STAR Medical

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customer insights

March 2008

Industry intelligence in association with STAR

Practice-based Commissioning is steadily establishing itself across the NHS. This month, Customer Insights profiles a role at the heart of this important activity. We interview Dinah Roy, Chair of a PBC Group in County Durham, and GP.

Define the Group and your role within it.

The PBC Group comprises 11 GP practices covering a population of 92,000 patients in Sedgefield Borough. Each practice has a responsibility to conduct PBC. Our purpose is to facilitate that and to do it as a group. Our function is to determine local health need and develop plans to meet it. As Chair, my role is to determine the direction of the group and negotiate with the PCT to get managerial, analytical and administrative support to implement these plans.

How does the relationship with the PCT work?

Each practice has an indicative commissioning budget. The PCT sets this budget and retains overall responsibility and accountability for financial balance. This creates a challenge for the PBC Group. Our aim is to develop plans to meet local health need, but the PCT covers a much larger population and although the health needs identified by the Director of Public Health are usually in line with the things you want to do locally, there are often additional things needed locally that are not integrated with the wider PCT plan. One of my main challenges is to improve that way of working to help practices understand about population needs and create commissioning plans based on the profile of their individual populations.

How does the commissioning process work at practice level?

A practice will come forward and identify a particular service that it thinks may be good for its population. At this point, they need to come up with a pathway and a business case for the service to be commissioned. But there is a great deal of confusion around this. The PCT needs to see a ‘commissioning intention’ – a robust plan that outlines why a service needs commissioning and the likely impact it will have. These commissioning intentions have to integrate with the PCT commissioning plan – there should only be one plan – and only once this is agreed can a practice switch hats and become providers and develop business cases to provide those services.

How can pharma help?

The industry can help provide crucial information. We often look to the PCT to provide analytical support and data on which we hope to base our commissioning decisions – referral patterns, prescribing trends etc. But it is not always easy to get this data from the PCT. This provides an opportunity for pharma. For example, I recently had contact with a representative who came to speak to me about a drug for peripheral vascular disease. In one sense, the drug was of no interest to me at all, but with him he had already prepared validated guidelines, validated pathways and examples of how services could be constructed to help identify appropriate patients. In a separate follow-up appointment, we started to get into the area of service redesign. This was really helpful. It’s easy to have good ideas about services – in fact it’s overwhelming and there’s too much of it – but to have support and information that is validated, and information about what has been done elsewhere is invaluable.

What other type of information is useful?

I get a lot of non-promotional contact with pharma, where we talk about service development or go through programmes that analyse prescribing data that they get from various sources – they are trying to be helpful and show how switching products can make savings etc. That’s helpful because again, though we look to the PCT for data it’s not always forthcoming as quickly as we would like. However, in that case, it’s always a bit of a hard sell. The service development stuff is actually more helpful.

How can pharma improve its interaction with you?

Often, it seems that some pharma people don’t understand how PBC works and where to pitch their support. There is a clear process. First, practices have to do the commissioning intention, get it all approved and pass over a plan to improve local health. Then there’ll be a service specification drawn up by the PCT, at which point practices can put themselves forward as willing providers. Pharma needs to get involved early on, because it is vital to get into the commissioning intention. They need to understand that they can’t actually start setting up the service at that point, but that it’s about identifying that there is a need and then showing how it can be met later on.

What other advice would you give pharma?

Don’t disregard the GP. Important information can reach us via GPs and there are many examples of where such exchanges have led to instances of service redesign. For example, we recently designed and commissioned a different pathway for patients with DVT. Two companies who provide different types of subcutaneous heparin contacted a GP and gave information for redesigning the service in a way that allowed us to anticoagulate patients in the community at the point they presented with symptoms, while they awaited their results. The doctors realised this was do-able and it really motivated them to support the idea. The reason to continue contact with individual GPs is because if they think something is going to work and help them, they will do it. In general, they don’t like theoretical information, but if they get the sense that an idea is workable and they can do it in their practice, it really appeals. So it is still worth representatives talking to individual practitioners but they need to change their emphasis. Instead of saying ‘this is a good drug and better than the competitor’s’ they should be saying ‘this is a place in this pathway’ where you should use the drug and this is the outcome that you’ll achieve and the improvement in health. And this is how you can fit it into your commissioning plan.

What is your main message to medical representatives?

I want to know that they’ve got something that is going to help the PBC group develop services. But I don’t want to have to spend all my time telling them how practice-based commissioning is supposed to work.

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STAR Medical

STAR House / 4 Kelso Place / Upper Bristol Road / BATH BA1 3AU

Tel: 01225 336 335 / Fax: 01225 326 398 / Email: solutions@starmedical.co.uk

STAR Medical Ltd. is registered in England & Wales Reg. No. 448 7307.
STAR Medical Contracts Ltd. is registered in England & Wales Reg. No. 577 0769.
Registered address 4 Kelso Place / Upper Bristol Road / BATH BA1 3AU.

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customer insights

March 2008

Industry intelligence in association with STAR

Define the Group and your role within it.

How does the relationship with the PCT work?

How does the commissioning process work at practice level?

How can pharma help?

What other type of information is useful?

How can pharma improve its interaction with you?

What other advice would you give pharma?

What is your main message to medical representatives?

exceptional job search

advanced job search

top ten jobs

Paediatric Representative, £28-32k plus £9k bonus

Territory Sales Rep - up to £30k salary!

Healthcare Development Manager

Sales Representative, top capital equipment company

Sales Rep, top healthcare company

Leadership and Development Manager, £50-60k!

Sales Specialist/Hospital Specialist West London

PCB Account Manager

Care Homes Account Sales Manager, Kent