PBC consultants Scott McKenzie and Gerry McLean sat down with representatives from five PBC groups earlier this year to discuss what organisational changes are needed for real budgets. Here is a snapshot of their summary report
•Moving to real budgets will need to be staged to ensure PBC groups have the capability to manage hard budgets. The whole budget needs to be taken on eventually but in a gradual way.
•A transitional approach will also be necessary in terms of handing over statutory powers from PCTs to GP multifunds.
•PBC groups will need to look at finances in much greater detail than they do at present and to break down costs in terms of administration and actual service provision.
•Management costs of the new real budgets organisations will be less than the 5% of the current PCT budget, as they will be more efficient, but will still be much higher than the current PBC group’s day-to-day running costs.
• The PBC group or the new organisation created would handle all communications and contract negotiations directly with the hospital trusts .
• The NHS pension should be factored in when developing organisations. Staff working in the new organisations will need to be able to transfer their terms across. Currently only organisations with GMS, PMS, APMS or SPMS contracts are able to pay the NHS pension. Commissioning is currently a non-pensionable activity.
• A population base of 100,000 is necessary to successfully manage risk.
• Longer commissioning cycles of perhaps as much as three years will be necessary.
• Real time data will be necessary to monitor and negotiate contracts.
• Clear definitions must be established about what savings can be spent on.
Designing the future of the NHS Real budgets