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Survival Guide: Commissioning budgets

Overwhelmed at the prospect of taking on commissioning? Dr Joe McGilligan gives you the information you need to get started

The Basics

Nothing is set in stone yet but typically GPs will receive £2 per patient to fund the development of consortia in readiness for 2013 and it is envisaged that consortia could have a running cost allowance of £25-35 per patient by 2014/15. Meanwhile, PCTs must continue to ‘enable' consortia to develop and to educate GPs in the complex world of NHS finance and contracting.

Business and financial rules will still need to be adhered to and GPs will need to have an understanding of what they are but not the detailed knowledge; consortia will buy in the specialist support they need. PCTs will remain statutorily responsible for commissioning until 2013 when the law will change but they have a duty to support consortia through the development process. PCTs have to ensure that debt issues are resolved by the end of 2012/13 as GP consortia will not be responsible for legacy debt that occurred prior to 2011/12, but we will have to work with PCTs to ensure that debts are minimised.

The budgets consortia will be given will be for the whole range of services including prescribing with a couple of exceptions. GPs will not commission primary care services; we cannot commission from ourselves, nor will we be responsible for commissioning specialist services such as HIV services or high cost drugs.

Having a total budget will enable us to move the money round the system and invest in services in the community or in a primary care setting and prescribing allowing hospitals to focus on truly specialised care.

Getting Started

Get the data - Historic Hospital Episode Statistics (HES ) which are extracted from the secondary users' service can be analysed at both practice and consortia level to highlight trends in activity and cost. The largest cost will be non-elective admissions which can be broken down into high impact users, complex elderly patients and long term conditions.

Understanding hospital episode data is an essential step in service redesign. For example, by identifying and targeting high users of secondary care, COPD patients can be reviewed and given a personalised health action plan optimising their treatment and empowering them to take more control of their own illness.

Practices own computer systems contain the best and most accurate data and by running MIQUEST queries in all the practices in a consortia and sharing the results you get a detailed local picture. This relies on trust and collaboration between practices.

There are a wealth of electronic tools available which consortia can access, free of charge, such as where you can build your searches to compare your consortia/practice with others in the country.

Analyse the data – Get someone else to do it for you. You will need to decide what would be nice to know and what you need to know. Getting the right specialist analyst support will be vital as having the data compressed into user friendly, easy to understand, bitesize pieces will pay dividends. The data needs to be available at practice level and for the combined consortium.

Benchmark the data – You need to address the areas of difference in terms of both activity and cost. This will identify variance in practices which can be investigated and provides an opportunity for practices to develop and support each other in areas where there are significant differences. For example, excessive use of secondary care should be examined further to understand any deficiencies in service provision or skills and knowledge. Crude figures will not be helpful. One doctor I know was found to refer ten times more patients to secondary care than colleagues in his practice but on investigation it was found that the practice had, in fact, the lowest referral rate in the area because that doctor was a GPSI.

Getting Results

Getting results is fundamentally about getting people to do their jobs in a joined up way. Having conversations with secondary care, community colleagues and representatives of primary care will ensure shared ownership of any changes. Some of the questions consortia can ask themselves are:

- How might you reorganise general practice to reduce costs for example by collaborative procurement and integrated back office functions which can be reinvested in direct patient care and mitigate the impact of GP contract changes being signalled in the White Paper?

- Have you got a well defined urgent care pathway which allows you to divert a significant no of A&E attendances through for example urgent treatment centres and thereby reducing value and volume of non- elective work?

- Where you live close to a main conurbation such as London or Manchester, have you repatriated all the activity you could deliver locally?

- Have you asked acute providers to move their outpatient services into local settings working to a community service specification and local prices?

- Have you maximised opportunities for offering primary care delivered services at Tier 2/intermidatary level?

The important thing to remember with results is that sometimes they take time to appear so don't be disheartened if they are not immediately apparent. Think about the results you want to see at the start of any service redesign project, decide what you want to measure and factor them in.

Dr Joe McGilligan is chairman of ESyDoc and a GP in Redhill, Surrey

Survival guide: commissioning budgets