1. XXX PCT Orientation Visit for the Improvement Foundation Practice Based Commissioning Development Programme
This event is designed to be an Informal and interactive event
Social care and secondary care in attendance
CE has letter from JO and Centre re programme
How teams can follow this up especially unscheduled care pathway planning

2. Aims of the Day Set out the detail of the programme
Clarify participation in programme
Discuss expectations
Discuss initial ideas for service redesign
Discuss plans for spread of learning
The aim of today is to ensure that everyone understands the programme and given an opportunity to ask questions, and have time to make plans to take forwards.
The IF is not an expert – this comes from yourselves, and secondary care colleagues.
We are though experienced in improvement and change management. We are here to support and facilitate and link you up with experts.
Not the experts in PBC
Talk about the aims of the programme
Take things back to the experts to find out

3. Improvement Foundation incorporating NPDT
Established 1st April 2006
Incorporates NPDT
Creates the organisational flexibility to enable us to continue to develop our improvement work
NHS
Other public services
International improvement work
Same people, same values, same business

4. Brief Background to Improvement Foundation
National Team
11 Improvement Foundation Centres

5. The Collaborative Process
An improvement method that relies on spread and adaptation of existing knowledge to multiple settings to accomplish a common aim
It is NOT:
A research project
A set of conferences
A passive exercise

6. Elements of a Collaborative
Clear aims
Framework of practical ideas
Series of Learning Workshops
Action periods in between
Protected time
Focus on measurement
Practical support
Use of tried and tested improvement method
PBC as the mechanism to underpin specific service improvements

7. Aim of the Programme
In partnership with SHAs and PCTs, maximise the number of PCTs and practices operating PBC:
in order to develop and improve services for patients
to embed a residual local skill base in commissioning for future development
This is the first programme commissioned in to support implementation of policy.
It is to improve services for patients therefore needs to be involved in the design of the services.

8. Opportunities Share experiences and learning
Linked into other “experts” and like minded peers
Access to a range of resources that can be tailored for each site
Opportunity to get involved at the entrepreneurial stage
Drive services to represent what your population needs
Better services for your patients
These are the opportunities this programme gives

9. Common Questions How will:
Any new commissioning decisions deliver improvements for patients?
Practices know they are delivering these improvements?
Ensure the benefits of PBC are meaningful for clinicians and aid clinical engagement?
Common questions have cropped up during discussions with practices and PCTs
This programme hopes to answer them by:
Ensuring appropriate and robust measures to measure improvement and ensuring reporting is accurate and timely
The programme is designed to include practices and PCTs
Sites need to ensure that secondary care is involved in redesigning pathways and be sensitive to their concerns
Patient choice must be available and full explanations of why the change has taken place ie seeing practice nurse rather than going to secondary care
Patients need to be involved on LIT and redesigning
Patient education about changes in behaviour
Getting patient stories before and after redesign
All decisions need to be have open and honest dialogue between clinicians/managers/patients
Developed in discussion with experts on the ground
These are the issues need to think about when planning PBC
Qualitative as well as quantitative
Supporting practices
Potential providers of services – engage patients and wider community
Secondary care as part of LIT especially for service redesign/pathways, reflects how primary and secondary care can work together
Umbrella picture

10. Acute trusts operate in this new environment?
Commissioning new patient pathways fit with patient choice?
Deliver improvements in unscheduled care?

11. Engage patients and the wider community to ensure services meet local need?
Decisions be made on the services to be commissioned, balancing resources, use of efficiency gains, managing risk?

12. Basic Principles Local aims for PBC Clinical engagement Good data
PCT support – people and funding
Local expertise
Menu of service areas
Quality improvement tools and techniques
These elements need to be the basis for commissioning
Need to have a clear aim, clear plans, links with PCT PDP and good practice plans
Need to look at quality not just quantity
Use the PCT knowledge and skills of procurement/local information/experience
IF can support with improvement tools and techniques
‘local’ for you and your patients
Good data – critical from acute provider, community services and others
PCT – have an expert on commissioning with the DES
Menu – flexible/ national targets but what the practices want to do
Quality – needed to do this and will get as support from the programme
Identify from reference panel what needs to be in place to make PBC work
Skills may already be in practice and PCT but are not obvious ie fundholder from practice may use their skills again

13. PCT Recruitment Wave One - National One PCT site per SHA
Bedford and Bedfordshire Heartlands
Uttlesford
Cambridge City and South
Huntingdonshire
Wave 1 (Eastern region)
Wave 2 (Eastern region)
Wave 3 (Eastern region)
Can come on for wave 3 with additional practices but no further funding

14. Waves 2 and 3
Welwyn Hatfield
Hertsmere
Watford 3 Rivers & Dacorum
North Herts & Stevenage
St Albans & Harpendon
East Cambs & Fenland
Suffolk East – Ipswich/Suffolk Coastal/Central Suffolk
Suffolk West
Maldon & South Chelmsford
Billericay, Brentwood & Wickford
Thurrock
Epping
Witham, Braintree & Halstead and Chelmsford
Harlow and R,B & BS
Basildon
Southend and Castle Point & Rochford

15. Timeline for PBC Support Programme
May 06
June 06
Sept 06
Oct 06
Dec 06
Jan 07
Mar 07
Wave 1
LW1
LW2
LW3
Wave 2
Preparatory
Period
Baseline
LW1
LW2
LW3
Needs adjusting
Wave 3
LW1

16. Programme Stages Preparatory phase Assessment point
Collaborative phase
Learning Workshop 1
Learning Workshop 2
Learning Workshop 3
All PCTs engaged in the process within 8 months
Action Periods

17. Membership of the LIT
As varied a group of managers and clinicians as possible
Effective leadership and ownership is crucial to drive forward improvements and sustain change
LIT should have a shared understanding and agreement of the common aims and purpose of the work – agreed vision
The LIT will help strengthen relationships between managers and clinicians and ensure service developments fit with local priorities, identified in the LDP and in line with local and national targets
Need top level commitment, CE/Lead Director
LIT meets monthly or fortnightly to move things forward at the beginning
Need to agree the vision not just PBC
What do you want to achieve?
Need information managers/finance at the preparatory phase

18. The LIT / Site
The Local Improvement Team (LIT) lead clinicians and managers will influence the local thinking and plans for PBC
Active participation in learning workshops
Regular meeting of the LIT
Implementation of ideas within action periods
Regular reporting - 2 years commitment to report
Sharing of learning both locally and nationally
Plans for spread
Needs active participation
Maximum of 15 people
5 lead GPs
Team is important
Meets regularly
Steer the programme and do the work
Knows what is happening locally with the practice teams

19. Role of the Project Manager
Support - Explain what needs to be done and how
Resource - Information/best practice/ ideas/feedback. Extensive network
Coordinator - Data collection/workshops/LIT meetings
Link - with the Centre and other practices
Facilitation –Process Redesign etc
Act as the main contact point for the Improvement Foundation
Be a local expert on the programme and improvement methodology
Provide monthly feedback to the LIT on progress with local and global measures
Ensure the PCT receives regular updates to meetings as appropriate
Support and coach practices as required
Ensure practices and other members of the team know how and when to report
Co-ordinate attendance and participation in all central training events and workshops
Ensure complete reporting every month – global & local measures, PDSAs, progress made
Capture and share good stories
Help to identify areas of work for presenting at workshops
Develop a spread strategy within the site
Ensure milestones are achieved
Suggest PM does this slide?
Introduces themselves etc etc
Send slide onto PM prior to event

20. Role of Improvement Foundation
Support
Facilitate
Training
Resource
Support and facilitate teams in making significant improvements in care pathway redesign and commissioning reform during the action periods between training events and workshops
Induction training for project managers on service improvement, change management techniques, and Practice Based Commissioning technicalities, plus on-going support during the programme
Provide training days and simulation events on core elements of PBC
A national network of Project Managers will be developed to spread and develop the learning from the programme.
Share information across sites and capture learning from each site
Support the establishment of local learning exchanges and national web based discussion forums

21. Preparatory Phase Learning from other programmes
Different PCTs at varying stages of development and readiness for the challenges of commissioning
Aim:
PCTs and practices to have the appropriate infrastructure in place before they engage in the collaborative phase (focus on service re-design)
Maximise the improvements to be made in patient services
Different PCTs varying stages development and readiness
Ensure Appropriate infrastructure
Clinical engagement
Budgets
Accurate data translated into information

22. Preparatory Phase Orientation visit to Local Improvement Team (LIT)
Assessment and action plan
Training events
Milestones / tasks:
Action period tasks in between training events
Mapping and analysis of services
Baseline measures for service areas
Today
Initial AF been completed by PCT (here for discussion today) following AF will be completed with practices at LIT meeting prior to submission
Consider who needs to be involved
Action needs to take place in-between events ie baseline measures/mapping service/analysis of data – don’t forget voluntary sector!
Mapping the system around the pathway
Eg urology, community services etc what information is available for patients
Take something from secondary care in put it somewhere else

23. Overview of the Assessment Framework
Developed to enable PCTs and practices to jointly assess themselves against criteria which forms a minimum standards framework
Increasing levels of achievement to ensure continuous review and improvement
The framework encompasses 2 main areas:
PBC Commissioning cycles
7 sub sections
Building capacity
3 sub sections
Generates an action plan for improving areas of PBC
Assessment – be assured that practices have contributed to it
Have a round the table discussion to discuss the values
Revisit after orientation and resubmit
Not be able to achieve all targets!!!!
Need to go to training event to complete framework

24. How to use the Assessment Framework
Initial completion by orientation
Discussion at orientation visit
Action plan developed by site
Resource pack and preparatory period training events to support progress
Completion again by 15 September 2006
6-monthly completion thereafter to continue to assess progress
Be clear expect everyone to be level 3 by LW1
Action plans in place to get to level 3
Don’t want you to be behind everyone else
Support and training required
Responsibility to take the actions to reach the level 3

25. Overview of Results from Wave 1
Baseline results – average score = 2.25

26. Preparatory Period - Training
Aim:
Provide sites with greater understanding and knowledge about different components of PBC
Validate what has already been done locally
Share what others have done
Attendance:
PCT Senior Management
PCT representatives from Information, Finance and Commissioning functions
Lead clinicians and practice managers
SHA PBC leads
Dates: 29 June 2006, 25/26 July 2006
Agendas: Plenaries and practical breakout sessions
Attendance – 8 people max who is best to be there?
Action – business planning framework

27. Feedback from the Wave 1 Training Events:
96% found the events good / excellent
Comments included:
The event was extremely informative and useful
Useful timeout to start planning how we can deliver PBC. Also reassuring to hear we are progressing as well as others!
BRILLIANT! I learnt much more than I could have hoped
Feel more confident about our plans for future re-design. Great opportunity to work with PCT staff
A real opportunity to get a head start on PBC and in particular get to grips with the tools needed and understand some of the challenges ahead

28. Mapping and Analysis As part of care pathway redesign
Process mapping of service areas for re-design
Patients should be included in the process mapping and analysis
Use the analysis of the process mapping to inform decisions on improvement – action plan
Support from Centre
Patients involved – need to decide when and at what level
Some training on this at training events
Tracking patients – engaged at what level

29. Baseline Measures Baseline measures to be reported in September 2006
Global measures to be reported on internet based system
Local measures should be developed by September and reported each month
The PBC Assessment Framework (PBCAF) will provide baseline measures for commissioning systems
The measures should be local
Baseline to LW1

30. Global Measures Scheduled Care
Number of referrals to hospital care for the chosen service area (excluding referrals sent to PwSIs instead of the acute hospital staff).
Number of referrals to hospital care for all specialities (excluding referrals sent to PwSIs instead of the acute hospital staff).
Number of 1st outpatient appointments at the hospital(s), age/sex standardised, per 1000 head of population, for the chosen service area. This will be a 12-month rolling figure.
Follow-up ratios for hospital care (excluding follow ups done by PwSIs instead of the acute hospital staff). This will be a 12-month rolling figure.
Put in new wording

31. Global Measures cont…. Unscheduled Care
Emergency admissions at the acute hospital (excluding those admitted to community hospitals), age/sex standardised, per 1000 head of population. This will be a 12-month rolling figure.
0-night length of stay at the acute hospital (excluding those admitted to community hospitals), age/sex standardised, per 1000 head of population. This will be a 12-month rolling figure.
Patient Survey (Voluntary)
A ‘before and after’ survey to record a sample of patients views of the chosen service prior to service re-design and post service re-design.

32. Parallel Learning Routes
Assessment Framework
Internet based training – web cast presentations
PBC tools
Website and web forum
Support for local learning exchanges
Simulation event
WE can arrange a simulation event but this will need to be externally funded
Check the slide

33. Reporting By 15 September sites will have:
Re-completed the assessment framework for submission
Tracked progress from baseline to assessment point
Agreed focus for the LIT for service re-design element of programme
Collected baseline measures: global and local
Undertaken service assessment
Further develop plans for future service developments

34. Group Discussion - Initial Actions
Assessment framework
Discussions on identified service areas for redesign
Plans for internal and external spread
Spread – looking at newly merged PCTs
Wave 3 – can come on board then

35. Service Areas Scheduled or unscheduled: Overall service areas
Specific service areas
Who is focussing on the specific area?
Local measures
Can choose either scheduled or unscheduled
Discussion service areas
Discussion who is doing what
Both not a choice between unscheduled and scheduled
Overall area or can do specific – look at data analysis
Getting determined who is going to do what

36. Wave 1 Unscheduled Care Admission avoidance:
LTC management – Diabetes, COPD, Unique Care/ Case management/ Patient self management
Clinical Assessment Units
Reducing A&E Attendance:
OOH –integration of services
Extended GP surgeries
Minor Injuries units
Scheduled Care – main areas:
Minor Surgery
Orthopaedics/ pain management
ENT
Outpatients - follow ups
Diagnostics
Dermatology
Scheduled Care: Specialist- one off submissions
Carpal tunnel
Cardiology
Family planning & sexual health services
Oxygen Assessment Team
Urology
Vasectomy