Xytal

NHS operating framework 2008

2007-12-18T16:36:00.000Z

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

2007-11-23T11:33:00.000Z

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

2007-11-20T10:21:00.000Z

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

2007-11-13T10:37:00.000Z

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.

2007-05-24T13:47:00.000Z

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

2007-05-06T08:41:00.000Z

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

2007-04-14T08:37:00.000Z

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

2007-04-13T17:27:00.000Z

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?

2007-03-09T12:10:00.000Z

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

2007-03-02T10:13:00.000Z

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

2007-03-02T09:49:00.000Z

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

2007-03-02T09:35:00.000Z

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?

2007-03-02T09:31:00.000Z

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

2007-03-02T08:58:00.000Z

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

2007-02-09T11:09:00.000Z

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

2007-02-09T10:54:00.000Z

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

APMS, PCTMS and SPMS

2007-02-08T11:44:00.000Z

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

2007-02-08T11:40:00.000Z

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

2007-02-06T13:20:00.000Z

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

2007-02-06T13:18:00.000Z

Why did they feel the need to say this?

The Rules of the Game

2006-09-05T10:56:00.000Z

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

2006-08-22T10:37:00.000Z

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

2006-08-22T10:31:00.000Z

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

2006-08-22T10:26:00.000Z

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

Future Privatisation

2006-07-02T08:32:00.000Z

Its started:

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

PbC and nurses

2006-07-02T08:17:00.000Z

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

2006-06-24T10:05:00.000Z

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

2006-06-24T09:57:00.000Z

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

2006-06-17T16:16:00.000Z

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)

2006-06-17T15:19:00.000Z

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

The Future of the Acute Hospital

2006-06-17T15:13:00.000Z

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

2006-06-17T14:53:00.000Z

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

2006-06-17T14:44:00.000Z

"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

2006-05-26T09:56:00.000Z

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?

2006-05-26T09:49:00.000Z

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

2006-05-19T13:55:00.000Z

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)

2006-04-18T14:49:00.000Z

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

2006-04-18T14:27:00.000Z

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

2006-04-13T10:01:00.000Z

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!

2006-04-13T09:55:00.000Z

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

2006-03-28T07:51:00.000Z

. 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

2006-03-28T07:44:00.000Z

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?

2006-03-19T09:48:00.000Z

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.

2006-03-19T09:42:00.000Z

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.

2006-03-04T07:25:00.000Z

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

2006-03-04T07:20:00.000Z

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

2006-03-04T07:05:00.000Z

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

2006-02-09T09:03:00.000Z

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

2006-01-31T09:53:00.000Z

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

2006-01-27T16:28:00.000Z

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

2006-01-17T15:03:00.000Z

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

2006-01-14T18:39:00.000Z

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.