Speaker after speaker explained their vision for PBC (practice-based commissioning - the policy of inviting groups of GP practices to review needs for their patients and make recommendations to their Primary Care Trust for changes), all the way from "the decision-making for care should be in the hands of the GPs" (Department of Health) to "we formed a consortium representing 97% of the population of the PCT, and now we're proposing services we might run".
Same old same old. The key issues remain:
- real figures relating to demographics (how many, what conditions would be expected) and activity (how many treatments currently provided)
- understanding the local process for acceptance of business cases for new services, and having followed the process, having the business cases accepted
- vertical and horizontal integration between different organisations with different priorities (we're all on the same side - how do we have different priorities?)
- trying to build incentives which bind unlikely bedfellows, and hoping that the incentives will actually lead to better care for the population and service users
- potential for conflict of interest when a GP refers to a service which they themselves provide
- long-term solutions in an environment where "long-term" can only ever mean up to the next policy change - if you haven't got a return on investment within 3 years, the ground rules will have changed before you do get one
A frequent comment from the audience was "how can you do it that way when we aren't allowed to?". It is painfully clear that different PCTs have set different environments for PBC, and what works in one part of the country only works because of co-operation. A quick look at the World Class Commissioning (WCC) scores suggest that the PCTs with the highest scores also have the most interesting PBC initiatives.
I'm certainly going to follow up many of the presenters who have useful and valuable solutions and/or contributions. I'm going to follow up with NAPC on how to make the politics work. And I've come away with many new ideas and new things to try. Thank-you