The National Primary Care Contracting Collaborative (NPCCC) supported the development of new contracting arrangements in primary care from 2004-2006.

It was set up to support PCTs, practices and other primary care teams in maximising the commissioning benefits achievable under the new contracting arrangements in order to improve services for patients.

The aim was to develop robust primary care models for re-designed patient services based on agreed local priority areas.

This programme is now completed. If you are interested in working with the Improvement Foundation please go to How we can help or click here to contact us.

Who is involved

Twenty eight PCTs were selected for the national phase of the programme, to pilot improved pathways of care and service delivery models. 

What we are doing

Primary care contracting is a mechanism to bring about strategic change in how patient services are delivered and commissioned. It provides an opportunity for commissioners to shape the whole patient journey, with primary care becoming the pivot around which secondary and community services are designed. 

Key priorities

The programme aimed to help organisations to develop primary care contracting models that support progress towards key priorities such as:

• Moving services from secondary to primary care
• Improving access and choice
• Reducing waiting times
• Ensuring real clinical and public engagement

Three service areas were identified: Unique Care, mental health and sexual health.

In order to develop an integrated and inclusive primary care commissioning and contracting process, and improved care pathways, practices and PCTs participating on the programme were encouraged to focus on:

• The redesign of service areas to best meet the needs of patients by improving choice, access and reducing delays in the patient journey
• The redesign of the systems or infrastructure needed to ensure effective commissioning, including the financial and information management required to underpin the redesigned service
• Ensuring patients and carers are engaged in the redesign of services and the organisational decision-making processes that underpin them
• Applying the learning to other service areas

Change principles

The four change principles outlined below were identified as the key elements that are most likely to result in improvements in primary care contracting:

• Develop strong clinical and managerial leadership to drive improvement
• Develop information systems and use information to drive forward change
• Redesign the delivery of services to meet local need
• Align resources and incentives to support service delivery

Primary Care Contracting Assessment Framework

The Primary Care Contracting Assessment Framework, which allows sites to self-assess against key factors that support successful use of the flexibilities of primary care contracts, to support service redesign, was created.

Key lessons

The key lessons learned were:

• Develop a shared understanding and strategic view between PCTs and primary care providers of what services need to be commissioned within their locality, using robust local health data to inform decisions.
• Improve capabilities and competencies to use the new contracting arrangements – GMS, PMS and Specialist PMS – as a driver for primary care improvement and innovation, and to shape the whole provision of patient care.
• Develop the ability to use the new contracting arrangements to further improve access, choice and address health inequalities.
• Improve understanding of the need to link service redesign and the systems that will support it – and involve clinicians and managers as partners in the process.
• Improve use of skill mix within teams to deliver improved primary care and consideration of all health professionals’ roles in delivering new GMS and PMS contracts.
• Improve public and patient involvement – and practical help in how to engage patients as part of the quality and outcomes framework.
• Provide support for frontline clinicians and managers to develop improvement skills to apply successfully to other service areas and across the wider health community

The sites used the learning from the programme to inform their development of practice based commissioning, which was introduced in the NHS Improvement Plan in June 2004.

Key results