Commissioning Eyecare Services with STPs Richard Whittington

Commissioning Context Commissioners face a situation where acute NHS services are under serious and sustained pressure. The current NHS deficit is estimated to be £2.8 Billion (NHS Confed figures & Kings fund) Offset by £1.8 billion STP in year funding An increasing number of trusts are struggling to meet constitutional standards An increasing number of CCGs are facing financial issues and Turnaround Too many patients are being seen in the wrong place and are waiting to long too be seen. From a commissioning perspective the current delivery model is not sustainable and the situation has not changed since this was last presented.

Commissioning Structure: CCG

Solution: Sustainable Transformation Plans (STP) What does it mean: CCGs to work through 44 STPs, which can be seen as regional commissioning organisations. STPs take in a range of CCGs and will also encapsulate local authority commissioning Simon Stevens: Several STP areas are moving to “accountable care” structures which ”will for the first time since 1990 effectively end the purchaser provider split” Individual CCGs would appear to have less of a development role in direct local commissioning across specified specialties.

Solution: STP Distribution

What are ACOs and LACOs The STP is the commissioning structure… ACO = Accountable Care Organisation The organisation that will actually deliver the service that the STP is going to commission. Very likely to be the local acute trust working in conjunction with other local providers both health and authority based. LACO = Local Accountable Care Organisation As above!

STP Questions: Will this enable commissioning at scale? Will it drive consistency across wider geographic areas? Will acute engagement improve or change if services are commissioning across a wide area? Will STPs facilitate the commissioning and development of both extended primary care and community monitoring services? Will STPs slow local commissioning? Will STPs alter NHS finance flows? How will STPs work with ACOs and LACOs?

Primary Care Response Questions: Is there now a need to consolidate PEC organisations into wider, more regional, organisations? If the commissioning agenda is delivered by ACOs, these may be acute trusts; therefore, commissioning discussions may be with different, what are they? Commissioners of all types may wish to commission wider specialty based services rather than specific primary care based services, will delivery models need to be modified? Community monitoring services may become the main priority. Are regional PECs best placed to deliver those services? Does the sector display unity as in a wider market? What are the impacts of this?