1. The NHS

2. How and who? Major change in structure + organisation 2013
Health and Social Care Act 2012
Key features and principles of change:
Move to clinical led commissioning
Increase in patient involvement
Greater focus on public health
Allowing healthcare market competition

3. Who provides services?
Primary care: GPs, dentists, pharmacists, NHS 111
Acute trusts: secondary care [A + E]
Ambulance trusts
Mental health trusts
Community health services
Distinction between providers and commissioners

4. Clinical Commissioning Groups
GP-led organisations [replaced primary care trusts]
Every GP surgery belongs to a CCG (200)
Represent on average 250,000 patients
Handle 60% of NHS budget
Plan and commission health services for its patients from different providers
Led by boards made up mainly of GPs

5. CCGs
How much money...?
Budgets based on “weighted capitation” taking into account:
Population
Age profile
Health of population
Location

6. Clinical Commissioning Groups
Better able to decide local priorities
More responsive
More efficient
Costs factor may compromise doctor-patient relationship
Focus on bureaucracy may take GPs away from frontline

7. NHS England Independent ‘arms length’ organisation
Has job of “improving health incomes”
Oversees CCGs and allocates money to them
Direct commissioning of some care, for eg offender healthcare, military healthcare
Has four regional teams: North, Midlands + East, London, South
Handles £100bn PA + holds organisations to account for how spent

8. NHS England ii Pays providers via “Payment by Results”
Used to be based on block contracts
PbR – reimburses costs of services actually provided at agreed national price

10. NICE – NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
Role – “to improve outcomes for people using the NHS + other services”
Decides on which drugs and treatments are available on NHS
Set up to address issue of “post code lottery” in which drugs/treatments available in some areas and not others

11. NICE ii Responsibilities:
Assess new drugs and treatments as they become available
Provide evidence based guidelines on how particular conditions should be treated
Provide guidelines on how public health and social care services can best support people
Provide information services for those managing and providing health and social care

12. NICE iii Decides if treatments: Benefits patients
Will help the NHS meet its targets, for example by improving cancer survival rates
Is value for money or cost effective [quality of life]

15. Healthwatch ‘Consumer’ watchdog for health and social care
Healthwatch group in every local authority area
Deals with complaints about all aspects of health care
Raises concerns with health care providers directly and can also refer up to CQC