DESIGNED TO CARE

Renewing the National Health Service in Scotland

A. Resource Allocation

1. The Health Board's allocation from The Scottish Office Department of Health will comprise its weighted capitation share of resources for HCHS, Prescribing, GMS and other practitioner related costs; and any specific funding requirements (Figure 2).

2. There will be agreed allocation adjustments between Health Boards to account for cross-boundary flows.

3. Health Boards will determine the initial allocation to its Primary and Acute Hospital Trusts, based again on the resource assumptions and plans in the HIP and TIPs.

4. PCTs can therefore expect an allocation that contains provision for their hospital based and community services, and their share of resources for prescribing, and GMS cash-limited funds. They will then set budgets for their hospital services by care group e.g. mental health, elderly, etc.; and for community based services.

5. PCTs will also take the lead in discussions on the application of the Joint Investment Fund (JIF) allocated by the Health Board.

Figure 2

B. Local Health Care Co-operatives

6. Co-operatives will cover natural communities. Their size will vary according to geography in the range 25,000 - 150,000.

7. Co-operatives will be an operational unit within the PCT responsible for managing and delivering integrated services across a defined area. The Co-operatives will be separate management entities but an integral part of the PCT.

8. The Co-operative structure will allow GPs to develop extended primary care teams which encompass district nursing, health visiting, midwives, community psychiatric nurses and professions allied to medicine within a multi-practice framework. Practices will be able to provide a wider range of services for their patients and will have access to specialist support e.g. public health, health promotion. Co-operatives will manage their own staff although contracts of employment will normally be held by the PCT.

9. GPs who do not wish to join a Co-operative will be allocated a notional budget for prescribing and their share of cash-limited General Medical Services. Community Services will be provided for them either by the Co-operative where there is one covering the majority of the area or by the area manager.

10. In areas where there is no Co-operative, transitional arrangements will allow existing GP fundholders to continue to hold a budget for community based services.

11. To allow for the development of different models to suit local circumstances, the Trust will allocate the Co-operative a budget that comprises some or all of the following:

• an agreed level of resources for community based clinical and PAM services based on weighted capitation;
• GMS cash-limited, which over time will move to a weighted capitation base;
• prescribing costs, which over time will move to a weighted capitation base;
• community hospital budget;
• an appropriate share of the JIF.

12. Whilst they will be responsible for managing and operating their budget, cash will be administered by the Trust, to whom the Co-operatives are financially accountable.

13. The Co-operative will be able to vire between individual budget heads, but as part of the PCT will be expected to contain expenditure within its overall allocated budget.

14. Co-operatives will be required to present regular financial and performance data to the Trust as well as an annual report that covers both financial and service information.

15. Expenditure by the Co-operatives will be accounted for separately by the Trust and consolidated in its annual account. Thus a Co-operative will be subject to audit examination by the Trust's statutory auditor - to whatever level the latter considers appropriate.