Practice based commissioning (PBC) is about engaging practices and other primary care professionals in the commissioning of services for patients. This clinically driven model of commissioning devolves responsibility along with practice based budgets to frontline clinicians who can, through effective service redesign, develop innovative services that meet local need.

GPs, nurses and other primary care professionals are in the best position to use their knowledge of patient needs to design better quality services for people in more convenient settings.

Funded by the Department of Health, our two-year PBC Development Programme is helping with the rapid implementation of PBC across PCTs, GP consortia and individual practices.

The national policy on PBC is set out on the Department of Health's website.

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

The national Practice Based Commissioning Development Programme commenced in 2006 and is now in the final phase of support. In total we are helping with the rapid improvement of PBC across 99% of PCTs.

What we are doing

The overall aims are:

• Engagement with local clinicians in the redesign of services (with a focus on both unscheduled and scheduled care)
• Redesign of commissioning systems to support improved service delivery
• Faster universal roll-out of PBC
• Development of PCTs and practices to deliver PBC.

In addition, the intention is to further the engagement of practices in PBC and also facilitate work that will assist towards the 18-week target and reduce emergency admissions.

Programme

The programme consisted of three phases:

1. A preparatory phase to ensure PCTs and practices had their data informatics and finance systems in place so they were ready to take advantage of the collaborative phase. The two-day training events delivered in this phase were based around the issues identified in the Improvement Foundation's Practice Based Commissioning Assessment Framework.
2. A collaborative phase consisting of a series of three workshops for sites to focus on the redesign of services and the further development of systems and structures of management support that would continue the development and sustainability of PBC.
3. An additional support phase where every PCT in the country has been offered further support from Improvement Foundation in the form of 1.5 day workshops to help progress planning and implementation of PBC with an emphasis on scheduled care, unscheduled care and achieving 18 weeks. The Improvement Foundation support for PBC is ongoing and can be tailored to support local need and extended to help PCTs engage additional stakeholders in PBC such as pharmacists, dentists and other healthcare providers.

Additional learning opportunities

The Improvement Foundation also offers extra learning opportunities to support PBC development:

Simulation events: Each one-day simulation event is run in three sessions, each representing one year in the NHS planning and delivery cycle. A total of 15 teams (of up to eight participants each) compete against each other to address the challenges that are presented to the teams through a flow of material. Teams prepare brief written responses, take part in interviews and make presentations to the media, politicians and SHA performance managers.

The events aim to help PCTs and practices to develop an improved, shared understanding of the benefits of PBC and how it could work within the context of local dynamics and system reform. They also test and develop the existing relationships and working arrangements between PCTs, hospitals and practices, identifying what might need to change to maximise the benefits of PBC.

Learning exchanges: Regional PBC Learning Exchanges are organised with SHAs specifically to meet the needs of PCTs and practices in their area. Some learning exchanges have focused on particular topics such as service redesign or how to use information for PBC, and others on the needs of specific groups such as practice managers or consortium leads. The learning exchange is typically a half-day every 3 to 4 months.

Webcasts

The Improvement Foundation has held a series of webcasts:

• An Overview of PBC Guidance and the DES
• PBC - What's In It For Me?
• Understanding Payment by Results and Developing Practice Plans
• PBC - Developing a GP Consortium
• Exploring the Potential of Community Pharmacy through PBC.

Click here to view all webcasts.

Pharmacy

There are many opportunities for pharmacists to become actively engaged in PBC both in terms of commissioning and redesign, and as providers of service.

The implementation of the new pharmacy contract and the publication of the pharmacy White Paper Pharmacy in England: building on strengths - delivering the future on 3 April 2008 emphasises the Government's vision for pharmacy. Pharmacy is seen as a profession and service which will help people to stay healthy and extend the role that community pharmacists play in the care of people with acute and long-term conditions.

The Improvement Foundation has been supporting the development of pharmacy over the past two years and has worked in partnership with SHAs, local pharmaceutical committees and primary care contractors. Recently the Improvement Foundation brought together pharmacists and practice based commissioners in the South East Coast SHA region for a one-day learning event to help develop a shared understanding of what services pharmacists could deliver through PBC.

Key results