How can Geriatricians help PCTs?

What on earth is world class commissioning? Department of health has set criteria by which it wishes PCTs to operate In 2007 it set out its “guidance” on what this entails and how PCTs should go about achieving this

World class commissioning... is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice based commissioners and others, Primary Care Trusts (PCTs),supported by Strategic Health Authorities (SHAs), will lead the NHS in turning the world class commissioning vision into a reality, adding life to years and years to life.

By putting the patient at the heart of decision making and having a long term focus on health promotion, WCC enables PCTs to commission high quality and value for money services, that meet the needs of their local communities

World class commissioning will deliver......better health and well-being for all– People live healthier and longer lives.– Health inequalities are dramatically reduced....better care for all– Services will be evidence-based and of the best quality, encompassing safety, effectiveness and patient experience.– People will have choice and control over the services that they use, so they become more personalised....better value for all– Investment decisions will be made in an informed and considered way, ensuring that improvements are delivered within available resources.– PCTs will work with others to optimise efficient and effective care.

Partnerships hold the key World class commissioning requires that PCTs develop dynamic partnerships with clinicians, local authorities and other commissioners, communities and providers of healthcare services. Working together, they will define, develop and deliver high quality and integrated services that are closely matched to the health and care needs of the local population.

Clinicians shaping commissioning Clinicians have a critical role to play in helping ensure NHS resources are used efficiently, to deliver high quality care for all. Clinical leadership and engagement are at the centre of each PCT’s journey towards becoming world class, and PCT boards have an important role to play in encouraging and supporting clinical leaders to help drive change and innovation in service provision.

Practice-based commissioning (PBC) is at the heart of world class commissioning.It empowers and supports local clinicians to work in partnership with PCTs to innovate and shape how resources are invested to deliver better health,better care and better value for their local communities.

11 competencies of WCC 1. Locally lead the NHS 2. Work with community partners 3. Engage with public and patients 4. Collaborate with clinicians 5. Manage knowledge and assess needs 6. Prioritise investment

7. Stimulate the market 8. Promote improvement and innovation 9. Secure procurement skills 10. Manage the local health system 11. Make sound financial investments

Integrated care pilots Dementia/mental health End of life care Long term conditions: – one pilot focussing (partially) on older people (Cumbria); – another on better integration with SS or mental health services (Cambridge, Torbay) Better access to care Falls and blackouts (North Tyneside) Substance misuse

The Leeds experience Secondment of a geriatrician from the acute trust to the community Assessment of benefit by geriatrician, intermediate care team and local GPs all positive 5 0.5WTE geriatricians contracted across the city (0.5 acute trust, 0.5 PCT)

successes Rapid response service Community matrons Joint care management service Integrated continence service: District nurse evaluation Community based specialist nurse clinics Consultant (geriatrician) and nurse specialist clinic Close links with acute trust urology and urogynae services in acute trust

Falls service Heart failure nurse specialists Respiratory team Early supported discharge stroke team

Ongoing work Care home medicine Falls service redesign Respiratory service redesign Development of the rapid response service Better clinical governance- morbidity/ mortality reviews, audit etc

Helpful behaviours Avoiding an adversarial climate Getting “alongside” the PCT Being seen as if not on their side, at least as even handed Providing data/ evidence

Barriers and frustrations Changing personnel (especially in management sector) Changes in structure of organisations (eg in Leeds, 5 PCT’s became 1; then PCTs split into commissioning and provider arms)

Lack of systematic data collectionMoving goal posts Changes in resource availability Organisational culture- role of consultant