with PBC organisations includes all aspects of initial set-up including relationships, organisational issues and governance. He also advises on recruitment, business planning and PCT negotiations. Further information is available from

Who can be a commissioner or a provider?

The opportunity to commission is not yours by rights – the Department of Health guidance allows for other forms of commissioners to be established.
This means that your commissioning intentions could also be on the agenda of other individuals or commissioning groups who may seek to address the commissioning strategy in your area. Given that there are no geographical boundaries in the context of who can commission, you would be well advised to keep an eye on other ‘friendly' commissioners.

The Government's aim is to improve the quality of care, increase capacity, support patient choice, drive value for money, promote greater equality and create a truly patient-centred service. It hopes to increase the opportunities to achieve this through the use of both private and not-for-profit providers.
So providers can come from a number of sources including ‘any willing supplier' for routine elective services, or those covered under the extension of an existing GMS, PMS or APMS contract, including under LES arrangements.
The point here is that you should not regard the commissioning agenda as yours – the guidance allows for a plurality of approach to meet the criteria outlined above, which in turn means an element of competition is needed in your approach.

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