Transcript The Future of Primary Care

The New NHS Opportunities
for Optometrists
Chris Town
Acting Chief Executive
Cambridgeshire PCT
The NHS is Changing –Why ?
• Rising deficits/overtrading £800m at end 2005/06 in spite
of unprecedented rise in expenditure from £32 billion in
1997 to projected £90 billion in 2008/09
• Government and independent observers believe that
there has been little transformational change resulting
from the new investment.
• PCT’s have not given commissioning sufficient priority
• The NHS has a lack of consistent data and the
knowledge of how to use it
• There is duplication of effort by multiple PCTs in the
technical process of contracting
• There are increasing concerns about Primary Care
performance - access, demand management, efficient use
of NHS resources including prescribing
• Clinicians have become less engaged in the processes of
decision making in recent years
• Some Acute Trusts have been “game playing” in regard to
Payment by Results and are still seen to be in an overall
position of strength
• ‘Minimal change’ is seen to be resulting from new contracts
for both Contractors and Employed staff including
Consultatnts
• Everyone seems to accept the need to focus on front end
prevention to begin to engineer shift in public behaviours
and expectation but little appears to be happening.
• The future
– A nation getting older
– Incidence of obesity/Diabetes etc rising rapidly
– 15 million people with long term conditions
– Major technological opportunities
• People want change:
– Greater control of their own health
– Support to remain independent
– Real choice
– More local care
– Care that is better integrated around individual needs
The New NHS
Money following the
patients, rewarding the
best and most efficient
providers, giving others
the incentive to improve
(transactional reforms)
More choice and a much
stronger voice for patients
(demand-side reforms)
Better care
Better patient
experience
Better value for
money
A framework of system
management, regulation
and decision making which
guarantees safety and
quality, fairness, equity and
value for money
(system management
reforms)
More diverse providers,
with more freedom to
innovate and improve
services
(supply-side reforms)
Therefore
• NHS and Private Sector are encouraged to develop
alternatives to traditional NHS services e. g
diagnostics , surgery, Primary Care etc
• PCT’s become the custodian of the health budget
and are responsible for ensuring health is improved
not providing care
• Patients make informed choices re where to get care
• Reducing tariff and competition mean costs are
managed and providers compete on basis of quality
• Practice Based Commissioners buy services “closer
to home” to prevent hospital referral/admission
• PBC is key to demand management – ensuring
patient and clinician concordance with care
pathways!
Old Principle
New Principle
The NHS is divided into primary
and secondary care and the
objective is to shift work from the
latter institutional to the former;
health and social care are separate
sectors
Patients require integrated
services designed to meet their
needs .
Diagnostics services are based in
hospital
Diagnostics are available where
appropriate
Consultants are specialists who
work in hospital
Consultants and other specialists
work in the most appropriate
settings
Consultants can only cover one site
Consultants work in networks
Old Principle
New Principle
GPs make home visits
A range of professionals can make
home visits
Patients are referred to
consultants
Patients can be referred to a range
of specialist professionals
Doctors prescribe
A range of clinicians prescribe
Strict demarcation between staff
and health and social care
Integrated teams focused on the
needs of patients
Planning is based on
professional roles
Planning is based on competence
The Challenges
• For PCT’s - Relationships will be critical: with
Independent Contractors, with local authority
commissioners, with providers(public and private
sector) and with the public
• Engagement of all stakeholders in the direction of
travel will need to be broadly based and rooted in
robust analysis.
• There will need to be a sustained, open and honest
conversation about change and priorities.
(Rationing ! )
• Anyone wishing to contract with the NHS will have to
feel and respond to challenge on quality and on
patients’ experience.
The End Point !
• Clinicians are engaged and accountable for
their decisions.
• The NHS and Hospitals in particular, manage
costs
• Unsuccessful providers go out of business
• Practice Based Commissioners manage
patient demand
• Patients get the right care in the right place
• Overall health of the population is improved
• Public/Politicians think the NHS is delivering
value for money !
Threats and Opportunities
For Optometrists
• Most PCT’s won’t know much about
what you have to offer
• Can you get access to the decision
makers to sell your proposals – would
you know who to approach ?
• Can you produce a realistic business
proposal/plan.
Specific Opportunities
• What can you offer PCT/PBC as alternatives
to hospital referral and follow up
appointments?
• Can you prevent admissions ?
• Payments for hospital procedures are fixed
so can you offer better costs for certain
diagnostic/treatment procedures?
• Can you offer better access to patients e.g
appointment times, locations.
Thought For The Day
It's always darkest before dawn. So if you're
going to steal the neighbour's newspaper, that's
the time to do it.