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Equity and Excellence:
Liberating the NHS
Ian Tipney
Chief Executive – NHS Somerset
23 September 2010
Timetable for Action
(Subject to Parliamentary Approval for Legislation)
Date
Health Bill introduced in Parliament
Shadow NHS Commissioning Board established as a special
health authority
Autumn 2010
April 2011
GP Consortia established in shadow form
2011/12
Formal establishment of all GP Consortia
2012
Strategic Health Authorities are abolished
2012/13
NHS Commissioning Board makes allocations for 2013/14 direct
to GP Consortia
Primary Care Trusts are abolished
GP Consortia hold contracts with providers
Autumn 2012
From April 2013
April 2013
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In Summary

Three year transition in which Primary Care Trusts retain statutory
responsibilities whilst GP Consortia emerge
There needs to be a recognition that:

Primary Care Trust will not retain current staff during the three year period and
recruitment/replacement will be problematic

GP Consortia need to be confirmed/licensed and developed to be fit for
purpose

We should assume that with Strategic Health Authorities and Primary Care
Trusts being abolished all statutory functions will be transferred to the GP
Consortia with the exception of responsibilities of NHS Commissioning Board,
Specialist Commissioning and Public Health – all to be defined

Through all the changes the public and patients need to have confidence in the
local NHS and reputation management within Somerset is crucial. This will be
particularly important for emerging GP Consortia
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Issues
• The development of GP Consortia
• Delivering Quality, Innovation, Productivity and Prevention
(QIPP) during the three year period
• Maintenance of a healthy system
• Reducing management costs by over 45% and ensuring
that organisations are fit for purpose
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GP Consortia
The Journey:
Somerset Health Authority with four
Primary Care Groups (2002)
Four Primary Care Trusts
NHS Somerset (2006)
GP Consortium/Consortia (2013)
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GP Consortium/Consortia

Financial risk (current Primary Care Trust budget £853 million)

The most effective structure to deliver services in the financial downturn
(QIPP)

Links with County Council/District Councils

Coherence of commissioning and strategic development versus tactical
purchasing
development of Cancer Centre
procurement of Shepton Mallet NHS Treatment Centre
development of 24/7 Primary Angioplasty
Community Hospital rebuilding programme

Management allowance for GP Consortia
WHAT IS BEST FOR PATIENTS
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Delivering Quality, Innovation, Productivity
and Prevention (QIPP)

From 2006 – 2010 budget rose by ~9% in each of the four
years

2010 – 2011 budget increase 4.5%

2011 – 2012 onwards (three year CSR) assume no real
increase

To meet the demand for services (population increase,
expectation, more dependent elderly care, increase in cost of
drugs and new interventions) it is estimated that the NHS will
need to save £20 billion over the three year period

Locally QIPP plans are being produced to meet this challenge
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Quality, Innovation, Productivity and
Prevention Workstreams

Shifting settings of care and optimising urgent care

Optimising elective care pathways

Best practice care pathways for long term conditions

Improving prescribing

Improving primary and community care

Improving mental health

Improving learning disabilities

Improving non-clinical productivity
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Long Term Conditions

End of Life Care
Care pathway and register introduced in seven practices – roll out early 2011
Care Coordination centre went live in May 2010
Two in-reach Palliative care nurses
End of Life website went live on 22 July 2010

Assistive Technology
Telehealth (First 100 kits purchased)
Initial focus in Bridgwater area – plans to roll out
Already evidence of prevented admissions and improved outcomes

Enhanced Care Co-ordination
Bridgwater GP Federation leading the workstream
Testing out a virtual integrated team approach to long term conditions
Roll out across the county

Personalised Care Plans
Web based personalised care planning tool
Roll out commencing with Bridgwater Federation
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Programme Management of QIPP

QIPP Programme Board (meets monthly) Provider Chief
Executives, WyvernHealth.Com, GP Federation Lead, Local
Medical Committee, Local Authority

Eight working groups – WyvernHealth.Com representative
on each

Finance, Human Resources, Estates and Information
Technology working groups
QIPP IS OUR MAIN BUSINESS OVER THE
NEXT THREE YEARS
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Maintenance of a Healthy System

Financial management is crucial over the next three years
- Prescribing
- Contract arrangements with NHS Providers, Private
Sector and voluntary organisations
- Delivery of cost improvement programmes
- Continuing healthcare costs

Abolition of targets
- Need to recognise the NHS Constitution (18 weeks)
- Most MORI surveys identify access as the biggest
concern for patients

Impact of cuts announced by other public sector bodies
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Management Costs

In 2006 when the four Primary Care Trusts were amalgamated,
management savings of £2.3m were delivered with a loss of 65 posts

NHS Somerset has one of the lowest management costs nationally

Targeted savings as part of the 45% national savings is nil for NHS
Somerset but £1.0m over three years for Somerset Community Health

Primary Care Trust staff could have opportunities with:
Regional outpost of NHS Commissioning Board (to be defined)
Local Authority (Public Health)
GP Consortia
Community Services

The designation of community services will be the first milestone and
biggest impact on staff at the Primary Care Trust

We do not know what the management allowance will be for GP
Consortia
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Transitional Arrangements
Primary Care Trust
GP Consortia
October 2010
1 April 2011
Shadow
Framework of
delegation to be
agreed for
Statutory duties
Abolished
Statutory
1 April 2013
Statutory
1 April 2012
Community Services
Separated
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Conclusion

Major re-organisation over a three year period

Financial challenge is unprecedented and clinicians need to
lead

Somerset starts from a very sound base
- money
- service delivery
- relationships

Tremendous opportunity to redesign services for patients
and provide care closer to home
WE NEED TO WORK IN A MORE JOINED UP WAY
THAN EVER BEFORE
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Group Discussions By PCG
Locality
The Gallery
Taunton Deane
Directors
South Somerset
Owners and Trainers
Somerset Coast
Exmoor
Mendip