Criteria for PCT
reconfiguration proposals
“Commissioning a patient-led NHS” specifies
that proposals for primary care trust reconfiguration will be expected
to consider
practice, PCT and strategic health authority functions to deliver
a fit for purpose health system with an effective and objective
commissioning function able to deliver high quality care and value
for money alongside the improvement of health promotion and protection.
Proposals will be assessed against the following criteria of the
PCT’s ability to:
· Secure high quality, safe services
· Improve health and reduce inequalities
· Improve the engagement of GPs and roll-out of practice-based
commissioning with demonstrable practice support
· Improve public involvement
· Improve commissioning and effective use of resources
· Manage financial balance and risk
· Improve co-ordination with social services through greater congruence
of PCT and local government boundaries
· Deliver at least 15 per cent reduction in management and administrative
costs |
The rapid reconfiguration of primary care trusts has raised
concerns for some health care professionals. The Department of Health
document “Commissioning
a patient-led NHS”, published this summer (PJ, 6 August, p156),
revealed that primary care trusts could be cut by as much as 50 per cent
and practice-based commissioning is to be implemented by the end of 2006 — two
years earlier than initially planned.
For the past few years, community pharmacists have been encouraged to
foster close working relationships with their PCTs so as to be in a better
position when it comes to planning and bidding for enhanced services.
With the move to universal practice-based commissioning, will these efforts
have been wasted?
John Carr, a practice pharmacist and chairman of the professional executive
committee at East Staffordshire PCT, is concerned about the direction
things are taking. “Pharmacy has had a lot of benefits out of being
involved and working closely with PCTs and I don’t know how that
is going to happen easily in the future,” he says. He is worried
that professional executive committees may become redundant. “In
none of the proposals in our part of the world has there been any mention
of clinical engagement. There has been no mention of whether PECs will
continue to be in place for these new PCTs that are being created.” He
fears that pharmacists may find it hard to establish a place on a large
PEC in a new PCT — if one exists.
Brian Jolley, a pharmacist and PEC chairman at Waveney PCT, agrees. “It
is hard to see how a PEC would fit into these new structures — would
they need a PEC if [commissioning] is being run by practices, which are
being managed by GPs,” he asks.
However, a DoH document “Practice-based
commissioning — engaging
practices in commissioning”, published in October 2004, indicated
that PECs should play a strategic role in commissioning services. It
states: “At the start of each financial period, practices or localities
should draw up an agreement for how they intend to use any efficiency
gains. The PEC will make a recommendation on this proposal to the PCT
board.”
It goes on to list things that PECs may wish to consider when making
their recommendations, including “that practices have the agreement
of community matrons, district nurses, health visitors, allied health
professionals and school nurses when making commissioning decisions for
patients who are also the responsibility of other primary care practitioners.”
Practice-based commissioning
Practice-based commissioning transfers the responsibility, and the
budget, for commissioning services from PCTs to individual GP practices
or to
groups of practices working together (localities). The PCT acts as an
agent to undertake any required procurement and administrative tasks
to underpin these processes and will be responsible for placing or managing
contracts.
It is the complete change of the function of PCTs that concerns Mr Jolley. “My
worry is about the challenge of practice-based commissioning and the
fact that, in some areas, enhanced budgets could be given to practice-based
commissioning consortia.” He argues that since pharmacists will
be bidding for enhanced services commissioned by practices, they need
to be involved in negotiations for the set-up of these services. “Guidance
issued on practice-based commissioning so far is not clear on what happens
with dentistry and pharmacy,” he says. “My view is that practice-based
commissioning is going to be the biggest challenge for pharmacy. Pharmacists
will need to have a flexible approach to providing new services in order
to survive.”
Mr Carr is less optimistic. “Moving in this direction, I think,
is a serious downturn for the closeness of pharmacists’ working
relationships with the NHS, which is a pity after what has been quite
a fruitful association in the past four years,” he concludes.
He believes that the only way pharmacists could have clinical involvement
in the commissioning process is for practice-based commissioning localities
to have a pharmacist as a member of a commissioning consortia board. Opportunities
Barbara Parsons, head of pharmacy practice at the Pharmaceutical Services
Negotiating Committee, believes the restructuring of primary care services
offers opportunities for pharmacists. “It is not just a case
of practice-based commissioning only being used to commission GP services.
It is also a case of community pharmacists being able to look at the
wider agenda and fitting in with the fact that all these services are
up for grabs,” she says.
She also highlights the additional opportunities for pharmacists in
the new general medical and personal medical services contracts: “If
you want to provide a phlebotomy service or a vaccination service there
is now also the possibility of becoming an alternative medical service
provider.” Ms Parsons points out that, with the Government trying
to balance payment by results and to move selected secondary care services
into primary care, GPs will not be able to do it all.
The PSNC has produced an LPC Briefing on practice-based commissioning,
which is available on its website or as a PDF (100K). It also hopes to publish guidance for community pharmacists on
practice-based commissioning
before the end of the year.
Next steps
The deadline for strategic health authorities to submit proposals on
the reconfiguration of PCTs to the DoH is 15 October. The DoH will
consider these proposals and issue its decision at the end of November.
If agreed, a public consultation on the proposed administrative changes
to PCTs will then take place.
Proposals on the provider aspect of PCTs will not be considered by
the DoH until after the publication of the White Paper on health
outside
hospitals due at the turn of the year.
PCT reconfiguration is expected to be complete by October 2006, with
changes to PCT service provision to be completed by the end of 2008. |
The
Pharmaceutical Journal