‘Super-enhanced service’ puts the local back into primary care commissioning

9 March 2016
 
Bolton’s £3.4m “super-enhanced service”, which aims to divert care from hospitals to GP practices and to help manage demand, is facing its first major test.
 
Recognising the need to reduce A&E attendances and improve the effectiveness of primary care, NHS Bolton Clinical Commissioning Group (CCG) developed the Bolton Quality Contract. The contract is also intended to address inequalities in healthcare and improve outcomes.
 
At its heart is a set of 19 standards, each with key performance indicators (KPIs), that practices have signed up to and receive graduated payments for meeting. The standards, which are designed to balance local focus on population health, value for money and best care, include:
  • Prescribing
  • Minimising referrals for certain conditions or treatments
  • Screening
  • End of life care
  • Best care for a series of long term conditions
  • Transfer of care
  • Patient experience.
 
Kathryn Oddi, the CCG’s primary care performance and support lead, explains: “We wanted to bring every practice to a certain level of income and we developed specifications that would level out inequalities of provision. We spent time working with practices to agree what is best care and told them we would invest additional money so they could deliver that.
 
“Practice funding has developed in such a sporadic way over the last 15 years with PMS, GMS and APMS. There was such diversity in funding and in provision.”
The quality contract boosts practice income to around £95 per patient – a significant increase for most. The average per capita income was around £73.50 plus £5 from local enhanced service payments.
 
Oddi says: “This is like one big enhanced service and we worked with NHS England because we needed to know where practices were starting from – what they were paying and what NHS England was getting for that. We needed to swap the KPIs in their contract to reflect ours.”
With practices suddenly seeing an income spike of up to £200,000, the CCG understandably asked each to produce an action plan showing their plans for additional staff and how they would meet the new KPIs.
 
“We expected them to spend 50-60% (of the additional funding) on new staff but we recognise they are up against it and we did not expect them to commit all the new funding at once,” she says.
 
The access standard not only requires practices to provide ten bookable sessions each week but specifies minimum opening hours (8am-6.30pm Monday to Friday) and requires at least 75 contacts per 1,000 registered patients each week. The contacts can be by a GP or nurse practitioner and either face-to-face or by telephone.
 
The set hours can help educate the public to seek help from their GP rather than A&E, Oddi says. During the winter the CCG is running a ‘Think your GP, not A&E’ campaign. Practices are also expected to have capacity to see patients deflected by A&E staff.
Oddi says: “Having the same opening hours and no lunchtime closures helps to reinforce the message to people that they should be looking to their GP first rather than A&E.”
 
She and her colleagues invested an “unbelievable” amount of time in working with practices and the local medical committee. They also discussed issues such as financial incentives for GPs with the General Medical Council (GMC).
 
Oddi says: “We felt very strongly that we had to take practices with us. We worked hard with the local medical committee and all the practices with regular engagement events. We showed them the suggested standards and KPIs and asked if we had missed anything or anything was too onerous.
 
“The GMC felt very strongly that no doctor should feel compromised on demand management and prescribing but the evidence shows there’s a 30% waste in prescribing and we are only seeking a 1% reduction in referrals. The GMC looked at the specifications and of course they were cautious but they said that as long as were emphasising waste and talked about inappropriate referrals and we educated and supported practices then that would be fine.”
 
She believes that the CCG’s move is an important step towards returning primary care commissioning to its local roots.
 
“As a CCG we are coming full circle because you need to understand the diversity of your primary care providers and know them and the circumstances they are working in. We have got all 50 practices signed up and that is a feather in our cap.
 
“The only way to tackle the NHS’s cash problems is to do more in primary care.”
 
Oddi says that data for the first six months of the year suggests “good progress has been made” but firm conclusions won’t be available for another few months. The prescribing standard, for example, sets practices a target of reducing spending by £59,000. Halfway through the year practices were averaging savings of £28,000 – just short of the target.

Download the March 2016 issue of Commissioning Excellence as a PDF.

 
Topics & resources Briefings

Latest News

Recommended Musculoskeletal Indicator Set launched

21 July 2017

Arthritis Research UK has worked in partnership with the musculoskeletal community, as part of NHS England and the Arthritis and Musculoskeletal Alliance’s (ARMA) Musculoskeletal (MSK) programme, to create the recommended MSK Indicator Set; a standard set of indicators for musculoskeletal health systems relevant to people with MSK conditions and commissioners. The list of indicators and final report are both available to view and download. The Recommended MSK Indicator Set reflects the agreed objectives for musculoskeletal health systems and is a mixture of generic and condition-specific indicators that includes both process and outcome measures. These indicators are intended to be used for local analysis which will highlight the reasons for variation.

Read More

More clinical pharmacists set to work in GP surgeries

21 July 2017

Further applications for Clinical pharmacists in the general practice programme have been approved meaning more than 520 clinical pharmacists covering 1,791 GP sites will benefit an additional 18.5 million patients. This builds on the 494 clinical pharmacists already working across around 650 GP practices as part of a pilot scheme. Clinical pharmacists work in general practice teams to help patients manage their medication effectively. This improves the quality of care and ensures patient safety as well as freeing up time for GPs to focus on patients with the most complex health issues. Applications are considered on an on-going basis and the next deadline is 29th September 2017. More information can be found on the NHS England website.

Read More

Sustainability and transformation plans: five key questions for planners

20 July 2017

This analysis identifies five key questions to ask each STP area to assess the potential impact of each plan. The scrutiny framework this paper outlines focuses particularly on workforce planning, access to services, service quality, integration of services and numbers of beds.

Read More

NHS England annual report and accounts 2016/17

20 July 2017

NHS England has published its annual report and accounts for 2016/17, detailing the work of the organisation over the last year and outlining some of the most significant achievements and challenges.

The report sets out progress made in delivering the NHS Five Year Forward View, the 2016/17 business plan and the Government’s mandate to NHS England.

Read More

Patients to benefit from £325 million investment in NHS transformation projects

20 July 2017

Health Secretary Jeremy Hunt and NHS England boss Simon Stevens have announced £325m of capital investment for local projects that will help the NHS modernise and transform care for patients.

Hunt and Stevens gave the green light to local capital investment schemes in 15 areas of the country, with the largest sums being used for urgent care in Dorset, surgery in Greater Manchester and cancer care in Cumbria.

Patients will see this investment deliver faster diagnosis for conditions like cancer, easier access to mental health care, expansion of A&Es, shorter waits for operations and more services in GP surgeries.

Read More