by Admin
1. July 2006 05:00
A NEW OPPORTUNITY
The adoption of practice-based commissioning may be slow, but the new structure provides unique market intelligence and powerful targeting opportunities for medical sales professionals. Pf’s Chris Ross explores the changing landscape.
IT IS WIDELY ACCEPTED that the full exploitation of Practice-based Commissioning will be in the vanguard of building the NHS as a primary care-led, patient-focused service. However, not all practices, or even PCTs, appear to have the level of enthusiasm for the project that the Department of Health would wish. Although some are fully engaged, many are lagging and could upset the end-2006 target of 100% coverage. Close monitoring of the progress made by PCTs in encouraging their practices to take on commissioning responsibility shows that adoption is slow. A new study by the National Health Intelligence Service (NHIS) demonstrates wide divergence in the movement towards universal involvement. Currently, some PCTs are able to provide full details of the composition of their commissioning clusters and the specialist programmes they are undertaking; while others, who are just starting, are clearly having difficulty in enthusing their practices.
However, it is clear that the data emerging from the study, which began in June, is of significant interest to pharmaceutical companies. It not only provides targeting information on which practices are doing what and where, but also gives details of specific disease and therapy specialisations.
Bearing in mind the recent White Paper, it is not surprising that dealing with the range of problems concerning hospital admissions is highest on many PCTs’ agendas. What is surprising, rather, is the very wide range of interests shown by the PCTs. From a sample of 100 PCTs, the top ten specialisations were:
| Specialisation |
Percentage of PCTs |
 |
| Dermatology |
48 |
|
| Orthopaedics and trauma |
28 |
|
| Diabetes |
25 |
|
| COPD |
23 |
|
| ENT |
20 |
|
| Diagnostics |
16 |
|
| Cardiology/Heart failure |
16 |
|
| Ophthalmology |
15 |
|
| Musculo-skeletal |
15 |
|
| Gynaecology |
13 |
|
Other specialisations include everything from audiology to urology, and from access to ultrasound.
NHIS has already analysed data from 200 clusters, and the results are available to NHIS subscribers at www.nhis.info. It has found that the average cluster contains 10 practices, but a number of PCTs have formed a single cluster to cover the whole PCT. This is not quite what the Government envisaged as a reforming move.
The Pf guide to practice-based commissioning
What is practice-based commissioning (PBC)?
PBC is about engaging practices and other primary care professionals in the commissioning of services. Through PBC, front-line clinicians are being provided with the resources and support they need to become more involved in commissioning decisions.
Under PBC, practices receive information on how their patients use health services. This information can be used for the redesigning of services by front-line clinicians for the benefit of patients. Practice-based commissioning gives clinicians greater freedom and flexibility to tailor services to the needs of the local community.
Which practices does PBC apply to?
The PBC Directed Enhanced Service (DES) applies to general practices only. The Department of Health guidance states that PCTs are required to offer the DES to all their general practices from April 2006. This guidance was written with the intention that PBC would apply to general practices, based on the criterion of a registered patient list. PCTs can, however, decide to delegate indicative budgets to other practices, provided that the budget can be clearly identified.
What will happen to the PCTs?
The PCTs will continue to deal with the administration (contracting, payments etc), which should mean limited additional bureaucracy. Under PBC, all proposals for savings must be agreed at the outset and must be spent on patient services. Unlike fundholding, where GPs could negotiate the cheapest price for acute services, with tariffs there is no longer any incentive to bargain on price.
What are the PCTs responsible for?
By the end of December 2006, the PCTs must ensure that:
• All practices are receiving information that will allow them to understand their clinical and financial activity compared with local and national indicators.
• All practices have received an indicative budget covering an agreed scope of services.
• All practices are receiving support from the PCT and the offer of an incentive payment (the DES or locally agreed payment) to support practice-based commissioning.
• Governance arrangements for practice-based commissioning are in place (these will be agreed in partnership between the practice and the PCT).
What is universal coverage?
Universal coverage will be achieved when all PCTs have put in place the arrangements to facilitate PBC. The Department of Health expects all PCTs to do so by 31st December 2006. This will involve all practices receiving information about their referrals, information on their allocation of the PCT budget, an offer of support from their PCT, and details of the local governance arrangements. The Department of Health hopes the arrangements will mean that all practices are significantly engaged in PBC by the end of December 2006.
| What GPs are saying . . . |
The BMA has cast doubt on Department of Health claims over the current adoption of practicebased commissioning. Dr Hamish Meldrum, Chairman of the BMA’s GPs Committee, said current implementation is "patchy" and GPs still face many barriers.
Commenting on a statement from the Department of Health claiming that more than 40% of GP Practices in England were adopting practice-based commissioning – the system in which family doctors decide which health services to buy for local people – Dr Meldrum said: "The Government’s statement might lead people to infer that more GPs are commissioning services for their patients than is the case. The incentive scheme is there to encourage practices to put a toe in the water of PBC but does not mean that actual commissioning is under way. It seems disingenuous to suggest that taking the first step along the road to commissioning is the same as actually commissioning the services. Studying a map isn’t the same as making the journey."
"Implementation of PBC is very patchy at the moment. While we support it in principle, we hear of far too many barriers being put in the way of GPs taking on a commissioning role. If the government seriously wants PBC to get off the ground in all parts of the country they need to take a close look at these barriers, which include significant PCT deficits, and instruct local NHS bodies – Primary Care Trusts – to work with and support practices instead of blocking the way ahead."
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A new playing field
So what does all this mean for sales representatives on the ground? Undoubtedly, practice-based commissioning has significant implications for interaction between sales professionals and clinicians. Close scrutiny and understanding of the changes within individual territories will provide invaluable opportunities for representatives to align their services and products with the specific objectives of PBC clusters.
The key question is: how can sales professionals exploit the new system?
The four-part plan for exploiting practice-based commissioning:
- Identify which PBC clusters exist in your territory. How many are there and where are they?
- Scrutinise the PBC plans for practices within your region. What are the priorities and the local health needs?
- Establish how practices will spend their indicative budgets. Which services will they support?
- Identify how your products can deliver value to these plans. How can you help deliver cost savings and improve health outcomes?
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This information is invaluable in targeting your customers. There is a great deal of uncertainly in the marketplace as the new PCT structure unfolds, and many organisations will welcome help as they come to terms with the practice-based commissioning reform. With this in mind, NHIS is publishing a series of Practice-based Commissioning Tracker reports to give non-subscribers access to information on the structure of practice clusters in each PCT, the disease/therapy specialisations on which the clusters are focusing, the names involved and an analysis of the commissioning specialisations.
Exploiting the obvious opportunities will be more effective for those armed with detailed market intelligence.
The National Health Intelligence Service provides local and national intelligence to support sales activities within the health sector. As the premier source of knowledge about the way the English NHS works, the NHIS is a mine of up-to-date structured and ‘contexted’ information.
Practice-based Commissioning Tracker Reports can be delivered to NHIS either as hard copy or electronically. The late entries to the process will be followed up over time to make the available data as complete as possible.
For more information, e-mail pbc@nhis.info. |
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