Since its formation in 2007 BPCC has consistently focussed on a number of key areas:
Engagement of Practices in BPCC and moving the health economy towards financial balance
The BPCC Executive has encouraged all member practices to understand PBC and have encouraged the acceptance of budget responsibility and accountability. This has been done through visits to all practices, discussion at BPCC council meetings, and the ongoing development of a ‘devolvement framework’ to allow BPCC to begin the process of moving towards a shadow budget and introduction of an Integrated Care Organisation. In 2009 all BPCC practices expressed the desire to move towards taking budget responsibility. In 2009/10, for the first time in a number of years, NHS Bucks has achieved a balanced budget and BPCC is pleased to have been able to contribute to this success. Since its formation in 2007 BPCC will have returned some £8-10M to NHS Bucks in efficiency savings achieved, to benefit the wider health economy.
Efficient prescribing with savings shared between Practices and the PCT (all savings reinvested for patient benefit)
BPCC Practices have been successful over the past three years in maintaining quality prescribing whilst controlling costs. This has been achieved through excellent Executive leadership, accurate timely information, a reasonable budget with the right incentives, and tailored support where appropriate. Investment by BPCC in this area to date has been some £350k. This funding has paid for a software programme (Script Switch) to help GPs identify the most appropriate medicine to prescribe and for Pharmacy Advisers to work with individual Practices and across BPCC to identify and help implement changes. Savings since inception have amounted to some £6M, all of which have been reinvested to provide patient benefits.
Effective management of referrals through clinical audit and education
GPs will seek additional help in the care and management of a patient’s condition where this is required in their clinical judgement. This can be achieved by various methods and not just by referring a patient to a consultant at a hospital. Inappropriate referrals to hospital are both time consuming and inconvenient for patients and expensive for the health economy. Identifying and using more appropriate local forms of referral, where available and seeking advice by telephone, can be of significant benefit to the patient and can help to save valuable resources. Over the last 2 years from 2007/8 to 2009/10 BPCC member practices have reduced referrals to hospitals by well over 10% without compromising patient care.
Increased primary care management of people with Diabetes and Chronic Obstructive Pulmonary Disease (COPD)
BPCC Practices have over 10,000 people registered with diabetes (3.4% of the patient population) and already manage most of those with Type 2 Diabetes in primary care. Many of its Practices also provide insulin initiation and, having identified those who have attended secondary care outpatient clinics; Practices are reviewing their patients with a view to seeking discharge where appropriate. As a result, patients who have traditionally had their diabetic care in the local hospital are gradually having more of their care at their local GP practice and therefore avoiding multiple hospital visits.
Overall, rates of emergency hospital admissions for diabetes are lower than the national average. However, the rate has been increasing in the most deprived 5% of the population. BPCC continues to work with its Practices, through working together and mutual support within clusters, to try to reverse the increasing rate of admissions, and to increase the percentage of people with good glycaemic control.
The number of people registered with COPD in BPCC Practices is some 2,700 (0.9% of the patient population), whilst the annual rate of emergency hospital admissions for COPD is 1 in 12 of those registered. A management programme for those with COPD has been rolled out across all Practices and early results are showing improvements in caring for those with this condition as well as reduced admissions.
Identification and more proactive care of those most at risk of hospital admission (referred to as ‘vulnerable patients’), including those in care homes and at ‘end of life’
Most patients would prefer to avoid having to be admitted to hospital unless it is absolutely necessary. Patients who have longer term illnesses or conditions (vulnerable patients) are generally more at risk of being admitted unexpectedly, but early intervention can reduce this risk. Similarly most people would prefer to die at home rather than in hospital. Helping those close to the end of life to achieve this is also important.
The aim of these programmes is to encourage and enable Practices to give more time to proactive management of those at greatest risk of multiple or terminal admissions into hospital, and thereby reduce the need for emergency admissions. This involves Practices:
Almost all patients in Care Homes served by BPCC Practices, who wish to have them, now have Advanced Care Plans, and admissions have fallen proportionately - emergency admissions from one Care Home has fallen by some 75%.