primary health care financing lessons from the uk beverly sibthorpe deputy director australian...
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Primary Health Care Financing Lessons from the UK
Beverly Sibthorpe
Deputy Director
Australian Primary Health Care Research Institute
Problems Facing NHS in 2000
Under-invested system Lack of national standards Demarcations between staff Lack of clear incentives Barriers between services Lack of support Over centralisation Dis-empowered patients
PCTs and Fund-holding
Primary Care Trusts (PCTs)
Regional fund-holder for all NHS services
Negotiate and purchase services for registered population• expanding range of public and private providers
Carry financial risk
nGMS Contract
new General Medical Services contract
Practice not GP
Basic package of services
Minimum Practice Income Guarantee
Quality and Outcomes Framework (QoF)
• 146 indicators / targets
Additional money for reaching targets
Information and Review
Information
- Single unique identifier
- Massive investment in IT
- Collation of information from general practices
Review
- Healthcare Commission
Forecast Changes – System
Hospital ~ primary health care interface Participation of private providers, including US
HMOs Greater emphasis on promotion and prevention Nurse-based immediate care clinics Prescribing rights for non-medical clinicians Better links with social services Specialist ambulatory services and clinics
Forecast changes – general practices
Practice cooperatives pooling management, financial and IT resources
Practices working jointly Practice nurses, physicians assistants, health care
assistants Practice nurse management of people with chronic
diseases Allied health professionals
Forecast changes - GPs
GP focus on diagnosis and management of complexity
GP specialisation
Alternative career pathways in management, policy, strategic planning and public health
Growth in salaried general practice
Forecast changes - IT
Internet-based decision support
Email consulting
NHS Direct for telephone and internet access to home-based care and advice
TV-based access to health advice
Sweeteners for general practices & GPs?
Additional practice income New money for premises and workforce New career opportunities Improved working conditions: • after hours• locum support• retirement pensions• education and training
Threats?
Focus on what’s measured; neglect of what’s not measured
Increased fragmentation Erosion of doctor-patient relationship Erosion of continuity of care Erosion of comprehensive care Gaming and rhorting
Immediate challenges
PCT restructure
Diversion of care/costs from hospital sector
Practice-based commissioning
Clinician re-engagement
PCTs as service providers?
Bold Plan !
Need for system change Care and resources out of hospitals Focused on performance Underpinned by information Consumer focused Concerned with equity General practice support
Lessons for Australia
Health resources finite
Regional approach to resource management
Re-orientation to primary health care
Sophisticated and flexible commissioning
General practice as entity
Rich information driving change
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