The Changing Face of UK Primary Care Mark Limber Carol Limber (CMA Group Consulting)

NHS Background & Funding…  4 th largest employer in the world (after Chinese Army, Indian Railway and WalMart)  Serves a population of 66 million people  budget of £437million* roughly £9 billion at today’s value 2008/9 over 10 times that amount -more than £100 billion  Average rise in spending over the full 60-year period of about 4%  60% of the NHS budget is used to pay staff. 20% drugs and other supplies, remaining 20% buildings, equipment, training costs, medical equipment, catering and cleaning  NHS funding comes directly from taxation. 2008/9 budget roughly equates to a contribution of £1,980 for every man, woman and child in the UK. * Exchange rate currently around £1 = $2 NZD

Health and Social Care Bill Central Themes Patients in control of their care - More influence / more choice Move to measuring Outcomes not Process Develop clinical leadership The Bill proposes to create an independent NHS Board, promote patient choice, and to reduce NHS administration costs.

Old and New Structures… Out with the old….. DH 10 Strategic Health Authorities 131 PCTs GP Practices Department of Health Strategic health authorities Primary Care Trusts Acute Hospitals Mental Health Trusts GPDentists Primary Care Clinics Ambulance Trusts

Old and New Structures… & In with the new. DH for Public Health NHS Commissioning Board 4 Clustered SHAs PCTs currently clustering Community Consortia ( ) Department for Public Health NHS Commissioning Board Community Consortia Any Qualified Provider

What would the Consortia do?  consortia (still not decided)  Responsible for commissioning effectively for their population  Demonstrating VFM  Responsibility for the money  Understand risk stratification / changing population  Understand profitability / internal and external SLR  Demonstrate local leadership  Big – Localness / Small – Connectiveness  Lead / Follow / Get out of the Way

Possible Structures… Federation Consortia Practice GP Patient Care Decisions Performance and Budget Monitoring Contract Management Risk Hardware & Infrastructure

Views from the GP World…  Most GPs probably not in favour  Lack of skills  Motivation  Knowledge  Desire  However – enough in favour to drive the changes  What about the rest of Primary Care?

The Challenges….  Political position is weak  Top down rather than bottom up approach  Watered down version  Resistance from the noisy few  Consortia will become mini Primary Care Trusts

Improving Health Outcomes

Improving Healthcare Outcomes…  The NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets.  Quality standards will inform the commissioning of all NHS care and payment systems.  Providers will be paid according to their performance. Payment should reflect outcomes, not just activity, and provide an incentive for better quality.

NHS Outcomes Framework… Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Effectiveness Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Patient experience Safety The framework will be organised around 5 national outcome goals / domains covering the breadth of NHS activity How EFFECTIVE the care provided by the NHS is What the patient EXPERIENCE is like How SAFE the care provided is These will help the public and Secretary of State for Health to track:

So, how will the NHS Commissioning Board drive improvements in the NHS Outcomes Framework?

The National Programme for IT

National Programme for IT… Background Live 2003 £6bn budget Connecting and standardising health IT systems Reduce costs Joining secondary and primary care UK split into 5 clusters (circa 10-12m population) Contracts awarded to 3 LSPs Some successes and some failures

NPfIT (Successes & Failures) Successes Principles were sound Localised standard systems PACS Choose and Book Those with no systems improved ‘Free’ Raised the profile of IT Failures Contract negotiation Too rigid Took many organisation backwards Took away choice Focussed on products and not functions Excluded best in class suppliers Over promised

Information Revolution…  Information Strategy published alongside the Health Bill  Seeks to put patients at the centre of the system  Involve patients in ownership of their information  Make information more freely available

Putting patients and public first… Patients will have access to the information they want, to make choices about their care. They will have increased control over their own care records. Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment. The Government will enable patients to rate hospitals and clinical departments according to the quality of care they receive.

Information and Technologies to Improve Communication

Care Closer to Home… Use of tele-health and remote devices E-consultation Ambulatory management of long-term conditions Service Redesign / changing roles e.g. (GPs / Nurses with Special Interests) Delivering services differently – telephone consultations / 1-1 for high risk patients Keeping patients out of hospital

Summary… Thank you for listening