Richard Armstrong

Head of Primary Medical Care Contracting

Department of Health

Practice-led Commissioning

What is it ?

Why

Legal Framework

Mechanics

Government Policy Themes

Decentralisation STBoP Foundation Trusts Care/Children Trusts Systems Reform nGMS/nPMS

Improving Performance Modernisation Agency/SHAs CHAI/Star ratings Improvement Plans

PCTs: The challenges Delivering the LDP

Access NSFs Other National priorities (Health Inequalities,

Drugs etc)

System Reform Choice Payment by results Foundation Trusts Secondary to primary care shift Contracting for Primary Care provision Real clinical and public engagement

PCTs: The challenges

The real challenge

Matching demand with

capacity, whilst meeting

Need!

Practice-led Commissioning

WHY? Empowering & engaging clinicians Choice, Access, Payment by Results Providing clear mechanisms for

accountability Allows innovation – creating plurality

of provision It works

Practice-led Commissioning

WHY NOT

Perverse incentives Distortions and gaming Transaction costs Alienating the profession

Full real practice level

budgets (PLBs)

Real PLBs with PCT

facilitated collaboration

between practices

Partial real PLBs

Reward schemes

Indicative PLBs

Profiling/utilisation/ peer

review

Direct management

Financial

Non-financial

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More likely/greater

Less likely

Practice-led Commissioning

Legal framework Rights & Responsibilities

- Clinical Team- PCT

Down to PCT to determine- scope- range and - form of arrangements

Not complete (or single) answer

Practice-led Commissioning

Mechanics Setting budgets

- Historic- Weighted Capitation- Something else

Managing Risk- Over/Under spends- Stop Loss/over time

Monitoring & Feedback mechanisms Contracting

Primary Medical Care – an updatenGMS 99.8% signed Getting practices paid Managing disputes Superannuation (employers cont)

PMS Quality points OOHs opt out price Contract variations

PCTMS/APMS Guidance & Directions