1. Improving NHS Productivity Dr Donal M Hynes Vice-Chair NHS Alliance PEC Chair NHS Somerset

2. No reduction in resources NHS Resource Gap

3. SelfCommunityPrimaryHospitalTertiary

4. SelfCommunityPrimaryHospitalTertiary

7. GP ownership Express the size of the problem in recognizable terms

8. Bridgwater Quipp Urgent care Elective LTCs Meds Primary Mental LD Non-clin 3,443,000 7,634,000 2,395,000 599,000 2,096,000 150,000 3,892,000

9. Bridgwater Quipp Total£20,209,000 50 GP one less referral to OPD per week £250,000

12. Bridgwater Qipp Total£20,209,000 Need to reduce emergency admissions by 130 per week every week 90

13. Fundamental cultural change 1.Population -active participant 2.Clinicians -proactive in health

14. Size matters 1.Rearrange services 2.Change core concepts

15. Form follows function

16. Size matters Delegating up is easier than delegating down Risk Management options Monopoly Commissioners

17. Golden rules for consortia 1.Come within budget 2.Hit Quality Targets 3.No noise in the system

18. Population engagement Provide governance –Open and transparent –Vested interests –Voluntary Organisations and commissioning

19. Population engagement Democratic Legitimacy –Tough decisions –Choice traded for Voice –Community responsibility ethos

20. Clinicians Primary Care Clinicians – Generalists –Patient in context of community –Responsibility for health maintenance –Local peer pressure/support

21. Clinicians Specialists –Non hospital-based –Not at the end-stage crisis point only –Not remote from patients environment

22. COSS Clinicians Community Orientated Specialist Services Develop community services Become more closely engaged with Primary Care clinicians Follow patient into community More of the same

23. CBSS Clinicians Community Based Specialist Services Manage patient as part of community In-reach beds Integrated with other clinicians Radical Change

24. CBSS Clinicians Emergency admissions Clinician to Clinician

25. Making it happen Conversations with local authorities Start looking at spend on a weekly basis within practice Clinician to clinician discussions

26. Why bother?

27. In any circumstances where there are concerns that an individual practice is causing ineffective or wasteful use of NHS resources, the consortium of which it is a part would be expected to work with that practice to address the relevant issues. If problems persisted and there were concerns that a practice was not meeting its contractual duties, the NHS Commissioning Board would need to address this as part of its responsibility for managing primary care contracts.