Commissioning a Patient Led NHS PCT Reconfiguration Malcolm McCann CEO Transition Lead South East Essex PCT

Content of Presentation Background to the changes –The Department of Health’s vision –Roles of the new PCTs and SHA Process and timeframes Managing the Transition Other issues –Expectations of OSC –Extend Audit of Transition

Background Letter from Sir Nigel Crisp - July 2005 National policy framework –Payment by results –Choice –Independent sector provision –Creation of Foundation Trusts White paper – Our Health Our Care Our Say –Better prevention, earlier intervention –More choice –Tackling inequalities and improving access to community services –More support for people with Long Term Conditions –Contestability / plurality of provision

Commissioning a Patient Led NHS – Department of Health’s vision (1) Delivering a better, more responsive health service that gives people control and choice Better engagement with local clinicians in the design of services Faster, universal roll out of “Practice Based Commissioning” (PBC) – by December 2006 Developing PCTs to support PBC and take on the responsibility for performance management through contracts with all providers, including those in the independant sector Reviewing the functions of SHAs to support commissioning and contract management.  STRENGTHENED COMMISSIONING

Commissioning a Patient Led NHS – Department of Health’s vision (2) Partnership working with Local Authorities to deliver “Choosing Health” Commitment to make £250million of savings in management costs, to be reinvested into front line services  Changes in function required consideration of optimal configuration of PCTs

PCTs - 3 FUNCTIONS Engaging with its local population to improve health and well-being Commissioning a comprehensive and equitable range of high quality responsive and efficient services, within allocated resources Directly providing high quality responsive and efficient services where this gives best value

PCTs – RELATIONSHIPS & ACCOUNTABILITY 1.Perform their functions for, and with, their local population, in pursuit of equality, quality, responsiveness, innovation, efficiency and affordability 2.Lead their local health system; and develop, and deliver their functions through, effective partnerships - particularly practice-based commissioners; and with Local Authorities eg in developing Local Area Agreements; and with the full range of different types of providers 3.Hold providers to account through commissioning and contracting 4.Are accountable to their local population directly and through OSC scrutiny; and to Strategic Health Authorities. PCTs operate within the framework of Department of Health policy; they are held to account for this by SHAs, not directly by the Department.

FunctionsRoles Engaging with its local population to improve health and well-being (i)Improving health status of its population, and reducing health inequalities, in partnership with LAs (ii)Contributing to well-being and sustainable community development, in partnership with LAs (iii)Protecting health including through a robust system of emergency planning Commissioning a comprehensive and equitable range* of high quality,responsive and efficient services, within allocated resources *(across all service sectors: public health, all types of primary care services including dentistry pharmacy and optometry, community health services, social care, mental health, electives, urgent care etc) The PCT primarily performs its commissioning function, for example in relation to acute services, through empowering, supporting and coordinating a comprehensive system of practice-based commissioners; who in turn are responsible for the care for their registered patients. Responsibility for commissioning primary medical services is not devolved to practices but fully retained at PCT level. Where appropriate, services are commissioned jointly with local authorities. Specialised services will be commissioned collaboratively with other PCTs (or nationally) in line with the findings of the forthcoming review by Sir David Carter due later in The PCT should underpin all aspects of commissioning with excellent and timely information and analysis. The five key commissioning roles are: 1.Assessing needs, reviewing provision & deciding priorities: assessing the needs of its population, gaining an excellent understanding of its’ expectations and wishes; mapping these against an evaluation of current service provision, including an assessment of the structure of supply and the ability of patients to choose; deciding its local priorities for developing and transforming services 2.Designing services: in partnership with practice-based commissioners, specifying the range, nature and quality of services to be provided along different patient pathways, in line with the White Paper Our Health, Our Care, Our Say; drawing on evidence of cost-effectiveness and best practice; enabling provider innovation; and reflecting expected capacity requirements 3.Shaping the structure of supply through stimulating provider interest, deciding when to go to tender, and by placing contracts. The aims being (a) to promote patient choice and competition between providers - and where not that is not possible, to maximise contestability for supply; and (b) to ensure services are joined-up for patients along pathways, through providers working in partnership. In discharging this aspect of commissioning, the PCT works closely with relevant SHAs and other PCTs 4.Managing demand for services and living within its cash-limited allocation of resources, particularly through a comprehensive system of practice-based commissioners 5.Performance-managing providers through contracts and wider relationships, to ensure contract requirements are met eg on national targets, quality and equity of access; and taking systematic account of patient and practice feedback. The PCT also regulates primary care performers. Directly providing high quality responsive and efficient services where this gives best-value Directly providing primary and community-based services (and for Care Trusts, adult social services), where the PCT’s commissioning function shows that direct provision of such services is best for patients and also provides best value for money for taxpayers. The PCT provider function must be clearly separated from the PCT commissioning function from Board-level down; the latter holds the former to account for delivery. The PCT also develops primary care contractors. PCTs – MAIN ROLES

SHAs - 3 FUNCTIONS Strategic leadership Ensuring local systems operate effectively and deliver improved performance Organisational and workforce development Strategic leadership

SHAs – RELATIONSHIPS & ACCOUNTABILITY 1.In discharging these functions, SHAs must work in partnership with their PCTs, and regional organisations, particularly Government Offices for the Regions 2.Hold PCTs to account for their performance 3.Are held to account by the Department of Health for ensuring their local health systems operate effectively and in line with Government policy

SHAs – MAIN ROLES FunctionsRoles Strategic Leadership (i)Vision: translate how national health reform policy including increased local freedoms can transform local health systems (ii)Develop strategic partnerships at regional level, to ensure health gain and well-being eg through regional development strategies, and to protect health, eg major incident planning (iii)Strategic oversight of Primary Care Trusts in relation to commissioning: particularly in shaping the structure of local supply; assessing capacity requirements; ensuring sufficient competition and contestability; supporting major service reconfiguration; and achieving financial recovery (iv)Support the implementation of certain national transformation projects eg Connecting for Health (v)Contribute to national policy development and evaluation, working primarily with the DH Policy and Strategy Directorate, and using local networks (vi)Manage corporate affairs as the regional headquarters of the NHS, including communications, reputation management, and Parliamentary business Developing organisations and the workforce (i) PCT development: supporting Primary Care Trusts to become fit-for-purpose in discharging their functions, and promoting best practice (ii)Provider development: supporting NHS trusts and mental health trusts to become NHS Foundation Trusts; supporting provider development including new entrants, social enterprise models, service reconfiguration; and major capital development – all in partnership with PCTs and in line with their commissioning plans; and supporting R&D (iii)Workforce development, including (a) ensuring all aspects of workforce supply - including education, training, and workforce planning - best support service demand; and (b) leadership development, including talent management; all in partnership with PCTs and providers Ensuring local health systems operate effectively and deliver improved performance SHAs are responsible for ensuring that that the PCT-led health systems within its area all operate effectively, taking account of national guidance and rules, eg on reform policy, financial management and risk-pooling. The main way in which SHAs perform this function and drive improvements in equity, quality, responsiveness and efficiency is by assessing and performance- managing PCTs to ensure they deliver their functions effectively; including by benchmarking local performance against other areas. Delivery will primarily be assured through effective PCT commissioning and contracting arrangements; the SHA does not directly exercise PCT functions itself. The SHA will continue to have a direct role in ensuring NHS trust performance, prior to the trust achieving Foundation status.

Process and timeframes (1) Informal consultation by Essex SHA July – October 2005 Organisations asked to take soundings and respond 2 or 5 PCTs in Essex was prevailing view Formal consultation by Essex SHA December 2005 – March 2006 Range of responses Considered by SHA Board and recommendation made for 2 PCTs in Essex (one for South Essex and one for North Essex)

Process and timeframes (2) May approval given by Secretary of State for 5 PCTs in Essex: –Mid Essex –North East Essex –South East Essex –South West Essex –West Essex To be formed on 1 October July 2006 – East of England Strategic Health Authority commenced

Process and timeframes (3) PCT Chair appointment process underway (to be announced July) PCT CEO appointment process underway (to be announced August) PCT Directors appointment process underway (to be announced October) ?Decision in relation to provision of services (for new PCT to determine)

Managing the Transition Transition Lead identified for each new PCT Transition Board established for each new PCT (membership = CEOs, Chairs, Executive Committee chairs and leads) Overseeing development and implementation of transition action plans to ensure minimal disruption to services Workstreams: –Business Continuity –Performance Management –Human Resources –Communications

Other issues Key stakeholder involvement – including Local Authority & OSC Patient involvement (inc. establishment of LINks) DoH Fitness for Purpose Assessment and Development Programme - Organisation development Staffing issues Provision of services – various options which the new PCT could consider Continued integration of health and social care