Transcript Document
'Business Opportunities arising from the White Paper'
PSMG, 30
th
January 2007
Paul Midgley Director The Healthcare Partnership
Office -0870 2413506
Overview
•
Introduction to
‘Our Health, Our Care, Our Say’
•
Overview of the four key themes
–
Theme one – case study
–
Theme two – case study
–
Theme three – case study
–
Theme four – case study
•
Issues – knowledge, skills, structural alignment, data
•
Summary – opportunities for partnership working
The single most important document since the NHS Plan of 2000……
Our health, our care, our say:
a new direction for community services
www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf
• Public consultation Summer /Autumn 2005 • Published January 30 Summer 2006 th 2006, passed by Parliament • England only • 240 pages • 10 year reform programme – legally binding
Our health, our care, our say: making it happen
Health and social care working together in partnership
October 2006 Progress report from 80 pilot sites
www.dh.gov.uk/assetRoot/04/14/00/65/04140065.pdf
Prevention & early intervention Improved Access, Tackling inequalities Choice and patient involvement Meeting needs of Patients with long term conditions
Smoking cessation Tackling obesity More homecare using technology
Prevention & early intervention
Reducing incapacity related unemployment Increasing resources and planning for prevention and early intervention Increasing self care and appropriate conditions management
Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions
Prevention & early intervention
Increased information on, and more input into support package for service users and carers Local service users input/feedback on services to be actioned where problems identified
Choice and patient involvement
Increased user satisfaction with their care package
Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions
Case Study – Individual budgets
Prevention & early intervention Choice and patient involvement
Joint working between health and social care communities and authorities to reduce inequalities Increasing
range
of urgent care services Easier registration with GPs, and improved access and convenience
Improved Access, Tackling inequalities More community based services
Promoting emotional and physical wellbeing services to prevent mental and physical health problems
Meeting needs of Patients with long term conditions
Improved support for patients @ home to prevent admissions including use of technology Improving community support for patients discharged from hospital Shifting services from acute hospitals to community settings
Specialties targeted for Hospital to community shift
• Dermatology • Urology • Orthopaedics • General Surgery • Gynaecology • ENT
To be addressed in ALL PCTs’ Local Delivery Plans…….and Foundation Trusts’ & Acute Trusts’ business plans – White Paper implementation will be monitored by the SHA & Monitor
PBC Early wins & top tips
PBC – early wins and top tips - DoH, February 2006
• Pathways for GPs to consider for redesign:
– COPD – Heart Failure – Long term conditions – Mental Health – Ophthalmology – Podiatry
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Most chosen clinical specialties in PBC plans* for redesign
These cover the obvious “ quick wins ” as follows :
Specialties
Dermatology Admissions Management Unplanned/ Urgent Care Diabetes COPD
Number of PCTS
86 73 56 46
% of Total
53.4 45.3 34.8 28.6 Orthopaedics and Trauma ENT Gynaecology/Obstetrics Cardiovascular Disease Musculo- skeletal Ophthalmology Prescribing Diagnostics Referral Management Urology Surgery – Minor Long-term Conditions Mental Health Rheumatology 44 43 37 34 33 30 30 29 28 24 23 20 19 19 27.3 26.7 23.0 21.1
20.5 18.6 18.6 18.0 17.4 14.9 14.3 12.4 11.8 11.8
* www.nhis.info - specialist enquiry
Key features of service redesign
1. Health needs assessment identifies priority clinical area for redesign (e.g. ‘Local Delivery Plan’ priorities, public health) 2. Existing clinical pathway mapped out and costed 3. All stakeholders meet to brainstorm options (facilitation!) 4. Various points of the pathway may be changed community based service, plus voluntary sector involvement – including use of PWSIs & consultants or specialist nurses running – looking for quick wins and cost savings first 5. Detailed Business Case(s) submitted to PCT outlining clinical and financial benefits of redesign of specific aspects by potential service providers 6.
‘Contracts’ set up for any new providers to be ‘accredited’ – may be accessible via Choose and Book’ referral system 7. Newly re-designed services will operate via protocols or guidelines including drug use (formularies)
e.g. Principia in S Notts – combining PBC & community nursing services e.g. United Health (Europe) in Derbyshire
Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities
Increased support for self care, an increase in ‘Expert Patients’ and ‘Expert Carers’ programme availability Users and carers get choice of services as close to home as possible
Meeting needs of Patients with long term conditions
Local partnerships between health and social care to deliver better services Prevention of avoidable hospital admissions
Services closer to home
Empowering & enabling individuals with long term conditions to take control of their health Regular Secondary care admissions
High % of professional care High-risk cases
Risk management in primary care e.g. Community Matrons
Equally shared care
Mainly managed in primary care including GPSI
More complex cases High % of self care
Diagnosed by primary care, health maintained by annual disease reviews Patients enrolled into ‘Expert Patient’ schemes
70 –80% of the people with long-term conditions
‘we could expect people who have gained self-management skills to make around 40% fewer visits to their GPs and 17% fewer visits to outpatient clinics. We can also expect 50% reductions in length of stay in hospital, and days off work because of sickness’
http://www.expertpatients.nhs.uk/public/default.aspx?load=publications
Dr Ian Greaves, Gnosall Medical Centre, SW Staffs
What does all this mean to pharma?
– – – – –
Selling in a post-White Paper NHS world Market Intelligence/Data/Joint business planning
• Whole primary and secondary care team need to know what’s on the PCT’s/each PBC cluster’s service re-design agenda and produce an integrated plan for working priority clusters
Networking/Influencing
• With key individuals in high potential clusters or high current users • Between secondary care and primary care KOLs • Provide redesign e.g.s from elsewhere • Network your KOLs with innovator KOLs from areas that have already successfully redesigned a similar service
Facilitation/Partnership
• Meetings – organising, facilitating, funding – practice/cluster/super-cluster/PCT/SHA/national level – With board/steering group stakeholders – With full service redesign group (multidisciplinary) – With full cluster group ie all practices represented
Evidence for guideline/formulary inclusion inc. health outcomes data
• Medical Information evidence pack for your product • Local/national KOL endorsement in person plus copies of existing protocols
Flexible Pull Through/Data/local marketing capability
• once product on guidelines, pull through by publicising guidelines in calls at meetings, etc • Production of locally approved materials
Who are pharma’s customers in
Other hospital Based advocates* PBC Cluster* Board Lead GP Director of Adult Social Services?
a PBC driven market?
Consultant* Area Px committee KOL Product members GP PBC* Cluster Board member GP PBC lead* for PCT PBC Commissioning practice Advocates GP lead* in disease area GPSI* in area of Interest to your product GP Senior * Director of Public Health (NHS/LA)?
Expert Patient manager PCT educational lead Protected learning time Community Nurse* PCT *pharmacist Medicines Management team Specialists inc matrons Salaried GP* GP Partner* Partner Other PBC Cluster board Tutors?
members Practice Manager Practice Nurse - non prescribing Prescribing * Practice Nurse -variety of grades & specialisations Community* Pharmacists – (extended service Provider?) Valued added Service providers – Improve access e.g. training
* Potential Rxer
Partnering opportunities
• 90% of practices are part of a
PBC group –
the new PCGs • 95% of practices have a
PBC business plan –
you need a copy •
Saving money
is a key driver in 2006-7 – beware!
• Providing more
services outside hospitals
is a key driver •
Service redesign
is complex, requires excellent
networking
and
communication skills (including local marketing)
• PHARMA has the
skills and resources the NHS needs
•
Patient education
is key – a Pharma strength •
Good intelligence
is paramount – you need data sources and skilled manpower to seek out opportunities for early engagement • More
formularies
will result from PBC – evidence based, peer reviewed prescribing will become widespread in primary care, requiring an account management approach