wessex local medical committees appraisals, commissioning and the new nhs dr nigel watson 21/11/2015...

WESSEXLocal Medical Committees

Appraisals, commissioning and the new NHS

Dr Nigel Watson

20/04/23 1


Dr Nigel Watson• GP

• Had 9 appraisals

• CEO Wessex LMCs• Has 8 performance reviews

• GPC – Represent Hants and IoW (1996 – to date)

• Chair – Commissioning Sub-committee of GPC (BMA)

• DoH committees• GP strategic commissioning • GP working group

• Centre for workforce Intelligence• General Practice Advisor


Quality

Individual• Appraisal• Revalidation

Practice• QoF – Quality performance

• Quality premium• CCG contract – benchmarking/peer pressure


How do we define quality in the NHS?


What is quality?

• Upper quartile performance?• Value for money - VFM?• Financial balance?• Technical care?• Customer service?• Improved process measures?• Improved clinical outcomes?


Countries whose health systems are more oriented towards primary care achieve• better health levels

• higher life expectancy

• better health outcomes

• higher satisfaction with health care among their populations

• lower overall health care costs

• lower medication use

20/04/23 6


Some facts

• GP consultation £20

• Walk in Centre £24

• NHS Direct telephone call £15

• A&E attendance £74

• OPD £100 – 30020/04/23 7


NHS Budget in billions


Challenges

• Flat cash

• Aging population

• 17 million people with long term conditions and rising

• New drugs and technologies

• Reduce bureaucracy

• Improve decision making


Issues to resolved

• Outcomes• Patient choice• Targets• Bureaucracy• Lack of clinical involvement in healthcare

planning• Clinicians – responsibility, accountability• Lack of close working with Local Authority• Money


Commissioning

• GPs commission services for the individual patient

• Prescribe• Refer• Admit• Co-ordinate care

• Proposals will ensure that GPs are involved in commissioning for a population


Clinical challenge

• GPs• Improve quality

• Align clinical behaviour with financial accountability

• Commissioning for individual vs population

• Reduce variability

• Greater peer review and peer pressure


Clinical challenge

• Consultants• Work with commissioners

• Contribute to reform

• Understand care outside hospital

• Stop silo working

• Understand the financial future of the NHS

• Integration of primary and secondary care


Appraisal

The purpose of the appraisal will enable all

General Practitioners to participate in continuous

quality improvement of the quality of their practice.

Although not it’s primary purpose, aspects of

appraisal may assist in the early identification of

doctors in difficulty so that they can be offered

appropriate support.


Quality improvement

• Reduce the unacceptable variability

• GP• Appraisal – who will commission?• Revalidation • Procedures for GPs whose performance causes

concern –PCT/LMC – the future?• Performers list – registration – PCT – NHSCB• CSU, CCG, sub-national NHSCB


Quality improvement

• Reduce the unacceptable variability

• General Practice• QoF• CCG• Quality Premium


QoF

• Quality improvement• 96.5 points• Average practice £12,500• Prescribing• Referrals• Emergency care

• Quality & VFM• Data, information, peer review• Contribute to commissioning process• Design, develop and utilise clinical pathways


Clinical Commissioning Groups

• Improve quality of general practice

• Peer review and peer pressure

• Devolved leadership• Commissioning Group Lead• Board• Locality lead• Practice lead


Quality premium

• How much?

• 5-10% of current GP funding

• Who will decide on achievement?

• CCG or Health and Well Being Board

• How will quality be measured?


Performance of practices

• Mirror the GP performance procedures

• What happens to a failing practice?

• Where will practice contracts be held?


Accountability and Probity

• All practices part of a Clinical Commissioning Group• CCG accountable to NHSCB• Practice accountability

• All GPs in every practice engaged

• Conflict of interest• GP/patient• GP role in CCG• Role of GP provider companies


Any questions?

wessex local medical committees appraisals, commissioning and the new nhs dr nigel watson 21/11/2015...

Documents