Practice based commissioning: applying the research evidence

Smith, Judith; Dixon, Jennifer; Mays, Nicholas; McLeod, Hugh; Goodwin, Nick; McClelland, Siobhan; Lewis, Richard; Wyke, Sally

doi:10.1136/bmj.331.7529.1397

Cited by 38 publications

(34 citation statements)

References 7 publications

(8 reference statements)

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“…straddling the 'programmatic' level and the 'organizational' level just above practices, thereby strengthening their ability to shape resource use). Research evidence supports the potential of practice-level purchasing to develop a stronger primary care focus within local health systems (Smith et al, , 2005. The English re-introduction of practice-level purchasing of services may therefore, with appropriate incentives, go some way to restoring GP involvement in PCTs and developing a stronger primary care orientation to local health planning and service development and is something that New Zealand could benefit from exploring for its PHOs.…”

Section: Discussionmentioning

confidence: 96%

“…Likewise, there continues to be scepticism about PCTs' ability to bring about significant strategic change to secondary care services through their commissioning as well as their ability to focus adequately on public health improvement Bramley-Harker and Lewis, 2005). The return to a system of practice-based purchasing which has been developing since 2005 within the framework of an overarching PCT commissioning organization suggests the possibility of achieving a balance between clinical engagement at the practice level, accompanied by responsibility for wider resource use in the health system, but this assumes that there are sufficient incentives for GPs to become involved in practice-based commissioning (Smith et al, 2005).…”

Section: What Does the New Zealand And England Experience Tell Us Abomentioning

confidence: 99%

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Primary care organizations in New Zealand and England: tipping the balance of the health system in favour of primary care?

Smith

Mays

2007

Health Planning & Management

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SUMMARYThis paper examines the experience of developing primary care organizations (PCOs) in New Zealand and England, exploring how far these new institutional forms have been able to 'tip the balance' of their host health system in favour of primary care. The original objectives for establishing PCOs in the two countries are assessed using published research evidence on the impact of PCOs covering: efficiency and cost containment; the development of clinical engagement and leadership; the development of primary care; and the purchasing of secondary and referred services. It is concluded that in both countries, progress has been made in aligning more closely the individual focus of general practice with the population perspective of the wider public health system. The New Zealand approach of using non-governmental PCOs is judged consistent with harnessing the professional culture of general practice towards community-based public health. By contrast, English primary care trusts (PCTs) are at risk of becoming remote from their origins as purchasers in primary care and general practice, unless the re-introduction of practice-level purchasing can provide GPs with new enthusiasm for local planning and service development.

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Section: Discussionmentioning

confidence: 96%

Section: What Does the New Zealand And England Experience Tell Us Abomentioning

confidence: 99%

Primary care organizations in New Zealand and England: tipping the balance of the health system in favour of primary care?

Smith

Mays

2007

Health Planning & Management

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“…There is a missing link between priority setting at national and local levels. This is highlighted in the United Kingdom by the absence of guidance on how managers and doctors are to commission effectively6 and by the relatively poor record of the NHS in implementing evidence from economic appraisals at the local level 7…”

Section: Why Do We Need An Economic Approach?mentioning

confidence: 99%

Using economics to set pragmatic and ethical priorities

Peacock¹,

Ruta

Mitton

et al. 2006

BMJ

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Ruta and colleagues described an approach called programme budgeting and marginal analysis, which they argue recognises the need to balance clinical autonomy with financial responsibility.2 We describe two checklists to aid managers and doctors in implementing local frameworks for resource management based on this approach. These checklists deal with pragmatic and ethical considerations that are central to the successful design and implementation of priority setting processes. Why do we need an economic approach?The challenge of setting health service priorities is greater than ever. In the United Kingdom, despite the Wanless recommendation for up to a £29bn (43%) real increase in health spending over five years 3 many primary care trusts are overspent, with the total deficit estimated to be £500m ($870m; €727m) in 2005. 4 At the same time, important questions remain as to what managers and doctors are meant to do with national health technology guidance in their local contexts of resource management. 5There is a missing link between priority setting at national and local levels. This is highlighted in the United Kingdom by the absence of guidance on how managers and doctors are to commission effectively 6 and by the relatively poor record of the NHS in implementing evidence from economic appraisals at the local level.

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“…20,21 The assessment of urban population needs must go beyond the current assumption that the practice population matches the geographic area from which it is drawn. This may become increasingly important as the range of primary care providers grows and the potential for selection of patient populations emerges, and with it the potential for exacerbating as well as reducing the health disadvantages associated with ethnicity and social deprivation.…”

Section: Implications For Practicementioning

confidence: 99%

Hospital data may be more accurate than census data in estimating the ethnic composition of general practice populations

Hull¹,

Rivas²,

Bobby³

et al. 2009

Journal of Innovation in Health Informatics

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Background Equity of service provision by age, ethnicity and sex is a key aim of Government policy in the UK. The prevalence, natural history and management of common chronic conditions, such as diabetes and hypertension, vary between ethnic groups. Developing and monitoring responsive local services requires accurate measures of ethnicity and language needs. Hence establishing the ethnic composition of GP populations is important. Objective To compare three methods of estimating the ethnic composition of GP registered populations in three east London primary care trusts (PCTs). Design Self-reported ethnicity, routinely collected at practice level (and considered the 'gold standard'), was compared with two indirect methods of attributing ethnicity. The indirect method currently used in the UK assigns ethnicity to GP populations based on geographical postcode attribution from the national census. A proposed alternative indirect method uses the ethnic breakdown of hospital admission data from practice lists to attribute ethnicity to the whole practice population. Comparisons were made between practice self-report recording and these two indirect methods. Bland-Altman plots

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Practice based commissioning: applying the research evidence

Cited by 38 publications

References 7 publications

Primary care organizations in New Zealand and England: tipping the balance of the health system in favour of primary care?

Primary care organizations in New Zealand and England: tipping the balance of the health system in favour of primary care?

Using economics to set pragmatic and ethical priorities

Hospital data may be more accurate than census data in estimating the ethnic composition of general practice populations

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