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Practised Based Commissioning
A developing area of activity for SEH is Practice Based Commissioning (PBC). Introduced in 2005, PBC is an opportunity for GP practices to take over from primary care trusts in commissioning services for their patients. Each commissioning GP practice is allocated and becomes accountable for an indicative budget, based on the needs of its patient population, by the local PCT. Developing care pathways that provide high quality, community based and more cost effective services enable PBC groups to make savings that can be invested in other services.
Early on, GP practices saw the value of grouping together and pooling their PBC budgets to develop care services and fund the necessary management support. SEH saw an opportunity to offer expertise in this area and, in 2006, set up a PBC management service. This offers GP groups the opportunity to employ a professional support team, with additional back office functions of HR, IT and finance provided at SEH headquarters.
Between them, SEH’s four PBC managers now support five of the six PBC groups in NHS West Kent. The team of Bianca Hardy, formerly a primary care development manager at West Kent PCT, and Sue Stanbridge, previously the general manager of medicine at Maidstone and Tunbridge Wells NHS Trust, manage four groups of practices, with Amanda Sadler providing administrative support. A second PBC team looks after practices in Dartford. The groups managed by Sue and Bianca are Tonbridge and Tunbridge Wells (17 practices), Weald (11 practices), Invicta (18 practices) and Sevenoaks (six practices).
“Each group has its own board and chairperson and each has evolved its own philosophy and dynamics,” says Bianca. “What they have in common is the development of care pathways that add quality, capacity and value. More patients are getting the right treatment more quickly as more spending is shifted towards primary care. This frees up money for investment in additional services.” Less complex cases that might previously have been referred to the acute sector are increasingly being treated by an intermediate tier of GPSIs (GPs with a Special Interest). These doctors – with additional qualifications in areas such as dermatology, cardiology, ENT, rheumatology and ophthalmology – run several specialist clinics a month at community based locations.
Sue and Bianca are continuously working with their GP groups to develop new care pathways. For instance, the Invicta group have developed a back pain pilot that has reversed the trend for back pain patients to be referred directly to orthopaedics. Instead, these patients are now referred firstly to the AMPS (advanced musculo-skeletal practitioner service, aka physiotherapists with additional qualifications). Here, they are either treated or referred on for pain treatment or acute care. In the first three months of the pilot, 45 patients were referred to the AMPS team. Five of these were referred on to the pain clinic, while no patients were referred to orthopaedics. “We are treating patients more quickly, with the result that they are getting better sooner,” says Sue.
Another role for Sue and Bianca is to support PBC groups in developing preventative strategies for patients with long term debilitative conditions. By improving communication between GPs, social services and district nurses, the project aims to assist high risk patients in better managing their own conditions and to more quickly recognise when the support of the primary care team is required to prevent a possible admission. A trial by the Invicta group, for example, seeks to tackle obesity by funding low income patients with a BMI over 30 to attend a leisure centre or Weight Watchers group. The patients must be aged between 35 and 70 and enthusiastic about improving their health in the long term, says Sue. “We may not see the payback for ten years but the aim is to reduce incidences of diabetes and chronic heart disease, as well as increasing life expectancy.
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