Delivering OOHs services David Carson National Clinical Lead Access & Choice Primary Care

What's happening A&E and Ambulance worried about being dumped onA&E and Ambulance worried about being dumped on COOPs worries about the futureCOOPs worries about the future Where are staff coming fromWhere are staff coming from PCTs face new world of commissioningPCTs face new world of commissioning Have providers the skills to work co-operativelyHave providers the skills to work co-operatively

Prejudice and perceived wisdom Is NHS better than GPsIs NHS better than GPs Are GPs better than the NHSAre GPs better than the NHS Are COOPs better than Private sectorAre COOPs better than Private sector Is the private sector better than the COOPIs the private sector better than the COOP COOPs compete as wellCOOPs compete as well

What it is Major opportunityMajor opportunity Achieve real joined up servicesAchieve real joined up services Providers have opportunity to innovateProviders have opportunity to innovate PCTs and trusts meet imperativesPCTs and trusts meet imperatives Patients get even more effective access to integrated health carePatients get even more effective access to integrated health care

Background Policy Framework OOH ReviewOOH Review RECREC NHSD ReviewNHSD Review Choice and PluralityChoice and Plurality

OOH Review Integrated OOH servicesIntegrated OOH services Network of providersNetwork of providers Clinical LeadershipClinical Leadership StandardsStandards Joined up planning and commissioningJoined up planning and commissioning

Reforming Emergency Care Same principles as OOHSame principles as OOH Current focus on A&ECurrent focus on A&E Solutions may reside outside A&ESolutions may reside outside A&E Chronic disease management - real opportunities in contractChronic disease management - real opportunities in contract Integrated response to Minor Illness and InjuryIntegrated response to Minor Illness and Injury

nGMS DOH fully committed to delivery of contractDOH fully committed to delivery of contract OOH will provide mechanism to meet in-hours nGMS ChallengeOOH will provide mechanism to meet in-hours nGMS Challenge Opportunity to build PC capacity and volumeOpportunity to build PC capacity and volume

Plurality NHSNHS Mutual / Voluntary SectorMutual / Voluntary Sector Private SectorPrivate Sector All have a roleAll have a role PCT provision is perhaps last choicePCT provision is perhaps last choice

GP opt out and re- provision. Relevant yes but perhaps not in terms of re-provisionRelevant yes but perhaps not in terms of re-provision 2 Different things2 Different things Opt out is Practice decisionOpt out is Practice decision Look beyond this questionLook beyond this question Staffed by GPs and others attracted to work in services and providersStaffed by GPs and others attracted to work in services and providers Are we looking back too muchAre we looking back too much

The delivery

OOH Challenge Information to support development.Information to support development. ProvidersProviders PCTsPCTs STHAsSTHAs Other IssuesOther Issues

Data

Capacity information Urgent need to collect and collate existing informationUrgent need to collect and collate existing information Use as basis of planning integrated serviceUse as basis of planning integrated service All data should be shared with all providers (including acute and ambulance service)All data should be shared with all providers (including acute and ambulance service) Should be mapped by:Should be mapped by: –Case mix –Geography –Time –Competencies

Providers

Who are the providers COOPSCOOPS PRIMECAREPRIMECARE AMBULANCEAMBULANCE A&EA&E COMMUNITY NURSINGCOMMUNITY NURSING SOCIAL CARESOCIAL CARE MENTAL HEALTHMENTAL HEALTH WICsWICs DENTISTRYDENTISTRY PHARMACYPHARMACY Any anyone else working OOHAny anyone else working OOH

Providers More opportunity for joint developmentMore opportunity for joint development Providers stop competing on all aspectsProviders stop competing on all aspects Co-operate and build on your strengths (None are good at all)Co-operate and build on your strengths (None are good at all) Limited view of opportunities by someLimited view of opportunities by some At scale Vs localAt scale Vs local More attention to planning processMore attention to planning process Provider development process is needed in every areaProvider development process is needed in every area

COOPs Brilliant jobBrilliant job Can be monopolyCan be monopoly Legitimate for PCTs to ask difficult questionsLegitimate for PCTs to ask difficult questions Not legitimate to exclude anybodyNot legitimate to exclude anybody Shift of ownership from those who are responsible as members to those who work as membersShift of ownership from those who are responsible as members to those who work as members Significant opportunity to increase local public involvementSignificant opportunity to increase local public involvement

Mutual Transfer COOP to COOPCOOP to COOP Basis of COOP membership changes from those with responsibility to those working within COOP.Basis of COOP membership changes from those with responsibility to those working within COOP. Will require support as per guidance from PCTsWill require support as per guidance from PCTs Working on governance modelsWorking on governance models –Provider development –Further papers coming

Commercial Providers StrengthsStrengths Resilience due to sizeResilience due to size Clinical governance structuresClinical governance structures Logistics and management capacityLogistics and management capacity Often complementary services to local COOPsOften complementary services to local COOPs

Ambulance service Also StrengthsAlso Strengths Part of networkPart of network IPASIPAS Do not have all the answersDo not have all the answers Have some of themHave some of them Must be at the tableMust be at the table

Providers Stop competing on every aspectStop competing on every aspect Yes the NHS as wellYes the NHS as well Co-operate and build a decent integrated service building on your strengthsCo-operate and build a decent integrated service building on your strengths Have confidence in what you do wellHave confidence in what you do well Accept that others have much to offer.Accept that others have much to offer.

PCTs

PCTs Support providersSupport providers Establish ProvidersEstablish Providers New territoryNew territory Support changeSupport change Have you contestability and sustainability?Have you contestability and sustainability? A network gives more options than a single preferred providerA network gives more options than a single preferred provider Yet to see an area in which a single provider has all the answersYet to see an area in which a single provider has all the answers

PCTs Potential for one PCT solution to destabilise othersPotential for one PCT solution to destabilise others Agree on what development activity could be sharedAgree on what development activity could be shared Inter PCT process requires attentionInter PCT process requires attention –Sign up at Board level Evidence based approach to optionsEvidence based approach to options Risk of narrow anecdotes and individuals views restricting thinkingRisk of narrow anecdotes and individuals views restricting thinking Single PCT options will be very rareSingle PCT options will be very rare

Development Process PCT agree areas of joint working across areaPCT agree areas of joint working across area –Workforce –Data –Provider development PCTs agree areas local workingPCTs agree areas local working Senior support to joint projectSenior support to joint project PCTs agree to provider support processPCTs agree to provider support process –PCTs will require to consider supporting the establishment of providers

PCTs 5 Years Guaranteed year on year funding increase5 Years Guaranteed year on year funding increase Some have made plansSome have made plans Some plans are goodSome plans are good Some will need revisitingSome will need revisiting Have you really addressed the issue or chosen the easiest option?Have you really addressed the issue or chosen the easiest option? May have to revisit some LDP priorities and even trust recovery plansMay have to revisit some LDP priorities and even trust recovery plans

STHAs Key roleKey role Mentioned in contractMentioned in contract Overview of PCT process nowOverview of PCT process now Review of plans and hot spotsReview of plans and hot spots Legitimate role in ensuring plurality and adequate provisionLegitimate role in ensuring plurality and adequate provision Benchmark and support PCT networksBenchmark and support PCT networks

Issues

Workforce Significant number of WF initiatives in Agency and in WDCsSignificant number of WF initiatives in Agency and in WDCs Important for STHAs and PCTs to ensure OOH and PC issues are on WDC agenda nowImportant for STHAs and PCTs to ensure OOH and PC issues are on WDC agenda now We will be issuing a summarised version on where latest WF information and evidence can be accessedWe will be issuing a summarised version on where latest WF information and evidence can be accessed No magic bullet but skill mix and flexible roles are keyNo magic bullet but skill mix and flexible roles are key Liberating the talents is a good example of moving to more flexible working patterns.Liberating the talents is a good example of moving to more flexible working patterns.

NHSD Review Technical LinksTechnical Links Capacity in 2004/5 and 2005/6Capacity in 2004/5 and 2005/6 Ensure that developed arrangements are consistent with NHSD direction.Ensure that developed arrangements are consistent with NHSD direction. NHSD commissioning framework likely during PCT planning processNHSD commissioning framework likely during PCT planning process

What I hear procurement PCT not talking to usPCT not talking to us Provider bullying meProvider bullying me Director of Finance wants me to tender first (for what?)Director of Finance wants me to tender first (for what?) Preferred providers (what is this? And what are the implications)Preferred providers (what is this? And what are the implications)

Procurement Open processOpen process Legitimate to include providers in processLegitimate to include providers in process “Cannot Talk” to providers is not true!“Cannot Talk” to providers is not true! Providers should identify strengths / weakness / benefits of joint workingProviders should identify strengths / weakness / benefits of joint working Agreement needed on process jointly across each networkAgreement needed on process jointly across each network

Competition Is not only about tenderingIs not only about tendering Its about contestability and strengthsIts about contestability and strengths Then working co-operativelyThen working co-operatively We do not have excess capacityWe do not have excess capacity We need to build capacityWe need to build capacity

What now in every area Functional inter PCT forum with clear terms of reference, objectives and timetable - The WHATFunctional inter PCT forum with clear terms of reference, objectives and timetable - The WHAT –Requires support and secretariat Functional provider forum to support identification of roles and opportunities for all providers - The HOWFunctional provider forum to support identification of roles and opportunities for all providers - The HOW –Requires terms of reference, objectives, support, timetable and secretariat

Opportunity Best opportunity in a generation to build on the best of current practiceBest opportunity in a generation to build on the best of current practice Will require focussed work and investment.Will require focussed work and investment. Drop the baggageDrop the baggage Lets get on and do itLets get on and do it And Deliver - Please!And Deliver - Please!