Practice Based Commissioning (PbC) Alliances: Commissioning Priorities

The four PbC Alliances in the Bradford District area have published their commissioning priorities, both as individual alliances and common district wide priorities as part of Bradford and Airedale tPCT health strategy; Achieving the best health for all. A major part of work for the alliances is the redesign of care pathways and a focus on mental health, emergency admissions and developing community services.

For more information on Practice Based Commissioning (PbC) see http://thirdsectorhealth.blogspot.com/2008/11/practice-based-commissioning-pbc.html

Re-design of Care Pathways
The structure of four alliances that coordinate PBC activity across four geographical areas ensures that primary care professionals can influence how services can be redesigned and commissioned to address the needs of their local population.

Lead by clinical leaders, current pathways of care have been reviewed and priorities identified for system-wide redesign including:

• Musculo-skeletal
• Cancer
• Ophthalmology
• Diabetes
• Sexual health
• Mental health
• Alcohol services
• Older people’s mental health
• Stroke
• Maternity
• Children
• Palliative Care

Under PBC, practices have developed commissioning plans on both an individual practice basis and on a more detailed basis for the alliance population. These set out priorities and aspirations for their patients and are based on robust health needs information for practice and alliance populations and on the local clinical intelligence that practices bring on the gaps in current service provision. A summary of the broad areas upon which alliances are focusing their efforts is detailed below:

Airedale and Wharfedale Alliance
 Reducing emergency admissions. Care pathways will be redesigned for patients being admitted to hospital for up to one day stays in order to reduce the number of inappropriate admissions.
 Developing community services. The role of community matrons will be expanded, along with expanding therapy services, intermediate care, the role of community pharmacy and the use of the voluntary sector. The provision of community services in neurology, anticoagulant and diabetes are also being identified as priorities.
 Improving the support in primary care for patients with mental health problems.
 The expansion of community counselling services, community mental health teams and the extension of the use of the third sector have been identified as areas of need.

CityCare Alliance
 Addressing health inequalities - CHD, diabetes, obesity, smoking cessation, infant mortality and COPD by using a range of different prevention and treatment options.
 Demand management and access to services – reducing emergency admissions.
 Service redesign – self care, management of long term conditions.
 Developing partnerships - seeking to develop partnerships within the community, other commissioners and service providers including the third sector.

Bradford South and West Alliance
 Reducing health inequalities. Including a primary care based alcohol support service, weight management services for the obese and overweight, sexual health services with a particular focus on teenage pregnancy, targeted smoking cessation services, community development workers for the most deprived areas and working with other providers such as children’s centres and older people’s CVS services to better integrate local support.
 Improving community based services to reduce emergency admissions. Including the management of more patients with respiratory, cardiac, and vascular conditions within primary and community care settings by developing the role of community matrons and community services, reducing falls, using the third sector and supporting patients to manage their own conditions.
 Improving the support in primary care for patients with mental health problems.
 Providing a primary care gateway service for patients, signposting and access to more generic services, counselling and psychotherapy services. Improving identification and the support of patients with dementia and increasing access and availability of social prescribing.

Yorkshire Primary Care Alliance
 Improving the support in primary care for patients with mental health problems.
 The expansion of community counselling services, community mental health teams and the extension of the use of the third sector have been identified as areas of need.
 Improve services for older people including those with mental health problems and the management of long term conditions, such as falls prevention.
 Provision of case managers to proactively manage long term conditions
 Improve sexual health and teenage pregnancy rates.
 Provide greater access to screening, prevention, primary and community services. To work in partnership with other agencies to provide an holistic approach to service delivery.