Clinical Commissioning Dr James Kingsland General Practitioner Wallasey Chairman Wallasey Health Alliance LLP National PBC Clinical Network Lead President National Association of Primary Care

PBC Key Messages PBC is here to stay, is moving forward and heralds a major change in the commissioning landscape, one which is critical to the NHS reform programme Clinical commissioning brings clarity about the exact nature of PBC and ensures a shared and consistent understanding of its role and contribution Extending provision of service to the registered population is inherent in PBC There must be different levels of engagement - a ‘one-size-fits-all’ approach is unrealistic Invest to save should be a guiding principle ‘PBC will be an essential aspect of PC for at least the next decade’ MS(H) speech 7/12/05 PBC delivers the directives of Our Health, Our care, Our Say – White paper Jan 2006

The Primary Care ‘Home’ Build on the best of traditional General Practice PHC is more than GP – but registered population and 80% of all NHS clinical consultations 90% of care solely undertaken in PC where needs of the individual as well as the community can be met Support for self care, care closer to home and LTC management Both bio-clinical and social determinants of health can be the responsibility of one ‘provider’ organisation and ‘practice’ can link with wider public health agenda The ‘home’ for extended skills and services

PBC in Context re-invigorating not re-inventing Commissioning & Providing

PBC and NHS Reform A key delivery mechanism for High Quality Care For All PCTs will not achieve World Class Commissioning status without the successful implementation of PBC locally – and PBC is held to account through WCC NHS Reform to be clinically driven, locally-led and embedded in partnerships Reaffirms Primary care as the fulcrum of NHS delivery and managing demand in a system under increasing financial pressure Promotes integrated approach to delivery of healthcare Supports wellbeing and preventative and personalised care Is there another way to guarantee patients access to the most clinically and cost effective treatments? The P&CC strategy themes of; People shaping services Promoting healthy lives Continuously improving quality Is delivered through PBC

Entitlements Management and financial information Management and financial support Swift budget setting and decision making Local incentive schemes Resources freed up through improved efficiency identified in PBC business cases – and as a minimum by right 70:30 split between PBC:PCT Access to regional innovation funds Arbitration by SHA where there is a local dispute PBC budget contains all elements of PCT spend except for PC contracting and as a minimum contains all hospital services, planned and unscheduled, prescribing, MH services, community/locality services and other ‘health initiatives’ (locally developed intermediate services, WICs and OOHs care)

4 STEPS TO AN ICO ? Association Incorporation Federation Integration

Integrated Care Offers better co-ordination of care with transfer to community settings Clinically-led comprehensive service with incentives to invest in health promotion as well as Dx and Rx Break down long-standing organisational divides. Demonstration sites from 1/4/09

Integrated Care Organisations Community, Primary, Secondary and Social Care Serve a registered population with much higher expectations. Clinical and financial responsibility and accountable for the health and well being of that registered population ICOs can choose to provide a range of services and contract with others for the rest, combining provision and commissioning functions Accountable for outcomes delivered through a unified contract with a PCT High performance can be incentivised through bonuses - Poor performance may face financial penalties. National Choice and Competition continue to apply

Leadership and Ownership ‘The NHS is only just beginning to grasp the importance of leadership’ NHS CE Collective and personal throughout the service Clinical leadership at the heart of WCC and quality agenda empowers clinicians across the system Subsidiarity promotes leadership development Leaders deliver co-production, align systems and change culture

PBC development and support National PBC Improvement Team Clinical Commissioning and Guide for GPs PBC Development Framework providers WCC assessments – 360-degree appraisal/partnership agreements Ipsos Mori NHS Networks and PBC connection Earned autonomy and hardening of budgets Shadow programme budgets for particular pathways and reducing burden of approval

The PBC champions network The next stage of PBC re-invigoration Bringing increased capacity and focus to the Quality Framework Programme and promoting clinical leadership locally Articulate consistent messages from ‘Clinical Commissioning’ and strengthen PBC implementation locally Support the capture of learning, help network best practice and help connect PBC groups Promote PBC to be established as part of every day practice