Practice-based commissioning Courage, conviction and culture

Practice-based commissioning

Courage, conviction and culture

What’s PBC about PCTs have paid bills - not commissioned PBC ‘handed’ GPs 50%+ of PCT spend – in

Sheffield over £500 million! PBC gives GPs and PCTs finance/activity

data so can see where patients and money going

Spend not matched to need - Wanless says focus on long-term care of elderly/ LTCs

GP-led redesign to help realign spend

Courage

From a PBC Manager view… Barriers

How do I engage busy GPs? What I found works

Ask GPs to help you improve quality of patient care – not save money. But show them where the spend is now.

Find your lead GPs. Back them to the hilt practically. Get business cases for redesign approved – its why GPs do PBC.

From a GP Point of View-Barriers

-Time-Relationships-Organisational culture-Organisational boundaries-Lack of support-Poor data

From a GP point of view -Enablers

PBC Lis PBC Support Patient support Knowing your stakeholders Organisational relationships Clinical Leadership

Conviction

“You don’t need an engine when you have wind in your sails” Paul Bate, 2004

Over 75yrs

7.4% population

£106 million on Emergency admissions43% of which was on over 75yrs age group

Falls = £6million1/10 over 85yrs

Crisis

How you might persuade and influence PBC clinicians

Knowing and being passionate about the patient journey

Understanding the context in which PBC takes place

Creating a clear vision for your patients journey and the pathway they take

Ensure congruency between the people and the delivery mechanism

Culture

Framing Infection ControlBad frame? Good frame?

Doctors Halving MRSA rates is a Government Target

Focus on the basics of excellent clinical care (peer to peer)

Nurses You must balance the need for beds with infection control

Patients’ safety and dignity come first

Infection Control Staff

Changing staff behaviour is your responsibility

You have CEO/Board support to do what needs to be done to eradicate infections

The Board It will be mandatory for a senior nurse to report rates at every Board meeting

Preventing avoidable infections tops the Boards’ strategic objectives and supports the achievement of other objectives

The Public Avoidable infections are caused by visitors and the public

Help us, help you

Send the message 10 times in 10 different ways

What have we done to date in Sheffield

Lis Unscheduled Care Les Care Homes Women's Continence Pathway Falls Dementia pathway Community Nursing for the over

75years

Direction

Prevention

Early identification

Working with Community and Hospital Geriatricians

A Citywide Strategy

High Level buy in

Across the Health Economy

Project management support

How PBC can help you Back in your constituency find out who

your consortia leads are and talk to them If you don’t know who they are email your

PEC Chair Tell them what can be fixed. If you have

data even better! Get consortia leads to champion reform

and put business case/pathways into PCT

Contact details

Agnes.mcAuley@sheffieldpct.co.uk

Eithne.cummins@gp-c88034.nhs.uk