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Keeping it simple

28 June 2011

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Managing Partner and Business Manager
Peacock Surgery, Nottingham

NHS Alliance Practice Managers’ Network

Michael’s main areas of focus are strategic planning, service redesign and patient and public involvement. An executive board member of Nottingham and North East consortium, Michael is currently leading on Transforming Community Services and the development of the consortium into a statutory organisation


Practice Manager
Marple Cottage Surgery, Stockport

Practice Manager Representative for North West
NHS Alliance Practice Managers’ Network

Johan leads a forward-thinking, IT award winning practice in Stockport, Cheshire. He is a board member of Stockport Managed Care  – a consortia of 53 practices set up to recommission and modernise health services in Stockport

The current NHS reforms herald a seismic change to primary care in England, with the demise of primary care trusts (PCTs) and the quantum leap to clinical commissioning. The role of the practice manager is always pivotal in implementing change and turning policy into a workable reality. Practice management can no longer put off engaging with commissioning because “it is just another initiative that won’t last”.

Ten reasons why practice management needs to take a lead in commissioning

The new Quality and Outcomes Framework (QOF) indicators for outpatients, emergency admissions and prescribing will mean that, to maintain practice income, the practice will need to understand and implement structure processes.
The patient participation directed enhanced service (DES) provides an opportunity to engage with patients, which will be essential in ensuring local services met the needs of local people.
Your practice will become increasingly accountable for its use of public funds.
Your practice will need to understand its referral trends just as well as it has understood its prescribing habits.
Your practice will need to build positive working relationships with your consortium – not belonging to a consortium is not an option.
Without strong community engagement, who will be blamed for rationing decisions once the PCTs are gone?
How will you develop the skill set to meet the demands on practice managers?
Which managers are better placed to make commissioning work?
If you do not have a plan, you may become part of someone else’s commissioning plan.
Clinicians leading the commissioning and redesign processes makes good sense.

Where to start
You already know far more than you think. Good starting points are:

  • Referral management. Make sure that you know what is being referred out of your practice. A lot of practices record outgoing referrals by using the appropriate 8H Read codes. This information is used to support clinicians to peer-review referrals.
  • Understand your commissioning budget. It is important to understand what is incorporated in your budget. The key budget lines will be for acute activity for outpatients and inpatient care. The scope of the budget will increase over the next two years, as will the level of delegation and accountability. The quality of the activity data backing the historic out-turn budget will be more robust for some budget lines compared to others. Where there is a lack of robust data, the budget line becomes more risky. Over the next two years there will be a staged movement towards a capitation-based fair share budget, explained in the Nuts and Bolts chapter.* Increasingly, consortia will take on delegated budgets with associated responsibility.
  • Contract performance and data validation. Make sure your consortium has a process for highlighting and providing evidence of poor contractual performance or potential inappropriate charging. You need to agree how evidence is collated, and the system for escalating issues needs evidence to back up the challenge if there is any hope of being successful. Find out the system for cleaning the data you receive so you focus on the right issues. Contract management needs to deal with common themes backed by evidence, rather than individual patient issues.
  • Redesign services based on local need. Clinical commissioning presents a real opportunity to transform local service provision to closer reflect local need and maximise available resource. While the QIPP (Quality Innovation Productivity Prevention) agenda is a challenge, it provides scope for addressing disjointed service inefficiencies.

Whatever comes out of the listening exercise, the direction of travel is certain not to be a U-turn – so practice management needs to be a leading force in creating the future.

Michael and Johan are the authors of the Commissioning Made Simple chapter of the latest NHS Alliance Nuts and Bolts of Practice Management guide, available from: