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What's in practice-based commissioning for you?

Why should GPs get involved in PBC? Dr Phil Taylor provides some answers

Why should GPs get involved in PBC? Dr Phil Taylor provides some answers

GPs need to understand that practice-based commissioning (PBC) is a key Government policy which is likely to become increasingly important to our daily lives.

The Government believes it needs PBC to counteract the power that the new system of Payment by Results (PbR) has given secondary care trusts. PbR is a system that places a cash price on most secondary care work. Most of that work is referred by GPs.The idea of PBC is to allow GPs, and through them their patients, the power to decide where this work is done.

In the White Paper Our Health, Our Care, Our Say, the Health Secretary set out her intent for health care to be increasingly provided in local community settings such as GP surgeries. The Government wants to see innovation.

GP practices are as 'local' as you can get, and have the ability to innovate.GPs have complained about secondary care work being transferred without accompanying resources virtually since the inception of the NHS.

PBC brings with it a mechanism for GPs to bid to carry out secondary care work at a viable rate of pay. This is a chance for GP entrepreneurs to redesign services to be better for their patients and to increase our income.Much is made of the opportunity for practices to reinvest savings made through controlling their budgets under PBC.

Although some practices have shown it is certainly possible to make substantial savings, this should probably be thought of as an added bonus, with service redesign and enhanced earnings being the main drivers for GPs going into PBC. For PCTs, making savings or controlling rises in expenditure is an important driver and practices that concentrate on high-cost areas ­ such as plans to reduce emergency medical admissions ­ are likely to find favour with their PCTs.

GPs need to understand that the Government is beginning to allow big health care companies to provide primary care services. It wants to see competition and calls this contestability. If you don't look to redesign and improve services in your area, then private companies will. Secondary care trusts may also be salivating over the prospect of taking over community hospitals and even primary care in a process known as vertical integration. GPs have to get involved or risk being sidelined.

Phil Taylor is a GP in Axminster,Devon, and NHS Alliance Payment by Results lead· Pulse PBC Seminar ­ 23 May, London. Call 020 7921 8606.

What you should be doing next

  • Talk to your PCT. Senior managers should be keen to help practices make a start on PBC. Find out how much support they are prepared to give. Forward-looking PCTs have helped practices draw up PBC plans. The most successful PCTs will have understood that PBC is the key to achieving financial balance and should be considering active managerial support.
  • Look at your PCT's local development plan. This gives the PCT's local priorities and should help you to understand what sort of plans it is likely to favour.
  • Look at 'national tariff'. This is the price list governing payments to secondary care. It can be found on the Department of Health website. Supportive PCTs should be able to help you make sense of it. The prices will give you an idea of where you might focus your plans. Also on the website are various guidance documents relating to PBC. At a minimum read the latest ones.
  • Ask to see your PBC indicative budget and get your PCT to talk you through it. Ask if calculations have started for 'fair share budgets'.
  • Ask your PCT if it will provide investment upfront to enable you to put plans into action. This may be via the directed enhanced services scheme about which some debate is continuing nationally, but forward-looking PCTs should be prepared to invest anyway.
  • Start by thinking about emergency admissions. Are there common conditions currently being admitted as emergencies which you might be able to manage differently? Look at the prices your PCT will pay secondary care. This will enable you to calculate any savings you might achieve through developing different services and will also give you an idea of potential income streams for the practice.
  • Look for support from other sources. The NHS Alliance has published a guide 'The Nuts and Bolts of Practice-Based Commissioning' that many practices have found helpful.

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