Copyright 2011 Right Care Integrating Pathway Hub: A Prime Contractor Model Dr. Alan Nye Director Pennine MSK Partnership Ltd January 2014 Online Learning Series Right Care for Populations

2 What’s the Problem? System of Care Micro-commissioning complex care pathways o Perverse incentives – PbR o KPIs process driven not population level improvement or patient experience o No effective performance management of care Lack of true clinical leadership Separation from clinical accountability from financial responsibility

3 Integrating Hub Model

4 Oldham

5 Pennine MSK Primary Care based organisation commissioned by NHS Oldham to provide non admitted care in rheumatology, orthopaedics and chronic pain Consultant led – provide 97% rheumatology and take patients to point of listing in Orthopaedics From May 2011 control £23m programme budget for MSK using prime vendor model Psychological medicine for chronic pain 9,500 new referrals a year Deliver traditional hospital based services from community – biologics and infusions GP and Registrar training

6 Programme Budget Commissioning Different from standard care Commission for defined population with a defined budget Commissioners have population quality based KPIs Have prime contractor which shares responsibility for care co- ordination and performance management

7 NHS Oldham Programme Budget’s MSK - £23m - Pennine MSK 1 st May 2011 Primary Care Local enhanced services Community Care Pennine MSK Physiotherapy, podiatry Secondary Care All activity included

8 Delivering Integration Commissioner will focus on clinical outcomes rather than process metric Patients at the centre of our redesign Work with third sector Use self management and self referral were clinically appropriate

9 Pennine MSK Impact Reducing per capita cost whilst maintaining quality

10 Pennine MSK Impact Reducing per capita cost whilst maintaining quality

11 Building on success… In 2013 Oldham has developed Programme Budget Commissioning for a Mental Health programme Over the coming year the CCG will develop this approach over a whole range of programmes.

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