Commissioning Development Programme: Primary Care Commissioning Dr Jill Loader PDIG , 8th November 2012

Navigating the new world Strategic Clinical Networks H&W Boards CCGs Health Watch HEE NHS CB LAs PHE LATs LETBs CSS LPNs Clinical Senates

Health and Social Care Act Greater voice for patients Clinically led commissioning with CCGs directly commissioning services for their population Focus on public health Greater accountability locally and nationally. LAs responsibility to join up local services Streamline arms length bodies

Deliver NHS Outcomes Framework Clinical Commissioning Groups Commission services for their local community elective hospital care, rehabilitation care, urgent and emergency care, most community health services, mental health and learning disability services Duty to work with NHS CB to drive up quality of primary medical care GPs provider role for primary and general medical services and LESs NHS Commissioning Board Improve the health outcomes for people in England Directly commission primary care, prison and military health, specialised commissioning Systems oversight, partnerships and relationships Quality improvement and clinical leadership and patient safety Authorise, develop and hold to account CCGs

NSH CB Directorates and Matrix Working (with patients and the public at the heart of everything we do)

10 LATs specialised commissioning hubs 27 NHS CB Local Area Teams 10 LATs specialised commissioning hubs 12 clinical senates https://www.wp.dh.gov.uk/commissioningboard/files/2012/06/lat-senates-pack.pdf

NHS CB 27 Local Area Teams CCG development and assurance Emergency planning, resilience and response Quality and Safety Partnerships` Configuration System oversight Direct commissioning - GP services, dental services, pharmacy and certain aspects of optical services; 10 LATs leading on specialised commissioning across England; smaller number of LATs carrying out the direct commissioning of other services such as military and prison health; model for the commissioning of NHS public health services and interventions still to be finalised.

Clinical Networks and Senates Clinical senates will help Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards (HWBs) and the NHS CB to make the best decisions about healthcare for the populations they represent by providing advice and leadership at a strategic level. Strategic clinical networks, hosted and funded by the NHS Commissioning Board (NHS CB), will cover conditions or patient groups where improvements can be made through an integrated, whole system approach. These networks will help local commissioners of NHS care to reduce unwarranted variation in services and encourage innovation. Cancer Cardiovascular disease (including cardiac, stroke, diabetes and renal disease) Maternity and children’s services Mental health, dementia and neurological conditions

Specialised commissioning Nationally 10 teams – same as now with a pharmacist post in each specialised team Specialised commissioning teams will lead nationally on a clinical area e.g. SEC – intestinal failure, Yorkshire and Humberside – CF Expect to see a cancer drugs fund team and an individual funding request team ( for specialised services) in each region – 4 Significant change for providers and specialised commissioning – draft ‘prescribed services’ published but not yet agreed. Sometimes a complete clinical area eg HIV, sometimes specialised part of clinical pathway eg renal disease Draft list of PBRe medicines that will be commissioned by specialised commissioning Proposal that list of medicine is by drug not indication – may be used for a non specialised indication Any new medicines and/or services will be commissioned nationally and implemented locally. Heather Weaver, SEC

Primary Care work stream of Commissioning Development Programme NHS Commissioning Board Executive Non-Departmental Public Body 38,000 contracts (£12.6 billion) Vision - exemplar commissioner strong commissioning based on clinical engagement and local relationships rather than contract management, facilitation and rapid spread of innovation/best practice

Local Micro Commissioning System for CCGs LETBs (Local Education & Training Boards) Health and wellbeing boards Local professional networks Contractors & Local medical committees Informing needs, demand, supply in primary care Peer review, benchmarking and development to deliver the contract CCGs NHSCB field force (contracting relationship with individual practices) NHS CB LAT Local intelligence, clinical expertise, innovation and development of integrated care pathways Maximising performance NHSCB central Implementation and development plans to reflect local circumstances Aggregation of need and assurance of performance Strategy, policy, contract, procedure and assurance of achievement of outcomes

Community Pharmacy NHS CB H&W Board Local Authorities CCGs Commission pharmaceutical services under terms of CPCF Market Entry and Exit based on PNA Performance and quality improvement Complaints LPN role H&W Board JSNA and PNA Strategic plan across health and social care to meet needs of local population Local Authorities Directly commission public health services from pharmacy, supervised methadone, needle exchange, EHC, Chlamydia screening and treatment, stop smoking etc Care homes CCGs Wider medicines optimisation agenda including medicines safety, support for medicine taking. Involve community pharmacy in care pathways. Potential direct commissioning of services such as access to palliative care medicines out of hours, minor ailment services

The proposal for Local Professional Networks has been developed to embed clinical expertise in the operating model Working in conjunction with the NHS CB LAT, the vision is for local professional networks to Provide a vehicle for clinically led and clinically owned delivery of; Quality improvement Best outcomes for patients that reflects local need Best use of NHS resources Planning and designing integrated care pathways Strategies for service planning and health improvement Leadership and engagement Ensure clinical leadership at the heart of the local operating model The design proposals for LPNs describe those functions where clinical expertise and leadership could add most value within local commissioning operating model Provide a system for commissioning managers and clinicians to deliver NHS CB vision together to a common purpose

Dentists, Optics and Pharmacy LETBs (Local Education & Training Boards) Health and wellbeing boards Clinical Commissioning Groups Contractors & Local rep committees Informing needs, demand, supply in primary, community and secondary care Peer support, peer review and benchmarking Local professional networks Local intelligence, clinical expertise, innovation and development of integrated care pathways NHSCB local Maximising performance NHSCB central Implementation and development plans to reflect local circumstances Aggregation of need and assurance of performance Strategy, policy, contract, procedure and assurance of achievement of outcomes

Local Professional Networks operating model in more detail Provide clinical leadership and facilitate clinical engagement at grass roots Be a feeder mechanism into other clinical networks Support and advise the NHSCB in the commissioning of these services Advise the Health and Well Being Boards Engage with local representative committees Maximise performance All primary care providers (influence, communications, roll out, embedding) Local clinicians (clinical expertise for ‘task and finish’ projects, quality improvement, pathway re-design, strategic development and planning) Local dental networks will be concerned with the whole dental pathway and could be the commissioning vehicle for the Board Local pharmacy networks will be a source of advice for the H&W Board and their duty to conduct a pharmaceutical needs assessment (PNA) and could add value to the NHSCB’s approach to medicines optimisation Local optometric networks have more to offer the local health system than the core commissioning responsibilities of the Board Core Clinical Commissioning Team (commissioning managers, clinical quality and network leaders, public health)

Local Pharmacy Network Test Sites East London and the City East Sussex Cheshire, Warrington and the Wirral Lancashire Southampton, Hampshire, IOW. Portsmouth West Yorkshire North East Cambridgeshire Essex Cornwall Devon Somerset Dorset Greater Manchester North Yorkshire and York Hertfordshire Staffordshire Suffolk Cumbria NHS South Yorks and Bassetlaw

Where do medicines fit into NHS CB Structures? Medical directorate (Domain 3 LTCs - Martin McShane) Chief Pharmaceutical Officer Deputy CPhO Nursing Directorate 3 medication safety posts transferred from NPSA Operations Directorate Specialised commissioning 1 national lead + 10 Local Area Teams with responsibility for specialised commissioning 1 WTE pharmacy support LAT primary care commissioning clinical leadership team (2 WTE 8b equivalent) Medicines optimisation leadership/accountable officer for CDs? Commissioning Development Dental, Pharmacy & Optical Contracts & Projects Senior Lead Senior Programme Manager, Community Pharmacy Contractual Framework

Statement from CPhO "By now I assume you would have all seen the structure of the Operations Directorate of the NHS CB. Like you, I am frustrated that the important role of senior pharmaceutical expertise and leadership has yet to be fully reflected in the structure. As you know, the chief professional officers for allied health professions, dentistry, healthcare science and pharmacy will be part of the senior structure of the NHS CB, responsible for the provision of high quality professional and clinical leadership and advice across the new health and social care system. Let me reassure you that Operations Directorate colleagues are working closely with us to ensure the NHS CB has access to the regional and local leadership it will need. For example, the local professional networks (pharmacy, dentistry, optometry) in primary care will be integral to the local area teams of the NHS CB.”

What else do we know about medicines structures? CCGs Important medicines optimisation role for local patients. Will either directly employ medicines teams or commission some or all services from another CCG or a CSS - variable across England HEE and LETBs Workforce planning, education and training for all NHS services, whole pharmacy workforce, new duty of co-operation for providers of NHS services LAs Commissioning public health services including from community pharmacy Care homes H&W Board responsible for PNA Health Watch Patients and public involvement and engagement through LPN, Medicines Optimisation Networks etc