Transcript Clinical Commissioning

Update April 2011
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“liberating the NHS” a major policy shift
introduced by coalition government
Significant change for NHS and local
authorities
We will all be involved- whether we like it or
not!
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Major shift in government policy, transferring
responsibility for commissioning care to GPs
Ongoing political disquiet- model likely to
change to involve other parties- secondary
care, other health professionals, patients
Improving care , saving money, transferring
responsibility and /or blame?
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Should be based on:
Improving outcomes for patients; prioritises
demand over supply, innovative approaches
to delivery of services
Patient empowerment; promotion of shared
approaches to care, keeping patients fully
informed, power to shape their own
healthcare, and support to care for
themselves
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Evidence based practice ;draw on research
expertise to use evidence to assess needs,
design services and monitor outcome
Community mobilisation ; values of public
service, harnessing the power of patients to
determine their own health outcomecommunity engagement. Integrating with
public health agenda, promoting wellbeing,
preventing ill health
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Ensuring the needs of the vulnerable,
overlooked or ignored are addressed
Sustainability ; commitment to the
sustainable use of resources – natural
environment, NHS finances and the time and
spirit of staff
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Organisations that will take on the task of
commissioning
Pathfinders ; current model to develop ways
of making it work locally, shadowing PCT
work
Will need to partner with clinicians and the
public, true collaborative working
Major challenge for leadership- breaking
down barriers between primary and
secondary care
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Breaking down barriers between health and
social care and professionals and the public
Engagement across traditional boundaries
Who will do it , and what support will they
get?
Currently volunteers , locally elected by peers
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Do they have the requisite skills?
Leadership
Knowledge
Vision
Priorities and context
Negotiation skills
Managing change
Respect
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Health needs assessment
Contracting skills
Financial and budgetary understanding
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……..ie a major undertaking!
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New role of Associate Dean for
commissioning in Surrey, Kent and Sussex
Taps in to deanery support, links to
university
Planned commissioning development
groups to tackle practical skills
acquirement, understanding and
knowledge, along the lines of the existing
appraisal development workshops
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National support through RCGP , LMC, BMA
Planned diplomas , academic modules via
universities to develop commissioning skills ,
possible portfolio careers for GPs
GP Tutor network tasked with helping
everyone to understand the processprotected learning time
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Why should I be interested?
ALL GPs are involved in commissioning
Every prescription and referral is a
commissioning act
It will never work without the support and
understanding of grassroot GPs
QOF will encourage you!
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Re allocated points for 2011-2012
96.5 points for quality and productivity
indicators
Encouraging increasing efficiency in use of
NHS resources
Cost effective prescribing
Reducing emergency admissions and hospital
referrals by use of alternate pathways
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2011-12 indicator changes:
http://www.bma.org.uk/images/summaryqof
guidance2011_v3_tcm41-204734.pdf
Local initiatives and the way forward
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You are a newly qualified GP and have been
asked to lead on delivery of the QP QOF in
the practice- how will you do this , and
what skills will you need?
Your practice has been approached by the
consortium to be told you are an outlierhow will you manage this situation?
Your senior partner is refusing to change
his/her prescribing or referral habit- and
they use the Brompton as the local hospital
is “not up to scratch” how will you address
this?
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NHS commissioning board
NHS outcomes framework will set
expectations for performance- within
resource parameters set by government
This board will manage GP contracts and set
practice level budgets for the new CCGs
Board will monitor and hold CCGs to account
SHAs and PCTs will go – PCTs from april 2013
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GP practices will have to belong to a CCG
Part of GP budget likely to go to CCG for the
delivery of commissioning outcomes
Current local example in funding practices to
participate in “high risk” patient reviews with
CMHT and Social Services- and to actively
review referral processes
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Local authorities will form a new relationship
with the NHS and CCGs
Public health will move to Las and be subject
to new health improvement programmes
Healthcare providers will be subject to dual
monitoring and licensing system
Monitor will become the new economic
regulator
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Care Quality Commission will monitor
delivery and infrastructure – all practices will
have to be CQC registered
Two key principles- putting patients first “no
decision about me , without me”
Proposed information revolution- allowing an
extended range of informed choice
Improving healthcare outcomes, Quality
improvement programme supported by NICE
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HealthWatch England collates national
information, acts as consumer champion
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1-Planning
Assessing health needs
Reviewing current provision
Capacity planning
Identifying gaps and priorities
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2- procurement
Service design / redesign
Defining contracts
Procuring appropriate services
Demand management
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3- monitoring
Monitoring activity and quality
Invoicing, data validation and payment
User and local authority views , choice
Feedback
All clinically driven, with patient . Public and
LA input
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Significant unhappiness with The Health and
Social Care Bill- RCGP , BMA etc
However , Bill now through The Lords- Royal
Assent expected before Easter
More savings needed- if current target met in
2015 , a further £20 billion savings needed
“ a decade of no money” Richard Douglas,
DoH director of policy, strategy and finance
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Essential part of MRCGP- community
orientation, teamwork, maintaining trust,
safety and quality
We are all involved in micro-commissioning
New skills of enquiry, analysis, collaboration ,
negotiation and presentation needed for all
CPD needs to change to recognise the
cultural shift
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Five P model for cpd
Personal needs – what do I need to further my
career?
Practice needs- what do I need to learn to
help develop my practice?
Patient needs- what do I need to learn to
provide good care for my patients?
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Population needs- what do I need to learn to
reflect the needs of my CCG population?
Political needs- what do I need to learn to
reflect the needs of the NHS?
And maybe some of you will wish to become
commissioners/ board members
Portfolio careers