NHS operating framework 2008

This link is to the recently published operating framework. It therefore sets out the direction of travel for the NHS in the next financial year. So, depending on your perspective, it will lay out the corporate pressures defining the commissioning priorities are OR what it is that providers are likely to be able to sell!

Audit Commission Report

This a report from the Audit Commission that shows that the lack of information on what actually goes on in the health service is slowing down PBC development. As the report says, this is a shame as it stops the patienrs receiving the benefits.

Payment by Results 2007/8

A little late to post this guidance. Helpful descriptions on what is NOT included in the tariff (and therefore subject to local negotiation). Also advice on "unbundling" the tariff. All useful for those wishing to transfer services to the community.

Payment by Results 2008/9

Click here for the initial circular from David Nicholson outlining proposed future changes. Of particular interest is the removal of the fixed tariff price for Dermatology to reflect "Cherry Picking"

PBC; from good idea to effective practice.

This paper form the Kings Fund reviews national progress to date and identifies "blocks" to process and then makes recommendations. Useful reading for those who feel they are not going as fast as they would wish

The Big Picture

This paper from McKinsey's gives an outline of the perils and pitfalls in the ways a government can manage change.

The evidence of the effectiveness on service relocation

Professor Rowlands from Manchester University has reviewed the management literature on what has been shown to work and what has not been. Our advice is to use this paper to improve on work that has gone before, rather than discard ideas asunworkable. Click here.

Guidance on PBC implimentation

Very helpful document from the GPC that sumarises the Department of Health guidance. Of particular interest are the sections on use of freed up resources and incentives. We suggest reading the GPC document first and then referring to detail in the DH document.

Primary Medical Contracts - who can hold what?

A very good paper from the GPC committee of the BMA that explains the differences between GMS/APMS and SPMS. It also gives an introduction to NHS pension eligability.

Essential for the business plan

We have recently come across groups who know that there are things they want to improve, but cannot free up the cash to do it. This paper from the NHS institute of Innovation and improvement shows how the reduction of acute admissions can acheive this.

Centre for Public Scrutiny

Have writen a paper that I have only just found despite it being May 2006. I put it up because I think it has a very good section on the differing roles of the SHA, the PCT and in particular the OSC (Oversight and Scrutiny Committee). These are areas to which the practices can be blind.

Interesting things uyou didnt know

This link is to the answers posed to the DH by a reporter about such things as "How much does the NHS cost", "How many prescriptions were cashed in per year" and is a really useful source of a sense of scale of the NHS. Have a quick look at it.

Where did all the money go?

Excellent radio 4 article on headline fate of all the money that was thrown at the health service. About half on pay (including a rise of numbers of managers by a third)

Clinical Engagement 2008 onwards

A report from a Kings fund summit:

"In a labour intensive industry, doctors, nurses and other health care professionals are the key resource - not just clinically, but managerially too."

PBC is one technique for making sure that the knowledge that clinicians have about what is good health care and what is not is used for the benefit of our patients.

GPs and consultants should work together in one stop health centres

Says it all really!

Mashta BMJ.2007; 334: 281

http://www.bmj.com/cgi/content/full/334/7588/281-a?ct

(Needs Athens or BMA password)

Its not easy at the DH either

A paper from the Nuffield Trust explaining recent changes at the DH and how that has affected the culture

APMS, PCTMS and SPMS

A very good guide published by the primary care contracting group on the differing forms of contracting. The only issue being that, for most of the readers here, it is aimed at the competition!

The opportunities for primary care

Click here for a paper by David Colin-Thome on the opportunities for teams that can come together and offer new services in the community.

Health Policy Forum

A very detailed and interesting view of how commissioning may develop. Complex at 54 pages. The issues about supplier side reform should interest any current providers (p18) . Click here

RCGP and RCP working together

Why did they feel the need to say this?

The Rules of the Game

The DH have published a full commissioning framework for the NHS and published a VERY helpful summary of the main points for practice based commissioners. Click here. It has to be essential reading before discussing with your PCT the contractual arrangements.

The DES

All over the place we have found PCTs "playing" with the DES, in some areas in a manner that if left unchecked would have caused the compltet collpase of PbC (an accident?). Please click here to read a very good BMA article on "What the DES does not include" and check your local situation.

How is everybody else getting on

Click here for the improvement foundation (the old NPDT) Pbc survey. This is practice reported data and quite different from St HA data (vide infra)

Acheiving 100% uptake

Click here to find out how the St HA's are reporting the uptake of PbC.

Future Privatisation

Its started:

http://politics.guardian.co.uk/publicservices/story/0,,1810012,00.html

PbC and nurses

The original documentation was clear that PbC was aimed at all front line professionals. This paper from Unison outlines concern about the engagement of nurses which we think are broadly fair. To move the debate forward I think that it helpful to distinguish the different contributions possble from (i) Nurses (ii) Organisations containing nurses (iii) Organisations led by Nurses.
(i) Individual nurses have skills that can suport the commissioning process, often formally identified as health needs assessment. (ii) In organisations that contain nurses, it is often the nurses that are closest to the patient delivering the all important work. For examples (and a bit more background reading) see this paper from the RCN. (iii) For organisations that are lead by nurses there are the same opportunities to improve patient care as there is for anybody else. We are please to be working with established and developing teams that are nurse led.

The TPBC DES

This, like the other 4 new DES is messy and difficult to understand. Click here for a link to the PCC mini bullitin on the DES which nicely pulls out the guts of the national guidance.

PCC Team PBC Bulletins

The Primary care Contracting Team issues regular bulletins:

Bulletin 1 addresses some of the key issues that PCTs face in terms of preparing to implement PBC. Included in the Bulletin are links to further examples from PCTs
- Bulletin 2 covers governance issues
- Bulletin 3 multi-professional involvement
- Bulletin 4 service redesign and delivery

They are a little dry and I suggest used when you have a clear idea of what it is you want to achieve. Then use them to help decide a list of tasks and achievements needed to get where it is you want to be.

What is the correct size for a General Practice of the future

A very strong paper by Professor Corrigan. How does PbC feed into this? Because talented PbC will be one of the factors that allows a practice to thrive (and grow). Click here

Workers Revolutionary Party (Again)

This time providing a counter view to the National Leaders viewpoint. Click here.