1. ©British Medical Association BMA presentation The five year forward view March, 2015

2. ©British Medical Association Presentation overview Background and implementation 5YFV overview New models of care March, 2015 2

3. ©British Medical Association Background ‘Five Year Forward View’ (5YFV) published October 2014  Vision for future of NHS in England by NHS  NHS England; Care Quality Commission; Health Education England; Monitor; Public Health England; Trust Development Authority ‘The Forward View into action: Planning for 2015/16’ published December 2014  First jointly produced annual planning guidance March, 2015 3

4. ©British Medical Association Implementation Conservative party manifesto gave full support Jeremy Hunt ‘biggest priority now is to transform care outside hospitals’ No formal implementation plan New groups/boards Forward view coalition group; Prevention board; New models of care board; Workforce advisory board; Primary care workforce commission March, 2015 4

5. ©British Medical Association Rationale for change Close widening gaps in health of population, quality of care and funding Rise to demographic and epidemiological challenges Coordinate care around people’s needs and wants NHS spending growth of past unlikely to be a feature of future March, 2015 5

6. ©British Medical Association Prevention New approaches to improving health and wellbeing Hard-hitting national action on tobacco, alcohol, junk food, excess sugar Enhanced powers for mayors and LAs on decisions relating to public health policy National diabetes prevention programme March, 2015 6

7. ©British Medical Association Empower patients & engage communities Support people to manage their own health (education) Integrated personal commissioning New/better ways to support carers Short alternative to standard NHS contract for charitable and voluntary organisations March, 2015 7

8. ©British Medical Association Strengthening primary care Stabilise core funding nationally over next 2 years Give CCGs more influence over wider budget (i.e. co-commissioning with NHS England) Expand workforce: GPs in training, community nurses, other primary care staff Incentivisation for under-doctored areas to tackle health inequalities March, 2015 8

9. ©British Medical Association Information revolution National Information Board (NIB) established  NHS, public health, clinical science, social care, local government and patient representatives Transform digital care  Comprehensive transparency of data  Fully interoperable electronic health records  Online GP appointments and prescriptions  Bring together hospital, GP, administrative and audit data March, 2015 9

10. ©British Medical Association Efficiency and productive investment Predicted gap of £30 billion per year by 2020/21  Growing demand, no further efficiencies, flat funding Historic NHS efficiencies of 0.8% per year inadequate Close £30 billion gap by 2020/21 by –Target of 2-3% efficiencies per year – how? –Investment for new care models – from where? –Some funding growth – the £8bn figure! March, 2015 10

11. ©British Medical Association New models of care Break down divides between different parts of health service, as well as between NHS and social care No one size fits all - nor should a thousand flowers bloom 1.Multispecialty community providers (MCPs) 2.Primary and acute care systems (PACS) 3.Urgent and emergency care networks 4.Viable smaller hospitals/acute care collaboration 5.Specialised care 6.Modern maternity services 7.Enhanced health in care homes March, 2015 11

12. ©British Medical Association Multispecialty community provider Groupings of GP practices offering a wide range of care Take on as partners, or employ, wide range of doctors, other clinical staff and social/care professionals Shift outpatient and ambulatory care out of hospital Develop new clinical roles ‘generalists/hospitalists’ Potential for delegated, capitated budget for registered list of patients, including social care Eventually an integrated provider of out-of-hospital care March, 2015 12

13. ©British Medical Association Primary and acute care system Single organisation providing NHS list-based GP and hospital services, with mental health and community services  Hospitals permitted to open GP surgeries with registered lists (in some circumstances) OR  MCPs to run their main district hospital Reinforce out-of-hospital care – not a ‘feeder’ for hospitals Redefine workforce roles e.g. blend gen. physician with GP Potential for delegated, capitated budget for registered list of patients, including social care Likened to Accountable care organisations (ACOs) March, 2015 13

14. ©British Medical Association Vanguard New models of care pilot programme – ‘the vanguard’ First wave of 29 sites announced in March  9 PACS; 14 MCPs; 6 Enhanced health in care homes Investment and support began in April Movement from ‘aspirant’ to ‘actual’ not guaranteed ‘Unofficial vanguard running in parallel at the same pace’ Benefits and costs known by end of next Parliament March, 2015 14

15. ©British Medical Association Acute care collaboration New vanguard announced in May - applications by end July Extends/replaces ‘viable smaller hospitals’ model  Incorporates some thinking from Dalton review Explore/create new options for FTs/NHS trusts Accountable clinical networks Specialty franchises Management groups Chains of multiple organisations March, 2015 15

16. ©British Medical Association Urgent & emergency care networks New vanguard announced 3 June 2015  Picks up Urgent & Emergency Care Review (Nov 2013) Overhaul of NHS 111, GP out of hours services, minor injuries / urgent care centres, ambulance services, A&E  Pilot sites to cover 2 million patients - roll-out in 2-3 years  ‘Collaborative exercise’ between hospitals, CCGs, social care services and primary care Review of performance indicators and payment systems March, 2015 16

17. ©British Medical Association Regulatory & financial backdrop Competition and procurement  Monitor’s duty to prevent anti-competitive behaviour Payment systems  National tariff/payment by results and perverse incentives Contracting/governance  NHS standard contract rigid  Prime contractor; prime provider; alliance contracting Financial crisis in NHS March, 2015 17

18. ©British Medical Association Questions? March, 2015 18 Contact info.hperu@bma.org.uk