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NHS reforms and
impact on Pharmacy
Objective
Update on the NHS reforms and Public Health and
Education Landscapes
Outline new structures, organisations and relationships
Key drivers of reform
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•Liberating the NHS; Equity and Excellence
•Public Health; Healthy Lives, Healthy People
•Social Services; Funding of Care
•Health & Social Care Bill
•Liberating the NHS: Developing the
Healthcare Workforce
Policy
Structure
Funding
Strategy
• Health Budget=£80bn
•NHS = £60bn
•Prescriptions & Meds = £12bn
•Public Health =£4bn
•Education = £4bn
©PharmacyVoice September 2011
National Commissioning Board
Public Health England
Commissioning Sectors (4)
Clinical Commissioning Groups
(>200)
• Field Force Teams (20)
• Local Professional Networks (20)
• Health & Wellbeing Boards (152)
• LETBs (15-25)
• Clinical Senates (15)
• Clinical Leaders Networks (?)
• Nicholson Challenge
• QIPP
• Care Pathways
• Outcomes framework
• Integration
• Information
Government
Secretary of State for Communities and Local Government
Secretary of State for Health
National Commissioning Board
Public Health
England
Healthwatch
England
Health Education
England
Commissioning Sectors (4)
Clinical
Senates
CQC
SHAs (10)
PCTs (151)
Local Authorities
Health & Wellbeing
Boards
Authorisation process
LETBs
Clinical Leadership
Networks
NHS Foundation
Trusts
PCTs Clusters
(50)
Clinical Commissioning Groups
Field Force Teams
Local Professional Networks
GP Practices
Direct relationship
Advising/influencing
LMCs
(100)
LPCs
(84)
LOCs
(82)
LDCs
(90)
To be abolished 2013
© PharmacyVoice January 2012
Monitor
Public Health England
Education and Training System
6
Commissioning environment
NHS
Commissioning
Board
Public Health
England
Community
pharmacy
Clinical
commissioning
groups
Local
authorities
7
Commissioning pharmacy services
Department of Health
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Public Health Service
National Health Service
Social Care Service
Public health
NHS
Social care
Smoking cessation
Weight management
Early diagnosis of
cancer
NHS Health Checks
Needle exchanges
Sexual health- EHC
Screening –
pregnancy testing,
Chlamydia
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Dispensing medicines
Overseeing medicines
compliance
Long term conditions
management
Medicine Use Reviews
(MURs)
Self-care patient support
Supplementary
prescribing
Primary care navigation
New medicines service
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Medication reviews
Nutritional support
Palliative care
Support for care at
home
Development of NHS Commissioning Board
NCB
NHS North
Field Force
Teams
NHS South
LPNs
Field Force
Teams
NHS East
LPNs
Field Force
Teams
NHS London
LPNs
Field Force
Teams
LPNs
The LPN and their supporting networks would also coordinate input and
engagement with all providers and performers locally
All primary care providers
(influence, communications,
roll out, embedding)
Relationship with the NHS CB
through local teams
Local clinicians
(‘pool’ of clinical expertise for
‘task and finish’ projects, quality
improvement, pathway redesign, strategic development
and planning)
Core Clinical
Commissioning Team
(commissioning
managers, clinical
quality and network
leaders, public health)
Clinical engagement and
leadership
Local variation where justified by
health needs
Consistency in approach to
commissioning
We envisage LPNs working as an integral part of the NHS CB field force,
developing close working relationships with CCGs and HWBs
Health &
Wellbeing Boards
LETBs
Informing needs,
demand, supply in
primary, community
and secondary care
Clinical Commissioning
Groups
Peer support, peer
review and
benchmarking
Local professional
networks
Local intelligence,
clinical expertise,
innovation and
development of
integrated care
pathways
Aggregation of
need and
assurance of
performance
Maximising
performance
NHSCB local
NHSCB
national
Implementation and
development plans
to reflect local
circumstances
Strategy, policy, contract, procedure and
assurance of achievement of outcomes
Specific functions where pharmacy local professional networks
could add most value to commissioning locally
To ensure local implementation of NHSCB Medicines Optimisation strategy where it relates
to pharmaceutical services
Develop PNA in partnership with local H&W Boards and develop and implement strategy
to ensure identified needs are met
Improving and Assuring Quality
Planning and Designing Local Care Pathways and Pharmaceutical Services
Clinical and Professional Leadership and Engagement
Specific elements to be tested over the coming months include:
•Structure and size
•Functions and scale of delivery
•Cost and value
•Relationships with local health economy and HWBs
•Cultural change
•Manager/clinician partnerships
•Practicalities of setting one up – appointments process,
engagement, arrangements
•Incentives to engage
•Conflicts of interest and how to overcome
• Clinical capacity and capability and any development needs
Key milestones
October 2011 – NHS
Commissioning Board
established in shadow
form as a special health
authority
Autumn 2011 – Further
consultation on funding
of education and
training
Autumn 2011 –
Government response
to choice and control
consultation
Autumn 2011 –
Government response
to information
revolution consultation
2011
21/07/2015
During 2012 – NHS
Trust Development
Authority established
in shadow form as a
special health
authority
During 2012 – Health
Education England
established in shadow
form as a special
health authority
April 2012 – Next steps
in extending choice of
‘any qualified provider’
(this will be phased in
gradually)
1 April 2013 – Public
Health England is
established
** If any trusts are not ready, they
will continue to work towards FT
status under new management
arrangements
1 April 2013 – Full
system of clinical
commissioning groups
is established*
*** Except for newly authorised
FTs, where Monitor’s oversight will
continue until two years after the
authorisation date if that is later
1 April 2013 – SHAs and
PCTs are abolished
October 2012 –
HealthWatch England
and Local HealthWatch
are established
1 April 2013 – The NHS
Trust Development
Authority takes over
SHAs’ responsibilities
for the foundation
trust pipeline and
overall governance of
NHS trusts
October 2012 –
Monitor starts to take
on its new regulatory
functions
1 April 2013 – Health
Education England
takes over SHAs’
responsibilities for
education and training
2012
*The NHS Commissioning Board
will only authorise groups to take
on their responsibilities when they
are ready
1 April 2013 – NHS
Commissioning Board
takes on its full
functions
2013
April 2016 Monitor’s
transitional
powers of
oversight over
foundation
trusts will be
reviewed***
April 2014 Expectation that
remaining NHS trusts
will be authorised as
foundation trusts**
2014
2015
2016
14
Engaging stakeholders
Local Professional
Networks
Local
Professional
Committees
Pharmacy
LPCs (84)
Dentistry
LDCs (130)
Optometry
LOCs (88)