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Text version of practicebasedcommissioning.info About this site PBC.info is a free Practice Based Commissioning Community Resource providing forums and advice for those engaged in commissioning. It is written and maintained by Xytal who are active in supporting Practice Based Commissioning clusters across the UK . Practice based commissioning has the potential, when linked to other reforms such as payment by results, to change the whole shape of the NHS. Yet after almost 2 years it is unusual to see any concrete benefits to patients. Within this website you will find the information you need to overcome these blocks. There are sections on Practice Based Commissioning and Payment by Results that cover key guidance. The section on "challenges" explains the implications. We hope you find it helpful.
Contact us For any queries please contact us using the details below: Address: Xytal Health Management Ltd Cotswold Innovation Centre Rissington Business Park Cheltenham GL54 2QB richard.more@xytal.com For further information visit www.xytal.com Xytal - Bringing Excellence to Primary Care Xytal is dedicated to providing training, coaching and consultancy to our clients in Primary Care. By specialising in this sector, we believe that we can offer genuine insight and unrivalled expertise to our customers. Practice Based Commissioning and Xytal - The potential for change Practice Based Commissioning offers great potential for change. The delivery of these benefits requires skills that have not been needed before within the practices. Xytal have therefore developed a model that describes excellence in this area - High Performance Commissioning (HPC). The capabilities required are described within the Xytal Competency Framework for HPC, this should be used as a skills escalator which has particular value when implemented in two ways: Firstly, to check that the team has the abilities needed to deliver its commissioning aspirations. This can protect the team from the demoralisation that follows when a team bites off more than it can chew and experiences early failures. Secondly, as a learning needs assessment tool, to plan the development of the team as to deliver increasing benefits for its patients. The Xytal competency framework is based on the four management disciplines of: - Financial performance - Learning ability - Stakeholder awareness - Process efficiency Excellence in all four areas is required to produce maximum patient benefit. Helping you turn Policy into Practice Our services adapt to fit the needs of you area. As well as bespoke consulting services that you would expect from a specialist management consulting firm, we offer: Outsourced management support. Rather than recruit and train new staff, use one of our managers to kick start the change process. Stand alone Practice Based Commissioning commissioning units. Avoid the transactional costs of the fundholding scheme by using one of our teams to support and administer the practice side of the commissioning thus avoiding the practices all inventing their own wheel (at taxpayers expense). Controls Assurance. Use one of our unique history of clinical/management experience to link clinical risk management and financial risk. Leadership Development. Gain the benefits from our research into clinical leadership to develop the ability of key individuals to lead and manage change. For more information about our services please visit www.xytal.com View the Xytal Blog by clicking here . You will find the very latest thoughts and findings on all things Practice Based Commissioning from Dr Richard More.
Practice Based Commissioning? The story of practice based commissioning began in 2004 with the publication of the Department of Health guidance. This, subject to caveats gave the practices the right to manage indicative budgets, to provide better care for their patients. The concerns raised about the potential effects on NHS financial stability are shown by the initial responses of the NHS confederation and the Chartered institute of Management Accountants . Our viewpoint at the time can be found here. PCTs and the Practices were expecting, in the fashion of the time, more prescriptive guidance. It was expected that this request for process guidance would be answered by the publication of the technical guidance. Despite this PCTs and Practices struggled to get going and realise the benefits promised by clinical engagement that had been outlined in the review of evidence. In fact despite high reported uptake of the DES it seemed that in July only 2 in 5 practices had expressed an interest. The government desire for change and understanding that the desire to improve the practice was a key driver for General Practitioners remains undimished. The Prime Minister has stated "Insofar as GPs can prevent unnecessary referral and treat patients in the primary care setting, they will benefit their practice financially"". It seems that Practice Based Commissioning is here for the foreseeable future, and the latest guidance to PCTs (November 2006) charges the PCTs with providing support and in para 4.4 says if that the PCT cannot provide the appropriate support it should provide a budget for the practice(s) to purchase such support. There is a headline summary for practices available from the DH. What is Practice Based Commissioning? "Commissioning is a term used liberally and variably within the NHS. For some, it is simply the process of securing services from providers by contract; for others, it encompasses the planning and design of integrated care pathways...Practice-led commissioning involves the devolution of some or all of these commissioning responsibilities from PCTs to primary care practices." (Lewis R 2004). Note that this talks about "practice led" but it does emphasise that the practices accept devolved responsibility from the PCT. In our experience practices thought that Practice Based Commissioning meant that they could set their own priorities and strategies as under fundholding. The resultant collision of these ideas and those of host PCTs led to a complete cessation of progress. More structure is given to the relationship between PCT commissioning and Practice Based Commissioning in the July 06 DH update on Health Reform Paragraph 2.1; "commissioning is the means by which we secure best value for patients and tax payers" And in para 2.7 "practices will have indicative budgets and the freedoms and incentives to exercise devolved responsibility for aspects of the commissioning and redesign of services" They advocating managing this process of improvement by a cycle analogous to the clinical audit cycle - Define future desired state, perform gap analysis, plan and execute remedial action, confirm that this has had the desired effect. For managers this is similar to the PDSA cycle that has been so successful. So commissioning is not contacting. Practices should use their technical clinical skills to establish and define the multitude of better ways of arranging patient care. Payment by Results An understanding of Payment by Results is essential to any commissioner. This is the concept of a single price for a single action for a secondary care provider in England . It was introduced in October 2002 and is important because the changes it allows support the development of new organisations doing new things. A summary of how payment by results works from the Kings fund can be found here and how it helps change happens is found in this paper by Monitor. This tariff tells commissioners how much care currently costs the tax payer. As always with any NHS policy there are details on interpretation and the guidance on implimentation 2007/8 is found here. Its only 40 pages long! For those looking to shift care into the community (specifically rehabilitation and diagnostics) the indicative budget for unbundling is important. Please note that PbR does not apply to services provided by the practice. Payment by Results has not always had an easy time. It does introduce financial instabilty into the system, instability is required for any change to occur. These risks are documented in the 2004 Audit Commission report. In the current financial climate the challenge is to design and implement change that provide better and cheaper care for the patient. Practice Based Commissioning Masterclass - 7th July 2005 , Dillington House. View Flyer Downloads Action Learning Presentation, Xytal These are the slides from Kevin Ball's presentation explaining the theory and practice of creating action learning sets Practice Based Commissioning and PBR Presentation, Xytal These are the slides from Richard More's presentation that outlines the framework of Practice Based Commissioning but crucially links the initiative with the funding flows known as "Payment by Results" Practice Based Commissioning Presentation, Xytal These are the slides from Dr Balian (Chair, Somerset LMC) in which he outlines the potential benefits for the General Practices of Practice Based Commissioning Practice Based Commissioning These are the slides from Dr Yoxall (Medical Secretary Somerset LMC) in which he challenges the practices to think of new ways of organising themselves to improve their abilities and capacities South Somerset PCT Presentation These are slides supported the presentation from Dr Sue Davies (PEC Chair South Somerset PCT) in which she outlines the realities that PCT's need to achieve, and how Practice Based Commissioning can support those. Future Events 15th February 2007 - "Promoting your practice." A 1 day interactive seminar for Nottingham LMC. Bestwood lodge hotel. Click here for flyer. PREVIOUS EVENTS 7th December 2006 - "Practice based commissioning, completely irrelevant to Tissue Viability nursing - Not!". Liska Community Center , Plymouth . 30th November 2006 - "An update on Primary Care Contracting - The opportunities therein" Wiltshire Commissioning Group 28th November 2006 - "The changing face of NHS contracting" Teignmouth Commissioning Group 23rd November 2006 - "Update on NHS commissioning changes" Weston Super Mare 15th November 2006 - "Managing Beneficial Change in General Practice ", Blandford Forum. Sandisons medicolegal update - download here. Download Xytal presentation here. Preparing to survive in a changing NHS. 4th October, Mid and North Devon , Hartnoll Hotel, Tiverton. 10th October, Plymouth , Novotel Hotel. 11th October, Exeter and Torbay , Haldon Race Course. For further information please click here. Business Team Training. A 2 day event rehearsing and refining the management and team skills needed to succeed in the new NHS. 19th and 20th September, Woodbury Park Hotel and Country Club For the agenda please click here and for further detail on the event please click here. For directions please see www.woodburypark.co.uk Recent reforms in NHS finance and organisation and how they contribute to hospital redundancies; If you cant beat them join them! 1-2pm Tuesday 15th August, Derriford Post Grad Education Centre and 12:30 - 2pm Wednesday 16th August, Knowledge Spa at RCHT, Treliske Hospital For more information, please contact us. More Previous Events Business Planning - Turning Talk into Action, Wednesday 19th July, St Mellion Golf and Country Club, St Mellion, Nr Saltash, Cornwall PL12 6SD For more information, please contact us. Practice Based Commissioning - Implications for Organisational Survival, 7pm Thursday 6th July, The Verzons Country Inn & Restaurant, Trumpet, Ledbury, HR8 2PZ For more information, please contact us. Practice Based Commissioning - Moving Forward, Thursday 6th July 2006 , Elbury Moor Medical Centre, Fairfield Close, Worcester For more information please click here 'The Future of Primary Care' - South West Primary Care Leads Network, Thursday 22nd June 2006 at the Cleve Hotel, Wellington , Somerset . For more information please click here To view the slides click here. Unravelling Cadriometabolic Risk - Royal College of Physicians, London , Friday 19 and Saturday 20 May 2006 Dr Richard more will be replacing Mike Sobanja, providing the expert's view on Practice Based Commissioning. For more information please click here. To view the slides click here. For the workshop slides click here. 'Genesis in Healthcare' - New Frontiers. Future Inn, Plymouth . 17th & 18th May An event planned for: Plymouth Area Redesign Board (PARB) & Plymouth Teaching PCT Organisational Development. For more information please click here To view the slides click here. The DES: The devil in the detail - Tuesday 16th May 2006 , Taunton . To view the slides click here. NHS Connecting for Health, London , Tuesday 25th April 2006 For more information please click here Practice Based Commissioning "Getting Started" Norwich - 21st March 2006 , Welwyn Garden City - 30th March 2006 , Bromley - 4th April 2006 , Heathrow - 5th April 2006 , Romsey - 27th April 2006 For more information please click here. For the slides please click here. More Previous Events Action on Practice Based Commissioning & Maximising the Cardiovascular QOF, Taunton , 28th March 2006 For more information please click here Practice Legal and Financial Update Seminar, Dorset , 8th March 2006 For more information please click here. To view the slides click here. Practice Based Commissioning and 'Super Clusters' - The Opportunity . New Malden , 25th January 2006 For more information please click here. For the timetable please click here, Practice Based Commissioning; Driving up momentum and working towards full implementation. Hospital Services Journal / NHS Alliance . 13th December 2005 For more information please click here. To view the slides click here. "Organising for success". A workshop exploring alternative corporate vehicles for Nottinghamshire LMC. 8th December 2005 Jointly presented with Andrew Lockhart-Mirams. View Lockharts Slides. Part 1 / Part 2. View Xytal Slides. Part 1 / Part 2 / Part 3. The implications of Practice Based Commissioning for Hospital Doctors. UBHT, 6th December 2005 . To view the slides click here. South of Somerset II - Haynes Motor Museum, 3rd November 2005 Second masterclass developing on the learning from the 7th July incorporating the developments in guidance. For more information please click here. NHS Alliance Conference - Manchester , 5th October 2005 . Download the powerpoints that Richard More delivered in his role as Chair: Abbey Manor Medical Practice Limited (an APMS provider). Newbury PCT - Ramada Hotel, 29th September 2005 . Masterclass for the practices of Newbury Primary Care Trust area. For more info please click here "Practice Based Commissioning" and "Payment by results". Who gives a monkeys? Lainston House Hotel, Winchester . Presentation available to view. Practice Based Commissioning Masterclass - Dillington House, 7th July 2005 Presentations are now available to download click here
Practice Based Commissioning - The Challenges In our experience of travelling the country supporting practices, LMC's, clusters and practices the challenges fall into two main categories; = What precisely is it that you want to do? = How are you going to organise yourselves to do it? This is compounded by the confusion between practice based commissioning and practice based provision. We explore this in our paper, Provision Vs Commissioning The situation is complicated in that the Direct Enhanced Service is only for 1 year. What next? The government is committed to shifting care out of hospitals, the spring 2006 white paper (Brief guide - only 28 pages) specifically lists Dermatology, ENT, General Surgery, Orthopaedics and Urology for pathway redesign. The commissioning guide for PCTs emphasises that these shifts should occur and, as we cited on the Practice Based Commissioning page, charge the PCTs with supporting this process. (For an overview please see the Kings fund). This highlights the introduction of competition to provide choices for patients and commissioners. So it seems that the time of the PCT as sole commissioners has passed. The reform think-tank paper suggests that this change may go even further with the potential for the introduction of private providers or LEA involvement. So it is well worth keeping involved with Practice Based Commissioning to realise the benefits for patients and practices. So there are benefits to be gained. To create and describe a new way forward is a skill in its own right. You must have: = A clear view of the future = Clear methods defining precisely what you wish to see happen = A process for making this happen = An understanding of organisational implications = A method of ensuring that what you whish to happen actually happened. It is in this difficult process of turning talk into action that we have supported clusters all over the country. For some of the more common questions and answers asked please click here. There still remains a great deal to be done. Please visit www.xytal.com to see how we can help Questions & Answers Xytal has, through its work with practices, PCTs, nascent clusters and LMCs unrivalled knowledge of the day to day issues facing front line professionals. Our solutions are all around efficiency and effectiveness, allowing the delivery of the service to which you aspire. We can bespoke support to any problem, but the commonest problems are; Every time we think we have agreed something it comes around for debate again. We understand this, it always happens when new teams come together with different histories. The most usual problem is that people haven't had time to take a deep breath in and decide their overarching priorities. This means that every detail has to be debated from the beginning, rather than agreed, as the sort of thing that the team wishes to do. We support this by working with the team using our strategic analysis technique to establish the goals of the team. When we think we have agreed on something but by the time we next meet everybody has a different memory of what precisely we meant. This is a result of confusion between strategy (where do we want to go?) and tactics (how do we get there?). Our strategic analysis prevents this by clearly establishing strategic objectives (goals) and tactical objectives (measures). We want to form a cluster but we can't agree what it is we want. Our strategic analysis technique enables the whole team to understand the consequences of decisions on the way that they see patients, earn money, appear to the patient, and the need for professional development. Once you understand these things decision making becomes straight forward. We really need a better clinical service but the PCT want a business plan full of irrelevant detail. This feeling is common. We are able to use our skill of "business planning for clinicians" (developed for the NPDT practice management development program) to define the clinical aspects of the service. This then allows our project management experts to create a document that meets the needs of the practice AND the PCT. Questions & Answers There is an enormous amount of work to do to create this new service. I am not sure I have got the time. We use our project management methodology to spell out precisely who does what when. This enables sensible decisions about locum back fill and timetabling to ensure successful implementation. There is an enormous amount of work to do to create this new service. I am not sure I want to do this. We provide mentoring and support for key leaders to both increase their ability and help them understand their own motivation. How can we set a sensible price for this service? We only want to be fair. We understand the difference between cost, value and price. We use our custom built software to understand the cost of providing the service. We can support you either by negotiating on your behalf or providing our negotiating skills training for your key individuals. We want to work with other practices but do we need to form a limited company? The answer to this question requires the combined skills of management consultancy, accountancy and law. We and our specialist colleagues to provide balanced advice based on the aims and objectives of you team. This is all very new and different from the old red book. Scary. Well it is and it isn't. Some of our professionals are clinicians, some not. Some of our professionals are from the private sector, some not. This means that we can use the skills of the private sector, which has always worked this way, but apply them to the NHS. It is much quicker and easier not to have to reinvent the wheel. The chances are that we have already heard about the challenges that you face. Call for the solution Advertising Opportunities Due to the success of practicebasedcommissioning.info we are now in a position to offer advertisers the opportunity to promote their own products and services via this website in the form of banner and skyscraper adverts and email sponsorship. pbc.info operates as a non-profit service providing a one-stop-shop of Practice Based Commissioning information for the busy practitioner. As the site has grown in popularity it now requires an increased amount of maintenance to ensure the information is up to date which takes time and therefore funding. The contributions from advertisers will go towards the hosting, maintenance and the future development of the site. We have over 1100 unique visitors each month to specifically looking for information on the latest developments in the field of Practice Based Commissioning. Visitors range from GP's, Practice Managers, PCT Managers, Educationalists, Event & Conference organisers and other commercial organisations. More information can be found in our Media Pack which is available to download here. For more in formation contact Kevin Ball on 01451 812 225 or email kevin.ball@xytal.com NHS guidance is continually changing. Please register for a password to access our latest findings. We will also keep you informed about updates to our websites. |