Outcome Based Commissioning
This discussion paper has been produced by the RCGP
Overview
There is clearly a problem in the way that General Practice is resourced. The Put Patients First –Back General Practice campaign has articulated the challenges we face from decreasing resources at a time of increasing workload in General Practice and wider Primary Care. This is perhaps inevitable given the different funding mechanisms that are in place in the NHS. Much of the resource given to secondary care is activity based – the more that gets done the more that gets paid – and this drives certain types of activity ever upwards. Politicians champion this by declaring triumphantly that year on year the NHS does more and more. In General Practice the more we do,the same we get. General Practice is seen as a sponge that can soak up work, including work moved from hospitals into the community; but the sponge is now saturated and is leaking all over the floor. The consequences of these funding mechanisms being misaligned are not just inadequate funding for primary care but also fragmentation of care, over-specified commissioning,poor quality of care and waste. Primary and secondary care funding needs to be aligned and needs to follow, not activity, but added value or outcomes. This paper begins to outline the need to move to a different funding mechanism based around outcomes that are virtuous not only for the individual but for primary care, the wider health care system and society itself. A move away from providing care in a transactional activity driven model would result in a better use of resources and is likely to
decrease the overall environmental footprint of health care in the UK. This would result in commissioning for the “Triple Bottom Line” which includes the needs of individuals and society, the economy and finally the biosphere itself. There is of course a need to underpin any funding
mechanism with a core offer in order to maintain the safety net of the provision of universal accessto General Practice services. A move to this form of funding would enable General Practice tobecome locked into a funding mechanism that would help us to move to a system that is more
sustainable, targeting resources towards keeping people well rather than paying when they become ill. It would also support the development of organisations with general practice at their heart that could support a sustainable future for primary care.
