The following commitments are made:

• Improve the amount of information on Trust, Hospital, GP’s, doctors and other staff available online.
• Focus on improving cancer and stroke survival rates
• Enable patients to access any healthcare provider that meets NHS Standards
• Open up the NHS to include new Independent and voluntary sector providers  
• Implement  a ‘ payment by results ‘system throughout the NHS
• Give GPs the power to hold patient’s budgets and commission on their behalf
• Link GPs pay to the quality of the results they deliver
• Cut NHS administration costs by a third
• Weight public health funding so that extra resources go to the areas with worst health outcomes
• improve funding for hospices and other providers of palliative care for children and adults

Our reform plan for the NHS

Over three years ago David Cameron spelled out his priorities in three letters – NHS. Since then, we have consistently fought to protect the values the NHS stands for and have campaigned to defend the NHS from Labour’s cuts and reorganisations. As the party of the NHS, we will never change the idea at the heart of our NHS – that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay. Labour promised to save the NHS but today, despite the massive increase in spending, the gap in health outcomes between the UK and the rest of Europe has actually widened. A decade of top-down, bureaucratic mismanagement has consistently undermined the professionalism and motivation of NHS staff and skewed NHS priorities away from patient care, creating a culture where ticking boxes is more important than giving patients the treatment they need. We can’t go on with an NHS that puts targets before patients. We understand the pressures the NHS faces. In recognition of its special place in our society, we are committed to protecting health spending in real terms – we will not make the sick pay for Labour’s Debt Crisis. But that doesn’t mean the NHS shouldn’t change. When you’re more likely to die of cancer in Britain than most other countries in Europe – and when the number of managers in the NHS is rising almost three times as fast as the number of nurses – the question isn’t whether the NHS should change, it’s how the NHS should change. We have a reform plan to make the changes the NHS needs. Our reform plan is based on the methods of the post-bureaucratic age – decentralisation, accountability and transparency. Applying these ideas to the NHS will help us improve it for everyone and allow us to meet people’s rising expectations. Instead of bureaucratic accountability there will be democratic accountability. We will decentralise power, so that patients have a real choice. And by publishing information about the kind of results that healthcare providers are achieving, we will make sure there is no hiding place for failure. If patients don’t like what they are offered, they will be able to find something better. This will drive up standards by allowing people to choose the best providers and by encouraging hospitals to compete for patients. Making doctors and nurses accountable to patients, not to endless layers of bureaucracy, will also save billions that are currently spent on needless bureaucratic checks – meaning we can spend more on the frontline services that make a real difference. When patients not only have the power to choose where they get treated but also the information to make an informed choice, then hospitals and GPs that don’t provide good care will have to raise their game. Doctors and nurses will need to use their new-found freedom to meet the needs of the most important people in the NHS – patients. We are the party of the NHS today because we not only back the values of the NHS, we back its funding and we have a vision for its future.

1.1 A patient-Centred NHS

Given the huge pressures faced by the NHS over the coming decades, our pledge to protect health spending will not be enough on its own to deliver the rising standards of care that people expect and deserve. The gap between what we will have to do and what we can afford to do presents an urgent need for reform. We have to make the supply of healthcare more efficient, and that means introducing reforms which, through decentralisation, accountability and transparency, will help us achieve our ambition for the NHS to deliver some of the best healthcare in the world.

We will scrap all of the politically-motivated process targets that stop health professionals doing their jobs properly, and set NHS providers free to innovate by ensuring they become autonomous Foundation Trusts.

With power comes responsibility and it's essential that doctors and nurses are properly accountable to patients for their performance. We will unleash an information revolution in the NHS by making detailed data about the performance of trusts, hospitals, GPs, doctors and other staff available to the public online so everyone will know who is providing a good service and who is falling behind.

We will focus on the health results that really matter, like improving cancer and stroke survival rates or reducing infections. We will measure our success against those countries with the most effective systems of healthcare, and enable patients to rate hospitals and doctors according to the quality of their care.

The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any healthcare provider that meets NHS standards. These choices should include not only hospitals, but also community health services – including allowing patients to use local pharmacists for services like screening and the treatment of minor ailments. So we will put patients in charge of their own health records, with the ability to choose which providers they share them with.

To give patients even more choice, we will open up the NHS to include new independent and voluntary sector providers – if they can deliver a service that patients want, to a high standard and within the NHS tariff, then they should be allowed to do so. To make sure all providers have the right incentives to succeed, we will implement a ‘payment for results’ system throughout the NHS. Meeting your healthcare needs can be complicated. That is why we want the family doctor to be a patient’s guide throughout the NHS. So we will give GPs the power to hold patients’ budgets and commission care on their behalf – either in hospitals or using other forms of treatment and therapy in GP surgeries or specialist clinics. And we will link GPs’ pay to the quality of the results they deliver.

Our reforms will devolve decision-making closer to patients, removing the need for expensive layers of bureaucracy to oversee the NHS. As a result, we will be able to cut the cost of NHS administration by a third and transfer resources that Labour is currently wasting on bureaucracy to support doctors and nurses on the frontline.

To make sure the NHS is funded on the basis of clinical need, not political expediency, we will create an independent NHS board to allocate resources to different parts of the country and make access to the NHS more equal.

1.2 A more Accessible and Accountable NHS

Our reform plan for the NHS will put patients first. They will be choosing the care they receive, and when and where they receive it. This will drive up quality, bring down waiting lists and improve cleanliness and infection control – because patients will choose to go to the best and safest hospitals where they can be seen most quickly.

Hospital-acquired infections like MRSA now kill more than three times as many people as are killed on the roads every year. So hospitals will not be paid in full for a treatment which leaves a patient with an avoidable infection.

Single rooms are needed to control infection and provide safety and privacy. We will end the scandal of mixed-sex accommodation and increase the number of single rooms in hospitals, as resources allow.

British patients should be among the first in the world to use effective treatments, but under Labour they are among the last. The current system lets Ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS. We will reform the way drug companies are paid for NHS medicines so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of their new treatments.

People want an NHS that is easy to access at any time of day or night. Labour’s plans to centralise the NHS have meant services closing and confusion about where to go for advice. We will reform NHS Direct and introduce a single number for every kind of urgent care to run in parallel with the emergency number 999. We will give people access to a doctor or nurse when the local family doctor’s surgery isn’t open, and we will stop the forced closure of A&E wards.

We want to give every mother and mother-to be world-class care, and to ensure that every child gets the best possible start in life. So a Conservative government will give mothers a real choice over where to have their baby,with NHS funding following their choices, and allow new providers to deliver maternity care – especially services like ante- and post-natal support. And we will introduce local ‘maternity networks’ to ensure that mothers can safely access the right care, in the right place, at the right time.

Under Labour fewer people are able to see an NHS dentist. So we will introduce a new dentistry contract that will tie newly-qualified dentists into the NHS for five years, allow dentists to fine people who consistently miss appointments, and stop paying dentists to carry out unnecessary appointments. These changes will allow us to give one million more people access to an NHS dentist and give every five year old a dental check-up.

One in four British adults experience at least one mental health problem in any given year and poor mental health costs the economy £77 billion each year. So we will remove the rules preventing welfare-to-work providers and employers purchasing services from Mental Health Trusts so that many more unemployed people and at-risk workers can be helped.

1.3 Improving the Nation’s Public Health

Today, the NHS faces unique upward pressures on spending. Lifestyle-linked health problems like obesity, smoking and alcohol abuse are putting huge demands on health services and are harming people’s quality of life. Our population is ageing, meaning more people living longer with chronic conditions and requiring regular treatment on the NHS. On top of this there is the pressure of infectious diseases like TB, HIV, Hepatitis C and pandemic flu. Each of these

At the same time, health inequalities are growing wider – the difference between the life expectancy of the richest and poorest in our country is now greater than at any time since the 19th century. We can’t go on like this. By creating an NHS that is accountable to patients not politicians, a Conservative government will be able to focus on public health and preventable disease – the surest route to improving the health of the nation.

With less political interference in the NHS, we will turn the Department of Health into a Department of Public Health so that the prevention of illness gets the attention from government it needs.

Prevention is better than cure, so we will provide separate public health funding to local authorities, which will be accountable for–and paid according to–how successful they are in improving their local communities’ health. And, as a progressive government, we will weight public health funding so that extra resources go to the poorest areas with the worst health outcomes through a new ‘health premium’.

It is essential that the parents and corers of terminally ill children get the support they need to make life liveable, comfortable and fun. We are extremely concerned that the government is not planning to renew the grant given to hospices to help support these children and their families. A Conservative government will provide £10 million a year funding beyond 2011 to support hospices in their vital work with children. In the long run, we will introduce a new per-patient funding system for all hospices and other providers of palliative care so that proper support for sick children and adults can continue.

Many patients with long-term health conditions want greater control over their care. We will preserve disability living allowance and attendance allowance and give patients with chronic illnesses or a long-term condition access to a single budget that combines their health and social care funding which they can tailor to their own needs.

The means test for social care leads to people being forced to sell their family homes to pay for care. For the first time, we will allow everyone – on retirement – to protect their homes from being sold to fund residential care costs by paying a one-off insurance premium of £8,000.

Download the Draft Conservative Party Health Manifesto here.

Congratulations to Marie Hoyle of Kakoty Practice who wins the Apple iPod Touch following her entry into our competition at the recent NAPC Conference. Look out for future competitions on our website and look out for the ongoing Cogniso templates as they begin to appear on our website: Business Planning imminent.

NHS to take responsibility for social care

The NHS is to be given far greater responsibility for social care under plans expected to be announced by the government in coming days, HSJ understands.

In what is claimed by Department of Health sources to be the most radical change to the NHS in decades, a paper to be published by health secretary Andy Burnham on the future “vision” for health policy is thought to include proposals to give the health service much greater involvement in social care.

The vision, considered a trailer for Labour’s manifesto commitments on health policy, is expected to emphasise the need for much closer integration of acute services, community services and social care.

In what is claimed by Department of Health sources to be the most radical change to the NHS in decades, a paper to be published by health secretary Andy Burnham on the future “vision” for health policy is thought to include proposals to give the health service much greater involvement in social care.

The vision, considered a trailer for Labour’s manifesto commitments on health policy, is expected to emphasise the need for much closer integration of acute services, community services and social care.

It comes ahead of the social care white paper in the new year, in which options will include merging of commissioning functions across health and social care. Ministers are understood to have instructed officials to work up different options for the ways in which primary care trusts and local authorities can work much more closely together.

The possibility of pooling budgets and joint commissioning of services have already been discussed. The government is also considering handing control of and funding for social care to primary care trusts. This would remove the incentive for health and social care to “shunt” costs from the NHS to local government and vice versa.

Social care is currently provided by local authorities, the majority of which are now Conservative controlled. A move towards greater control of social care by the NHS has been described to HSJ by an NHS source as one way to “rip the guts out of” Tory-controlled councils.

Since becoming health secretary, Mr Burnham has repeatedly said he wants to make the future of social care one of the top three issues in the general election campaign. A long-awaited green paper on the future of social care - and how to fund it in the face of the demographic time bomb caused by the ageing population - was published at the start of the summer.

Both Mr Burnham and the prime minister Gordon Brown have described their intention to set up a National Care Service to run alongside the much-loved NHS.

In a speech to NHS medical directors two weeks ago, NHS chief executive David Nicholson said: “We have got to think about how local government manages provision and whether we can integrate directly health and social care horizontally across the system.”

He said: “One of the bits of evidence we do know is that the real productivity gains, the real quality and productivity gains in the future, are at the interface of secondary and primary care, at the interface between NHS and social care, at the interface between empowered patient and the service.”

Mr Nicholson cited mental health trusts as a good model for the provision of integrated services. Several mental health trusts already provide both mental health services and social care through one organisation.

He said: “We’ve got a whole set of really good models for the integration of whole systems working and that’s our mental health trusts. Many of our mental health trusts run complete systems and do it fantastically effectively.

“And over the last few years have dramatically shifted the balance between hospital and community services. It seems to me that’s a really powerful model that we should think about much more seriously for the future.”

The Department of Health said at the time that further details on the implications of Mr Nicholson’s comments would not be available until after the pre-Budget report, which will be published tomorrow.

In addition to Mr Burnham’s vision for the future of the health service, the Department of Health is expected to publish its annual “operating framework”, setting out its expectations for the NHS in 2010-11, within the next two weeks.

A new Care Quality Commission (CQC) report published 27th October highlights that the NHS may be at risk of failing to prevent harm to patients from medicines due to inadequate information sharing.

Medicine-related issues may account for 4% of all hospital admissions and over 10,000 deaths in England a year with an estimated annual cost of £466 million in England is. (Pirmohamed et al, Adverse drug reactions as cause of admission to hospital, BMJ, 2004.)

The CQC highlights areas needing improvement.

The CQC reported that there are risks to the safety of patients when they are prescribed medicines, particularly after leaving hospital. Incidents involving medication, such as prescribing errors and failures to review medication after discharge, were the fourth most commonly reported to the National Patient Safety Agency during 2008. One study estimates around 4% of all hospital admissions are due to preventable medicine-related issues.

81% of GP practices surveyed said when hospitals sent them summaries of the care they had provided to patients, details of medicines prescribed were incomplete or inaccurate ‘all of the time’ or ‘most of the time’.

The CQC also found nearly half of practices were not systematically providing hospitals with information on: previous drug reactions (24%); other existing illnesses, known as co-morbidities (14%); or known allergies (11%), when patients are admitted.

The study highlights areas needing improvement. To learn from the report click here to go to the CQC website.

Tackling rising demand for services can seem like a daunting task. This toolkit helps to break demand down into factors and create manageable workplans to address them and achieve real local change, in line with QIPP – Quality, Innovation, Productivity and Prevention.

It contains examples from practices and PCTs that may help you as you formulate plans for dealing with increasing demand for emergency care in your area.

The DH have published a toolkit for improving urgent and emergency care pathways by understanding increases in 999 demand. PCTs can use this to inform their commissioning plans for ambulance services and identify areas for action in urgent care.

Tackling rising demand for services can seem like a daunting task. This toolkit helps to break demand down into factors and create manageable workplans to address them and achieve real local change, in line with QIPP – Quality, Innovation, Productivity and Prevention.

It contains examples from practices and PCTs that may help you as you formulate plans for dealing with increasing demand for emergency care in your area.

Click here to open the PDF Toolkit.

Whilst travelling the other day, I decided to read a book on organisational change and the hundred day challenge. Before I opened the book I glanced at the back cover where it read: ‘We don’t make tough calls. We try to accomplish far too much, spread our resources way too thin, and then wonder, why everything moves forwards at a snail’s pace.’

Christine O’Connor

Whilst travelling the other day, I decided to read a book on organisational change and the hundred day challenge. Before I opened the book I glanced at the back cover where it read: ‘We don’t make tough calls. We try to accomplish far too much, spread our resources way too thin, and then wonder, why everything moves forwards at a snail’s pace.’

That statement could have been written for the NHS. When you look back over the period of time since the launch of the NHS Plan, consider all the policy that has been written, the amount of reorganisation that has taken place, the number of high level consultants advising or involved with the NHS, and perhaps more importantly, the amount of tax payers money that was earmarked for investment and change to improve the patient experience, not a great deal has been achieved. Yes, waiting lists are much more a thing of the past and some services are now available closer to home in some areas, but has £60billion worth of change been delivered? I think not!

2009/10 sees unprecedented spending in the NHS at investment levels of circa £110billion. 2011/14 will see unprecedented levels of resource reduction for the NHS to the tune of £15-20billion as the credit crunch bites harder. So where does that leave the NHS from the point of the view that the required changes still need to happen but now there will be less and less financial resource to achieve it with and greater and greater efficiency savings expected. Only recently David Nicholson was quoted as saying ‘all bets are off’’ and advising that the NHS ‘needs to move away from being built for growth to being able to sustain itself in a prolonged limitation on resources’. He suggested that the scale of resource limitation would be such that the way the NHS has worked in the past will not necessarily deliver in the future. Now where have we heard that before?

The rise of the management consultant

Over the past years, the NHS has relied heavily on high powered management consultancies that generally advise large corporate organisations. This was best evidenced when ‘turnaround’ was in vogue. But were these consultancies the most appropriate to help the NHS through its financial change challenge by coming in and implementing ‘lean’ thinking and often dramatically cutting staff and services? Did this really help the NHS progress? Or once gone did the justification for reinvestment arrive in the planning process. In truth can methodologies which are applied to business truly be applied to the complex nature of a business that is funded by the tax payer, dependent on clinicians and overrun by management? How much of a difference to the day to day working of the NHS would it truly make if one layer of the all too often, innovation blocking management were to be taken out? How much more money then, could be channelled into the frontline approach to commissioning to really get the job of change delivered? Yet this drive towards resource limitation and efficiency savings may mean that even more money is spent on high level management consultancy and that could be even more worrying. I am not against using external support to enable changing working practice to take the NHS forward; why would I be; after all I am a change manager myself. But the difference comes when an external input enables the changes to reach the point ‘where the rubber hits the road’ as they say; in other words the clinician is the real answer to change delivery. This is where change consultancy needs to be active. We need to get back to the principles that started all this, and OK, before you say it, those ideas were not perfect either but the principles were sound. What am I talking about? Simple. As an example, the Kaiser Permanente principle of the clinician manager relationship, where the clinician leads the thinking and the manager does the doing. This in itself would make a major difference to achieving change and funnily enough isn’t that exactly what we are trying to achieve with Practice Based Commissioning?

Practice based Commissioning: the real change vehicle

I’m sure that heading has just made you chuckle, but you know that is exactly what Practice Based Commissioning was meant to be: the critical vehicle for change, putting the primary care clinician in the driving seat. But what has the NHS, in general, managed to do to a great change idea? This answer is very simple: neutralise it? How? Create as much bureaucracy around it as possible and make it truly difficult to lever an innovative idea. How many middle managers does it take to disable a business case: only one and it happens regularly and what happens when you continually get knocked back; you stop getting up for more! I exaggerate to make the point but I am sure that many of you reading this article will actually relate to this. My point however is truly important: Practice Based Commissioning is probably the only real change tool with the potential to see us through these troubled times and the GP is probably the person who will be in the best position to support the patient as services are challenged around the country due to lack of funds.

And so to change...

Can we do it! Yes we can! Do we want to? Probably not but this is about survival now. David Nicholson also recently talked about a ‘smouldering platform’. Kaplan and Norton in their books about the Balanced Scorecard approach to change and strategy talk about the ‘burning platform’. I have to say the ‘smouldering platform’ worries me more as this indicates much more of an unknown factor, a bit like never knowing exactly when the volcano will erupt.

So, it almost feels like the NHS is back where it started, before the NHS Plan. Maybe it is but it should be much richer for the learning and now much more able to change without reliance on finance as the lever. Many great leaders of change will say that real cultural change or the paradigm shift can only truly happen when there is nowhere else to go for the solution and it lies within; I think that is where we are now. Changed working practice is at the heart of making the NHS work. When I say that however I do not just mean clinicians changing their thinking and modus operandii, I mean managers and I mean the public. If the NHS is to survive to continue to be the ‘big idea’ that Bevan had: a service free at the point of delivery, then there are some truly tough challenges ahead and hard decisions to be made.

Is it deliverable?

Who knows? We have been trying for 12 years that I know of to deliver this new NHS. But perhaps now the environment is right. We have no extra funding to create ‘bolt on’ services because we are too frightened to decommission; managers in PCTs will have to cut teeth to begin to commission and performance manage their providers, who, just now, are far more street wise than they are; regulation and standards will begin to bite and challenge organisations, including general practices, regarding ‘fitness for purpose’ and the public will continue to demand a gold standard service for bronze level investment. It’s a tough nut to crack and I for one do not believe that any further investment in high level strategic input from management consultancy will make the change more likely to happen. Real deep change platforms require a crisis or a sense of urgency but even this can be viewed in different ways:

The pessimist: ‘We must change before someone else does it for us...it can only get worse!’
The realist: ‘We have to do this...our very existence is at stake!’
The optimist: ‘ Let’s change before we have to.These are challenging but exciting times. Clinicians have everything to play for. So how do we make the best opportunity.’

Intuitively we all know that it is best to change before you have to. Management consultancy however, will also need to consider how it needs to change to support execution and not just advise on strategy if it is to truly contribute to the agenda. I am still in the school of thought that if clinicians get behind this we can do it. So where does your thinking lie?

Christine O’Connor is Chief Executive of Catch On Group, a change management organisation with a focus on executing strategy and practice based commissioning.

I held an awayday for all the GP members shortly after I took over as chair. We thought about what our aspirations were for PBC and I fed back to the then-PCT chief executive that we felt PBC had to be a bigger deal for the PCT and much more about commissioning in the round rather than smaller schemes. The chief executive listened, agreed with where we were coming from and asked what we wanted.

THE DESIRED CHANGES

At this point we were very clear about what we wanted to change- and less so about what we actually wanted from the PCT to make this possible. The stumbling blocks we identified were:

• Disagreement over savings. We appeared to have saved £1m but the data was not robust enough to support this. The PCB consortium had been satisfied with how the budgets had been set but he director of finance questioned whether genuine savings had taken place or whether the budget had not been set as tightly as it could have been in the first place.
• A question mark over how the PCB manager should be replaced.
• PCB board meetings were a talking shop. Made up of 20 people, the majority from the PCT, little has happening in terms of business plans, workstreams or influencing commissioning.
• A feeling that we wanted to make PCB more about commissioning for the overall better health of Runcorn, a deprived area coming under Halton which has the third worst female life expectancy in England, higher than average rates of obesity,CVD,and alcohol-related hospital stays.
• All four consortiums in the PCT seemed to have different cost envelopes for PBC.
• We were not getting routine basic data on hospital activity, referral rates and so on.

APPOINTING CONSULTANTS

Catch On Group was already providing management support for a neighbouring PCT so they were on our patch. We invited a number of consultancies to pitch at a consortium board meeting and rates ranged from £500 to £1,500 a day. Catch on was the most focused on what we wanted and is one of the five organisations appointed by the Department of Health to support PBC. The PCT funded our work with Catch On, initially for six months and then another six months- we are now just coming to the end of this.

When we told the PCT about wanting to work with Catch On we simply explained the PBC manager had left and we wanted to use an external agency. They agreed bearing in mind the cost of appointing a new manager and paying GPs to do some of this work would have come to more than £100,000. Catch On doing eight to 10 days a month comes in at £7,500 plus VAT.

And because of the inactivity following the resignation of the manager, we had not fully dipped into the amount set aside for the PCB group for that year.

MAKING CHANGES

From the start, Catch On were clear our focus should be on what we wanted to achieve for the people of Runcorn. Our acute hospital, Halton General, had merged with Warrington some time before and for a variety of reasons was unable to sustain a range of services locally. So there was the opportunity to provide clinically appropriate services locally so patients didn't have to go off our patch.

Catch On and I visited each member practice to explain the direction-that we wanted to become an autonomous consortium and therefore we needed to put some structures in place.

Catch On gave us an external view of our arrangements. We needed someone with enough clout and authority to say "this is what is right and acceptable"

They told us we wouldn't get anywhere unless we made certain changes,particularly concerning the board structure, and they helped us talk yo the PCT with some authority rather than just sounding as if we were moaning.

OUTCOMES

Becoming independent
We wanted to be independent from the PCT and Catch on provided clarity that having a business manager employed by the PCT wasn't the way to achieve this. Catch On had a very clear expectation of what the board was supposed to be - that it is a job of work, not just turning up to meetings. And that it was about seizing the agenda ourselves.

They suggested we move to a smaller code board of six GPs, nurses, practice managers and so on, to focus on a particular project.

We now have a more streamlined process for business plans. Those under £50,000 will go to a smaller group at the PCT, including the four local PBC chairs, so they can be signed off much faster, Individual practices are now committed to, and held accountable for, delivering those workstreams. We have got a number of business plans that are being submitted, including cardiovascular risk screening. And we refreshing a number of other business plans that were already in place but not really active, such as extra services for mental health. Some £498,000 of submitted business cases have now been agreed in principle.

Drawing a line under the 'savings'
The savings issue was a thorny one and it's very difficult given our circumstances to know the reality of the situation. The PCT and consortium have drawn a line under it and there is an agreement to provide recurrent  funding of £1m a year for our PBC group - separate from PBC incentive funds and management allowance - so we are clearly going forward.

We've agreed we won't get too hung up on whether the funding is from consortium savings as long as we got good services into place. That's what's important, not whose budget it is. The director of finance told me 'we should give you the budget and let you get on with it'. Whether that will happen, I don't know, but there is a sea change in how business should be done.

Fairer funding
We no have a standard cost envelope for running all four PBC boards across the PCT patch, with the same funding per head. Catch On provoked some real cultural change there and the system for funding consortiums is a lot clearer and a lot fairer. The final figures have not been agreed yet but we submitted a document to the PCT outlining our expectations and explaining what we considered to be acceptable and those point were applied to all four PBC groups.

Better data
We had some real problems with data. Catch On helped us negotiate and the PCT responded by making some real changes. Now each practice see its own data for referrals and hospital activity monthly, including admissions for one day or less. And the PCT has approved support with analysis. Its approach now is to ask 'what do you need and how can we help you?'. Before, we were getting excuses and excuses, now we are getting really useful data we can actually unpick.

Last November, the PCT scored 10 for performance management under World Class Commissioning, but once for information. Now the PCT has set up a clinical care group where we GPs sit around a table and talk about what information we need. We get details on the top 10 patients who have attended A&E or been admitted as electives. And we can look at how they presented, whether it was by GP referral or self-referral or 999 and what condition they were admitted for and what the communication was between secondary and primary care.

With finances, before it was always a bit of smoke and mirrors. Now we  understand budget-setting methodology and how funds can be released against business plans.

Better PCT relations
The PCT has responded very well to our grasping the nettle. Without Catch On, things might have been very different. We now have a good representation at PCT level on all the various  commissioning groups. There seems to have been a sea change in how PCT managers view the consortium - they realise their aspirations for health gains can't be achieved without us. So now the consortium is working with the PCT on the same agenda around health gain.

Dr Cliff Richards is a GP and chair of Runcorn PBC consortium

Hampshire, UK, 28th November 2008 - Catch On Group has been successfully appointedby the Department of Health to support the development of practice based commissioning (PBC) across England.

On hearing the news, Chief Executive, Christine O'Connor said; "Catch On are delighted to have been one of the five organisations selected. We are already working with 15 PBC consortia and 20 PCTs across England. Our practical experience means we have a wealth of tools and techniques which we hope can be used to benefit more areas of the country."

"We believe that harnessing the skills of clinicians to lead identified change in services in order to deliver better care for patients is essential to the future of us all as users of the NHS and as taxpayers. Working with PCTs to harness their skills in contracting and larger scale commissioning and supporting them to enable practice based commissioning can result in the delivery of real, sustainable service change."

The framework contract commences from December 2008 and runs for 3-5 years. Details on accessing the framework approach can be found on www.dh.gov.uk. For further information about Catch On Group please visit our website www.catchon.co.uk and click on the Practice Based Commissioning page or contact us at pbc@catchon.co.uk.