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WESSEXLocal Medical Committees
Appraisals, commissioning and the new NHS
Dr Nigel Watson
20/04/23 1
WESSEXLocal Medical Committees
Dr Nigel Watson• GP
• Had 9 appraisals
• CEO Wessex LMCs• Has 8 performance reviews
• GPC – Represent Hants and IoW (1996 – to date)
• Chair – Commissioning Sub-committee of GPC (BMA)
• DoH committees• GP strategic commissioning • GP working group
• Centre for workforce Intelligence• General Practice Advisor
WESSEXLocal Medical Committees
Quality
Individual• Appraisal• Revalidation
Practice• QoF – Quality performance
• Quality premium• CCG contract – benchmarking/peer pressure
WESSEXLocal Medical Committees
How do we define quality in the NHS?
WESSEXLocal Medical Committees
What is quality?
• Upper quartile performance?• Value for money - VFM?• Financial balance?• Technical care?• Customer service?• Improved process measures?• Improved clinical outcomes?
WESSEXLocal Medical Committees
Countries whose health systems are more oriented towards primary care achieve• better health levels
• higher life expectancy
• better health outcomes
• higher satisfaction with health care among their populations
• lower overall health care costs
• lower medication use
20/04/23 6
WESSEXLocal Medical Committees
Some facts
• GP consultation £20
• Walk in Centre £24
• NHS Direct telephone call £15
• A&E attendance £74
• OPD £100 – 30020/04/23 7
WESSEXLocal Medical Committees
NHS Budget in billions
WESSEXLocal Medical Committees
Challenges
• Flat cash
• Aging population
• 17 million people with long term conditions and rising
• New drugs and technologies
• Reduce bureaucracy
• Improve decision making
WESSEXLocal Medical Committees
Issues to resolved
• Outcomes• Patient choice• Targets• Bureaucracy• Lack of clinical involvement in healthcare
planning• Clinicians – responsibility, accountability• Lack of close working with Local Authority• Money
WESSEXLocal Medical Committees
Commissioning
• GPs commission services for the individual patient
• Prescribe• Refer• Admit• Co-ordinate care
• Proposals will ensure that GPs are involved in commissioning for a population
WESSEXLocal Medical Committees
Clinical challenge
• GPs• Improve quality
• Align clinical behaviour with financial accountability
• Commissioning for individual vs population
• Reduce variability
• Greater peer review and peer pressure
WESSEXLocal Medical Committees
Clinical challenge
• Consultants• Work with commissioners
• Contribute to reform
• Understand care outside hospital
• Stop silo working
• Understand the financial future of the NHS
• Integration of primary and secondary care
WESSEXLocal Medical Committees
Appraisal
The purpose of the appraisal will enable all
General Practitioners to participate in continuous
quality improvement of the quality of their practice.
Although not it’s primary purpose, aspects of
appraisal may assist in the early identification of
doctors in difficulty so that they can be offered
appropriate support.
WESSEXLocal Medical Committees
Quality improvement
• Reduce the unacceptable variability
• GP• Appraisal – who will commission?• Revalidation • Procedures for GPs whose performance causes
concern –PCT/LMC – the future?• Performers list – registration – PCT – NHSCB• CSU, CCG, sub-national NHSCB
WESSEXLocal Medical Committees
Quality improvement
• Reduce the unacceptable variability
• General Practice• QoF• CCG• Quality Premium
WESSEXLocal Medical Committees
QoF
• Quality improvement• 96.5 points• Average practice £12,500• Prescribing• Referrals• Emergency care
• Quality & VFM• Data, information, peer review• Contribute to commissioning process• Design, develop and utilise clinical pathways
WESSEXLocal Medical Committees
Clinical Commissioning Groups
• Improve quality of general practice
• Peer review and peer pressure
• Devolved leadership• Commissioning Group Lead• Board• Locality lead• Practice lead
WESSEXLocal Medical Committees
Quality premium
• How much?
• 5-10% of current GP funding
• Who will decide on achievement?
• CCG or Health and Well Being Board
• How will quality be measured?
WESSEXLocal Medical Committees
Performance of practices
• Mirror the GP performance procedures
• What happens to a failing practice?
• Where will practice contracts be held?
WESSEXLocal Medical Committees
Accountability and Probity
• All practices part of a Clinical Commissioning Group• CCG accountable to NHSCB• Practice accountability
• All GPs in every practice engaged
• Conflict of interest• GP/patient• GP role in CCG• Role of GP provider companies
WESSEXLocal Medical Committees
Any questions?