Update April 2011

 “liberating the NHS” a major policy shift introduced by coalition government  Significant change for NHS and local authorities  We will all be involved- whether we like it or not!

Introduction  Major shift in government policy, transferring responsibility for commissioning care to GPs  Ongoing political disquiet- model likely to change to involve other parties- secondary care, other health professionals, patients  Improving care, saving money, transferring responsibility and /or blame?

Effective commissioning  Should be based on:  Improving outcomes for patients; prioritises demand over supply, innovative approaches to delivery of services  Patient empowerment; promotion of shared approaches to care, keeping patients fully informed, power to shape their own healthcare, and support to care for themselves

Effective commissioning  Evidence based practice ;draw on research expertise to use evidence to assess needs, design services and monitor outcome  Community mobilisation ; values of public service, harnessing the power of patients to determine their own health outcome- community engagement. Integrating with public health agenda, promoting wellbeing, preventing ill health

Effective commissioning  Ensuring the needs of the vulnerable, overlooked or ignored are addressed  Sustainability ; commitment to the sustainable use of resources – natural environment, NHS finances and the time and spirit of staff

commissioning consortia  Organisations that will take on the task of commissioning  Pathfinders ; current model to develop ways of making it work locally, shadowing PCT work  Will need to partner with clinicians and the public, true collaborative working  Major challenge for leadership- breaking down barriers between primary and secondary care

commissioning consortia  Breaking down barriers between health and social care and professionals and the public  Engagement across traditional boundaries  Who will do it, and what support will they get?  Currently volunteers, locally elected by peers

GPs in consortia  Do they have the requisite skills?  Leadership  Knowledge  Vision  Priorities and context  Negotiation skills  Managing change  Respect

GP consortia  Health needs assessment  Contracting skills  Financial and budgetary understanding  ……..ie a major undertaking!

What support is available?  New role of Associate Dean for commissioning in Surrey, Kent and Sussex  Taps in to deanery support, links to university  Planned commissioning development groups to tackle practical skills acquirement, understanding and knowledge, along the lines of the existing appraisal development workshops

What support is available?  National support through RCGP, LMC, BMA  Planned diplomas, academic modules via universities to develop commissioning skills, possible portfolio careers for GPs  GP Tutor network tasked with helping everyone to understand the process- protected learning time

Grass roots GPs  Why should I be interested?  ALL GPs are involved in commissioning  Every prescription and referral is a commissioning act  It will never work without the support and understanding of grassroot GPs  QOF will encourage you!

QOF and commissioning  Re allocated points for  96.5 points for quality and productivity indicators  Encouraging increasing efficiency in use of NHS resources  Cost effective prescribing  Reducing emergency admissions and hospital referrals by use of alternate pathways

QOF and commissioning  indicator changes:  guidance2011_v3_tcm pdf guidance2011_v3_tcm pdf  Local initiatives and the way forward

Case Scenarios  You are a newly qualified GP and have been asked to lead on delivery of the QP QOF in the practice- how will you do this, and what skills will you need?  Your practice has been approached by the consortium to be told you are an outlier- how will you manage this situation?  Your senior partner is refusing to change his/her prescribing or referral habit- and they use the Brompton as the local hospital is “not up to scratch” how will you address this?

 NHS commissioning board  NHS outcomes framework will set expectations for performance- within resource parameters set by government  This board will manage GP contracts and set practice level budgets for the new CCGs  Board will monitor and hold CCGs to account  SHAs and PCTs will go – PCTs from april 2013

 GP practices will have to belong to a CCG  Part of GP budget likely to go to CCG for the delivery of commissioning outcomes  Current local example in funding practices to participate in “high risk” patient reviews with CMHT and Social Services- and to actively review referral processes

 Local authorities will form a new relationship with the NHS and CCGs  Public health will move to Las and be subject to new health improvement programmes  Healthcare providers will be subject to dual monitoring and licensing system  Monitor will become the new economic regulator

Care Quality Commission will monitor delivery and infrastructure – all practices will have to be CQC registered Two key principles- putting patients first “no decision about me, without me” Proposed information revolution- allowing an extended range of informed choice Improving healthcare outcomes, Quality improvement programme supported by NICE

 HealthWatch England collates national information, acts as consumer champion

 1-Planning  Assessing health needs  Reviewing current provision  Capacity planning  Identifying gaps and priorities

 2- procurement  Service design / redesign  Defining contracts  Procuring appropriate services  Demand management

 3- monitoring  Monitoring activity and quality  Invoicing, data validation and payment  User and local authority views, choice  Feedback  All clinically driven, with patient. Public and LA input

 Significant unhappiness with The Health and Social Care Bill- RCGP, BMA etc  However, Bill now through The Lords- Royal Assent expected before Easter  More savings needed- if current target met in 2015, a further £20 billion savings needed “ a decade of no money” Richard Douglas, DoH director of policy, strategy and finance

 Essential part of MRCGP- community orientation, teamwork, maintaining trust, safety and quality  We are all involved in micro-commissioning  New skills of enquiry, analysis, collaboration, negotiation and presentation needed for all  CPD needs to change to recognise the cultural shift

 Five P model for cpd  Personal needs – what do I need to further my career?  Practice needs- what do I need to learn to help develop my practice?  Patient needs- what do I need to learn to provide good care for my patients?

 Population needs- what do I need to learn to reflect the needs of my CCG population?  Political needs- what do I need to learn to reflect the needs of the NHS?  And maybe some of you will wish to become commissioners/ board members  Portfolio careers