Practice based commissioning

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Overview of PBC

Local practices in Brighton and Hove have been actively involved in PBC since April 2006.  Three locality commissioning groups are in existence covering the East, Central and West localities population. Governance and strategic decision-making is coordinated via a City-wide PBC Operational Board that meets on a monthly basis and is chaired by the PBC locality chairs.

We have committed to maintain the engagement already in place and to work jointly with PBC to develop systems and processes and to change current ways of working.

An enhanced operational framework has been developed to ensure PBC localities have greater engagement in the clinical commissioning agenda linked to our Strategic Commissioning Plan.

• Brighton and Hove PBC framework 2010/11 (747kb Word file)

It focuses on:

• PBC’s link to the strategic focus of the PCT (including far more clinical engagement in the strategic decision making process)
• The financial framework (including achievement of financial balance and the implications of poor performance )
• The context and outcomes expected through the effective management of PBC across NHS Brighton and Hove by both the PCT and GP Practices (including aligned resources internally within the PCT to support PBC)

PBC priorities

• Developing a more cohesive locality structure that manages practices in a more operational way linked to performance management and clinical engagement. Constituent practice agreements have been developed to ensure this process is achieved.
  
  
• The management of demand, clearly linked through to performance. This operational management is seen as the minimum level of PBC engagement.

• Clinical leadership and engagement: The future leaders of PBC should be GPs and practice managers, supported by operational managers.
  
  
• Clinicians should be part of the whole process of development of service redesign and shaping future strategy; and they should be involved in a way that allows them to take ownership.

• Defining a revised financial framework and budget setting methodologies that support PBC, delivered through high quality data management processes and tools.

• A dedicated resource allocated to support PBC . This comes in the form of a PCT team created to cover service redesign; finance and data management; and management support.

Clinical commissioning

The development of a clear clinical commissioning structure is now in place with primary care clinicians taking a leading role in both the strategic decision making and operational management of the PCTS commissioning strategy.

Our governance arrangements promote and encourage local clinicians to play a central role in the identification and delivery of local quality and efficiency improvement priorities.

Clinicians are actively involved in supporting the adoption and development of service specific indicators for quality, ensuring local ownership for reviewing and improving quality so that the needs of the local population are best met.

Through this process, commissioners work in collaboration with providers to understand quality issues and identify and implement solutions which facilitate continuous quality care improvement.

The key mechanism for supporting this clinical engagement will be the newly formed Clinical Commissioning Executive and the Practice Based Commissioning Operational Board.