Practice Based Commissioning – An update and some local information

Anyone at the Pharmacy Showcase event on Thursday 14th June would have noticed that a lot of the talk was about ‘Practiced Based Commissioning’ (PBC). Words like clusters were mentioned frequently and we talked about pharmacists needed to be involved in these clusters. But having talked to a number of pharmacists after the event, I realise that there is still a great deal of uncertainty around this issue amongst pharmacist. Hopefully this article will clarify what we mean and what you need to do next.

Background

Traditionally Primary care Trusts have commissioned (or bought) care for patients from hospitals, pharmacists, nurses and doctors. For example, pharmacists are currently being paid by the PCT to provide a smoking cessation for patients.

For a long while GPs have been saying that they could commission (buy) services for their patients cheaper and more locally than the PCT do. They also believe that they understand what their patients need and therefore are in the best position to negotiate with other providers such as hospitals and pharmacists to provide that care.

As I am sure you are all aware a large number of PCTs have over spent their budgets in the past few years and have now had to reduce the number of services they commission (buy) as a means of saving money. This plus the pressure from GPs for them to be more in control of their own commissioning has led the Government towards the Practice Based Commissioning idea.

With Practiced Based Commissioning groups of GP surgeries (clusters) are encouraged to work together to decide on what their priority areas are (i.e. areas of care that they think they can commission better than the PCT does) and to work with providers (hospitals, pharmacists etc) to get appropriate services that are clinically and cost effective to their patients. Most GP practices have joined clusters (as there is a lot of work needed to commission services and its best done as a group rather than as individuals) although a few practices are working on their own.

The clusters are all still trying to find ways of working and its early days in their development. Each cluster has someone at the PCT who is helping them and each cluster has a Lead person (generally a GP) who acts as a sort of chairman and then other GPs and practice staff work on the PBC committees to look at their priority areas, develop plans to address these priorities and then negotiate with potential providers to deliver the services they need.

Finally, one of the incentives for GP practices to become involved with PBC is that the cluster gets to keep 70% of any savings they make when their commission services (the other 30% goes to the PCT).

Who is in which cluster across South Staffordshire

Across the whole of South Staffordshire there are 6 PBC clusters

What has PBC got to do with pharmacists?

Currently any enhanced services, such as the provision of EHC, a minor ailments scheme or a smoking cessation scheme has been commissioned from the PCT. As these PBC clusters get more established they will take over the commissioning of these services and may choose the look for other providers to do them! More importantly they may be looking for provides to offer other services that pharmacists could get involved with such as Long Term condition Managements, INR testing or Weight management clinics. These could be opportunities for pharmacists to become more involved with additional enhanced services.

What is the LPC doing about PBC?

As an LPC we have been making contacting with the PCT leads for PBC and discussing ways in which community pharmacists could support the work of the clusters. We have produced a number of service templates for the clusters to look at for example:

1. Weight management from community pharmacy
2. Supporting patients with mental health problems from community pharmacies
3. Focussed Medicine Use Reviews
4. Minor ailment schemes

We are trying to build relationships with the clusters and would ideally like to get a community pharmacist appointed onto the boards of each of the clusters. But, whilst the PBC groups are happy to hear from us they are saying they want ‘local’ pharmacists to represent themselves, not someone who they don’t know….that is where you come in!

What should pharmacists do now?

Just like everything in life it all comes down to communication. If every pharmacists made a point of talking to their local GPs about what they could offer the PBC in terms of enhanced services then when the PBC come to commission services they will think of pharmacy as a possible provider. If we don’t tell people what we could do no-one is ever going to ask us to it!! So….go and chat to your local GP surgery about PBC, find out how involved they are, what their priority services are and try and think of any help you could offer to help them met their priorities.

If you need moral support or just want to chat about what is happening in your locality please contact your local LPC representative or go through me, Ruth Goldstein.

Hopefully this article has helped clarify what PBC is and why it is important for you to get involved. Please feel free to contact me if you have any further questions or want support/advice when going to talk to local GPs.

Ruth Goldstein (LPC Service Development Manager).