1. CONFIDENTIALLEODIS HEALTHCARE LLP Practice development Workshop Commissioning Finance 09 February 2012

2. CONFIDENTIALLEODIS HEALTHCARE LLP Workshop Goals and Topics 2 Understanding CCG budgets what is new? Financial environment and clinical decision making Understanding linkage between activity, Finance & QIPP Financial communication between CCG and its practices Implications for CCG and member practices Performance management at practice level

3. CONFIDENTIALLEODIS HEALTHCARE LLP 3 What’s Different Now? GP FundholdingPractice Based Commissioning Clinical Commissioning Date 1991-972005-20112013 + Budget Real (Negotiated) Indicative & Delegated (Negotiated to Capitated) Real (“Fair Shares”) Scope Elective CareSelect Hospital and Community Health Services ALL Hospital and Community Health Services except NCB remit Clinical Governance NoSometimes Yes Formal Status IndependentVoluntary Statutory How Selected Voluntary, self-selectedVoluntaryMandatory Source: Kinds Fund, “Clinical commissioning: what can we learn from previous commissioning models?”, 2010

4. CONFIDENTIALLEODIS HEALTHCARE LLP 4 Revenue Resource Limit = Clinical Service Costs Running Costs + Units x Unit Price Population Health Management Utilisation and Market Management National Tariff Local Tariff Block Arrangements Direct + Shared Core Functions CSO & Leeds Shared Health Finance 101 Business Fundamentals of a CCG Allocation for CCG to Spend Breakeven Devolved to practices Linked to COMPACT

5. CONFIDENTIALLEODIS HEALTHCARE LLP Quality, Innovation Productivity & Prevention (QIPP) NHS has to save £20bn by 2014/15 No real growth in the NHS for the next decade Growing demand and ageing population Cost pressures (new drugs & treatments) Impact on the level of service if we don’t do things differently Practices are a key innovator and implementer of QIPP programme Leeds QIPP Targets 2012/132013/142014/152015/162016/17 QIPP -9,072-5,967-6,000

6. CONFIDENTIALLEODIS HEALTHCARE LLP Payment by Result (PbR) – Why Important to GPs? Contracts will be agreed at CCG level with providers, 90% PbR Appropriate treatment in the right setting Focus on ensuring pathway compliance Practice will receive commissioning information – activity, finance and referrals – and will work with CCG to interpret and take actions COMPACT – Will be partially linked to successful compliance and implementation of pathways and maintaining budgetary control PbR Development Being extended beyond secondary care Mental health Ambulance Community Services

7. CONFIDENTIALLEODIS HEALTHCARE LLP Implications for CCG and member practices CCG to balance its books need to work with member practices to operate within allocated budget. Collaborative working to achieve financial balance Practice based budgets Activity & finance information sharing and communication Performance management & Compact CCG financial position will impact on the level of services that can be commissioned by a CCG 7

8. CONFIDENTIALLEODIS HEALTHCARE LLP Checkpoint 8 Break into 4 groups Each group has been assigned a finance and Activity scenario In your own group, work through the following: 1.Discuss insights and follow up questions / actions 2.Present back to broader group Health Finance 101

9. CONFIDENTIALLEODIS HEALTHCARE LLP Handouts Identifying issues & potential actions

10. CONFIDENTIALLEODIS HEALTHCARE LLP Group Exercise: Scenario 1 Handout (Practice – I) Major Highlights / IssuesPotential Action(s) / Solution(s)

11. CONFIDENTIALLEODIS HEALTHCARE LLP Group Exercise: Scenario 1 Handout (Practice – I) Major Highlights / IssuesPotential Action(s) / Solution(s)

12. CONFIDENTIALLEODIS HEALTHCARE LLP Group Exercise: Scenario 2 Handout (Practice S) Major Highlights / IssuesPotential Action(s) / Solution(s)

13. CONFIDENTIALLEODIS HEALTHCARE LLP Group Exercise: Scenario 2 Handout (Practice – S) Major Highlights / IssuesPotential Action(s) / Solution(s)

14. CONFIDENTIALLEODIS HEALTHCARE LLP Handouts Understanding Accountability

15. CONFIDENTIALLEODIS HEALTHCARE LLP Group Exercise: Scenario 2 Handout Major HighlightsPotential Actions/Concerns Fill in some answers?