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Annual Report 2009/10
Involving clinicians in shaping health services
Practice Based Commissioning (PBC)

Practice Based Commissioning (PBC) is a way of working that gives clinicians the support and funding to develop local services.

By devolving budgets to GPs through Practice Based Commissioning, GPs and other primary care professionals are able to drive the commissioning process and design services to better meet the needs of their patients.

Working closely with partners including hospitals, the local authority and voluntary organisations GPs are best placed to assess local needs and the prioritisation and design of health services to make the best possible use of resources available to them.

There are four Practice Based Commissioning Consortia in Sheffield - Central Sheffield PBC Consortium, Hallam and South Consortium (HASC), West Consortium and North Sheffield Consortium

Last year business plans and service developments were taken forward in a range of areas:

In anticipatory care, all four Consortia agreed to deliver a model developed by HASC and North Consortia. This model focuses on reducing avoidable hospital admissions for patients over the age of 75 and has three key components:
- A register of patients, created by GP practices, who for a variety of clinical and social reasons are more likely to be admitted to hospital as emergencies. The aim is to support the GP and the practice so that more attention is focused on to these patients to help them stay out of hospital
- Alignment of Residential Care Homes to GP practices and specific GPs. This gives the Home continuity of care from a smaller number of GPs and each gets a weekly “ward round” from the GP. Each resident has a management plan which the care home staff and community services deliver. Finally, community pharmacists ensure that residents’ medications are regularly reviewed
- A redesigned falls pathway, which improves the community based risk identification and management for elderly people.
With chronic obstructive pulmonary disease (COPD) the Central PBC Consortia piloted a community based model designed to reduce the number of COPD admissions to hospital. This model brings together specialist nurses from the hospital and the community under the leadership of GPs with a specialist interest in COPD. It also makes use of a Met Office technology system that advises patients who are vulnerable at times of more extreme weather
With the “Roving GP” initiative, the Central PBC Consortium piloted additional GP support for urgent home visits. Early evidence from the pilot shows that admissions can be appropriately avoided to hospital if the GP visits the patient promptly and community services support the patient at home
North PBC Consortium led on a piece of work to help patients make better use of both the adult and children’s accident and emergency services. This work included the promotion of the “Choose Well” campaign which helps patients to identify where urgent care services can most appropriately be accessed
West PBC Consortium developed a range of cardiology services that are now provided in the community. These give patients an equivalent alternative to hospital care. When hospital care is needed it means the patient doesn’t need to have tests repeated
All four PBC Consortia were involved with a range of developments over the last 12 months for managing the care of patients with diabetes in the community.
One of the biggest clinical developments that PBC Consortia led over the last 12 months was the successful redesign and procurement of community physiotherapy services. We are confident this will result in a better and more consistent community physiotherapy service for Sheffield residents.

Partnership working and co-commissioning

NHS Sheffield and the PBC consortia have developed the co-commissioning relationship significantly over the last 12 months. In particular this has resulted in the establishment of the Clinical Commissioning Executive (CCE), which is a three way partnership between the Executive Team of NHS Sheffield, the Professional Executive Committee and PBC consortia clinical and managerial leads. The CCE is now responsible for developing the contribution of PBC consortia towards the priorities of ABH.

2010/11 Priorities

Through the CCE PBC consortia have agreed to prioritise 6 key areas for 2010/ 11. These are:

Further developing the model of anticipatory care for the over 75s to reduce avoidable hospital admissions
Enhancing community based care for patients with diabetes
Rolling out the community based model for care of patients with COPD and reducing the number of avoidable admissions
Reducing other avoidable emergency admissions and accident and emergency attendances for adults and children by ensuring that GPs, community and hospital services provide more joined up services
Supporting appropriate referrals to hospital and community specialists
Ensuring that PBC contributes directly to reducing health inequality in Sheffield

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