Clinical CommissioningClinical Commissioning

Dr James KingslandDr James KingslandGeneral Practitioner Wallasey

Chairman Wallasey Health Alliance LLPNational PBC Clinical Network Lead

President National Association of Primary Care

PBC Key MessagesPBC Key Messages• PBC is here to stay, is moving forward and heralds

a major change in the commissioning landscape, one which is critical to the NHS reform programme

• Clinical commissioning brings clarity about the exact nature of PBC and ensures a shared and consistent understanding of its role and contribution

• Extending provision of service to the registered population is inherent in PBC

• There must be different levels of engagement - a ‘one-size-fits-all’ approach is unrealistic

Invest to save should still be a guiding principle

The Primary Care ‘Home’The Primary Care ‘Home’Build on the best of traditional General PracticePHC is more than GP – but registered population and

80% of all NHS clinical consultations90% of care solely undertaken in PC where needs of

the individual as well as the community can be metSupport for self care, care closer to home and LTC

managementBoth bio-clinical and social determinants of health can

be the responsibility of one ‘provider’ organisation and ‘practice’ can link with wider public health agenda

The ‘home’ for extended skills and services

PBC in ContextPBC in Contextre-invigorating not re-inventingre-invigorating not re-inventing

Commissioning & Providing

PBC and NHS ReformPBC and NHS ReformA key delivery mechanism for High Quality

Care For AllPCTs will not achieve World Class

Commissioning status without the successful implementation of PBC locally – and PBC is held to account through WCC

NHS Reform to be clinically driven, locally-led and embedded in partnerships

Reaffirms Primary care as the fulcrum of NHS delivery and managing demand in a system under increasing financial pressure

EntitlementsEntitlementsManagement and financial informationManagement and financial supportSwift budget setting and decision makingLocal incentive schemesResources freed up through improved efficiency

identified in PBC business cases – and as a minimum by right 70:30 split between PBC:PCT

Access to regional innovation fundsArbitration by SHA where there is a local

dispute

4 STEPS TO AN ICO ?4 STEPS TO AN ICO ?AssociationIncorporationFederationIntegration

Integrated CareIntegrated CareOffers better co-ordination of care

with transfer to community settingsClinically-led comprehensive service

with incentives to invest in health promotion as well as Dx and Rx

Break down long-standing organisational divides.

Demonstration sites from 1/4/09

Integrated Care OrganisationsIntegrated Care OrganisationsCommunity, Primary, Secondary and Social CareServe a registered population with much higher

expectations.Clinical and financial responsibility and accountable for

the health and well being of that registered populationICOs can choose to provide a range of services and

contract with others for the rest, combining provision and commissioning functions

Accountable for outcomes delivered through a unified contract with a PCT

High performance can be incentivised through bonuses - Poor performance may face financial penalties.

National Choice and Competition continue to apply

Leadership and OwnershipLeadership and Ownership‘The NHS is only just beginning to grasp the

importance of leadership’ NHS CECollective and personal throughout the serviceClinical leadership at the heart of WCC and

quality agenda empowers clinicians across the system

Subsidiarity promotes leadership developmentLeaders deliver co-production, align systems

and change culture

PBC development and supportPBC development and supportNational PBC Improvement TeamClinical Commissioning and Guide for GPsPBC Development Framework providersWCC assessments – 360-degree

appraisal/partnership agreementsIpsos Mori NHS Networks and PBC connectionEarned autonomy and hardening of budgets

The PBC champions networkThe PBC champions networkThe next stage of PBC re-invigorationBringing increased capacity and focus to the

Quality Framework Programme and promoting clinical leadership locally

Articulate consistent messages from ‘Clinical Commissioning’ and strengthen PBC implementation locally

Support the capture of learning, help network best practice and help connect PBC groups

Promote PBC to be established as part of every day practice