More teamwork needed to make PBC a reality

A report by an independent steering group of experts from the NHS, supported by Dr Foster Intelligence has called for more teamwork between PCTs and GPs to make practice-based commissioning (PBC) a reality.

The group was unanimous that the successful implementation of PBC is a pre-requisite to the modernisation of the NHS. But the accurate, real-time information that GPs need to make decisions is not currently available in many areas, the report argues.

In the foreword to the ‘The Intelligent Practice’ report, Sir William Wells, chairman of the report group, says: “We strongly recommend that a number of information framework pilots are set up between PCTs and commissioners in a representative cross section of different population profiles, with a view to developing a model(s) which could be used as a baseline by commissioners.”

He adds: “GPs as commissioners are at the front end of the government’s drive to introduce professional purchasing services to improve the quality and availability of healthcare for their patients. It is crucial that they are in receipt of timely and accurate information on which to base those important commissioning decisions.”

The report sets out an information framework for practice-level commissioning including some principles around the presentation and interpretation of data. It attempts to make a clear distinction between the information needs of every GP and those of a lead commissioner or commissioning practice.

It sets out two frameworks of minimum information requirements: one for every GP and another, more detailed one for lead commissioners.

The report reminds GPs that information about health needs is available now at PCT level, but not at practice level.

“Information wider than healthcare should be included to give a strategic overview of education, employment, housing stock, etc. All this information should be shown as a trend, and broken down by geographical area, if possible.”

It adds: “Real-time information about local services should be provided, which should include information on their financial stability. This should give information about cost, quality and capacity and up-to-date information about decommissioning. Examples of

services include specialist clinics, intermediate services and self care providers.”

In reference to finance utilisation and budgets the report suggests: “It should be possible to analyse this data at individual patient level. This data should be benchmarked and shown by practice, specialty and disease group.”

For commissioners, the report suggests that all activity in the surgery should be reported in a clear and concise manner for all to be able to understand.

“They should show activity and spend information, broken down for each patient care pathway, such as diabetes, mental health and CHD. This breakdown should include data for independent sector treatment centres. These indicators should be reported by exception, and should only be reported if activity goes over budget or appears to be an outlier.”

It adds: “Outcomes data should be presented by provider, to include independent sector treatment centres. Readmission rates are particularly important for mental health and respiratory conditions.”

The steering group hopes that GPs’ unique understanding of their communities, combined with reliable and accurate information, will allow practices to design the best services for local needs.

Steering group member Dr Michael Dixon, GP and chairman of the NHS Alliance, said: “None of us within the health service can commission effectively without accurate and comprehensive data. Too often, that is lacking. In some areas, there is not even agreement as to what information is necessary. This report is an excellent practical aid to developing the information systems we need. It should be essential reading for all GP and PCT commissioners – and for senior managers too.”

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Links

Dr Foster Intelligence – www.drfoster.co.uk