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.

The Future of the Acute Hospital

A very well written paper that does not define the future hospital, but the principles that should guide what a hospital does, and therefore what in needs to be. Of relevence for us becouase it is the obverse of the same principles that suggest what should be provided in the community. Click here.

The future NHS; Private providers

This report from the Kings fund is, as you would expect, well written by a group that contained public sector and private sector employees. It is a discussion paper and provides food for thought for future leaders of future organisations.

Scope of Budgets

"Although PCTs can help to identify priority areas (for example where referral rates and emergency admissions are high), the scope of indicative budgets is for practices to determine. Even among the leading implementers, practices were only interested in managing the budget for a limited range of services at this point. PCTs need to have a clear strategy in place now to meet the DH’s requirement that practice budgets cover the entire scope of health services .... over a three-year period."

Auidit Commission report. For full report click here. Highly recommended no punches pulled.

Fair Shares Budget Setting

The link to the DH tool kit and guidance is here. Note the last page on the tool kit showing how old the data used is.

What is commissioning?

Is an argument that runs and runs. There is a nice definition in the code of conduct referenced below: there are far more academic definitions from the Kings Fund. But to get your DES for commissioning you have to agree with your PCT. The DH commssioning template is found here.

Payment by Results

As the situation is evolving and different areas interpret PbR differently I wanted to bring to readers attention the code of conduct. Should be of value in supporting disspute resolution.

Payement by Results (Again)

A short (12 glossy pages) on the pros and cons of PbR by Monitor (the NHS regulator). The clearest exposition of the isse we have yet seen (Published End of March 06). For details click here

Whilst up in Liverpool I heard a very clear presentation on the current state of PbR and PBC finances from Phil Wadeson the Director of Finance. He has kindly allowed us to use his slides and they can be found here

Collaborative working

Some of our clients are struggling to understand the PCT perspective. Here is a link to the primary care contracting team tool kit for PCT's. The key part for us is the assessment framework in the annex. This is where your PCT should be going . Help them!

Quiet on the website front as had a very busy passage of play involving Norwich, Ipswich, Taunton, Bromley, London and Liverpool. Very interesting to meet all these different groups. It seems to be that the current challenges mainly fit into one of four groups:

1. Establishing the objectives of the PBC team
2. Developing a corporate vehicle that is most likely to deliver these goals
3. Developing a business plan that turns the talk into action
4. Staffing the corporate structure / delivering the business plan

Resolving these issues, in the correct order, will be the thrust of the Xytal early April workload.

Integrated Service Improvement Plans

. A process for co-ordination of service redeseign. This was something that had not crossed our radar until recently. We do not think practices are all aware of this process which all PCTs are required to undertake. We have not been able to down load all the materials off the website. An ISIP from a PCT should give a practice a clear idea which services it can offer that are likely to be bought. For details please click here

Payment by results reinstated

The payment by results tariff has now been republished. A covering note can be found here explaining the changes. The actual tariff can be found here. These changes have been critical for PCTs and Hospital Trusts but the reality is that the changes have occured in areas marginal to most practice based commissioners.

Workers Revolutionary Party - a fair perspective?

I present this paper purely to support debate. It does emphasise the potential of Payment by Results to destabilise the system. Not all would agree with the proposed response.

Cluster formation.

Many thanks to the 6 clusters that are now using our support to develop and deliver services in a new and better way. We are pleased to be able to use our links with specialist accountants Sandisons and specialist lawyers Lockharts to deliver the complete support service.

Payment by Results in trouble.

The payment by Results tariff for 2006/7 has been suspended. This on the face of it is catastrophic for the financial planning process for next financial year.

Payment by Results

A short paper from NatPACT on Payment by Results. Quite short on what payment by results actually is but good on helping understand the implications from an NHS managers perspective.

DES Publication

The "Towards Practice Based Commissioning" DES is now published. Please click here for the BMA summary, and for the specification. The helpful guidance notes (Focus on.....) can be found here. We are currently writing our commentry, which is the most difficult we have to write to date. If you would like an advance copy please contact us: info@xytal.com

Publications

More paper from the DH. Practice based commissioning: early wins and top tips. This time another round up of stuff that professionals have acheived around the country. All show evidence of decreasing waste and increasing efficiency. All show an understanding that activity costs money and it is better to commission effective services rather than ineffective. However these are examples of PROVISION, and in the way the DH does, have been labeled COMMISSIONING. Forget the difference at your peril!

Publications

Just when you think it has gone quiet for a while the DH springs into action. As well the operational issues referred to below the white paper is also published. For the whole paper click here; and here for a summary.

Publications

2 big publications in the last part of this week. The first gives the direction of travel for many of the so "what are they actually going to do" questions. This is the clearly labelled: The NHS in England: The operating framework for 2006/7. The second is more pertinent; Practice based commissioning: achieving universal coverage. This sets out much more of a framework for practices and PCTs to engage constructively. For those of you who are fortunate enough to have the offer of budgets a link on the same page takes you to: "Weighted capitation shares at practice level"

Payment by Results

Payment by Results continues to cause much difficulty among innovators. We are rewriting our main site to give updated guidance but in the mean time for an overview of the implications please click for our paper. For a more detailed view, modelling the way that the finances will actually work please see the paper that we found on the British Society of Art Therapists website.

DES Publication

Interesting that the publication of the DES is slightly different depending on whether you read the NHS confederation publication or the BMA! Watch this space.