1. CCG Perspective on Integrated System Redesign Tim O’Donovan September 17th 2013

2. The existing MSK system MSK System Redesign: the redesign of services that diagnose and treat bone, muscle, and tissue conditions and disorders, and associated pain (ICD-10 Chapter XIII, M00-99) – Includes elective orthopaedics, rheumatology, physiotherapy, podiatry and chronic pain – Excludes trauma and non-elective activity MSK patient population approx. 45,000 Over 25 different provider contracts Total budget circa £25 million

3. The challenge: the patients’ view Referred to the wrong service/clinician – Frustrated by no direct referral from part to the system to another: “ping ponged back to GP” – Continual onward referral to different elements of care until diagnosis is received Poor co-ordination of information and administration across the system No integration with social care at assessment Long waits for and within outpatient clinics Difficult to get in contact with team post-op

4. BCCG MSK Strategic Vision The White Paper: Liberating the NHS, provides an opportunity to move towards integrated systems of care BCCG response to the opportunity and challenges highlighted – Encourage integration of services through a system contract with aligned incentives, improving the co-ordination of patient care through a PRIME CONTRACT – Commissioning for outcomes, better value and less waste, with patients getting the right care in the right place, first time – Empower clinical leadership to challenge and champion, and to develop new ways of providing care across the pathway

5. Specification Single budget, prime contract for 5 years Four main types of care: – Patient support and empowerment – Support, education and advice for primary care – Community-based MSK service – Use of hospital facilities only when those facilities are needed Incentivised game-changing outcome measures

6. Prime Contractor

7. National Context Prime Contracting Alliance Contracting Integration Incentives Payment/Capitation/PBR Outcome Focus System Approach

8. Members Involvement Approach your local CCG/s, overview and scrutiny, opportunities, good ideas e.g. joint injections Opportunity to get involved through workshops, clinical networks – Output is influencing specifications, KPIs, outcome measures Check supply to health – advertising market engagement workshops, procurements Are you linked in locally? Discussion with local colleagues on provision, federation, consortia, stand alone practice