1. Advent of New Era for NHS Maniac or Visionary?? George Boulos CCG Lead N & W Reading

2. Father of the NHS 1948

3. £60 Billion

4. Overt Aim Management of services by commissioning “from bottom up”

5. Covert possibilities (our fears) Pot emptied by escalating cost of medical care GPs in firing line from all angles for ‘squandering’

6. Heads together

8. So what is GP Commissioning really about Rod Smith Chair North and West Reading Clinical Commissioning Group and West Berks Federation of CCGs

9. The challenge ahead - Increased spend Labour

10. Planned Changes NHS spend/head 2011- 15(= £20 Billion Saving)

11. So how is it shaping up in NHS Berks West Currently all care is commissioned by NHS Berks West PCT with £658,474,000 PCT proposed 1 GPCC -GPs have chosen to develop 4 federated GP groups –Wokingham- South Reading – North West Reading - Newbury Government gave GPs right to choose group size Small size chosen to foster GP ownership Could end up as Federation or Merged Organisation

12. So who are North & West Reading GPCC 10 practices –Balmore Park,Priory Ave,Peppard Road,Emmer Green, Western Elms, Tilehurst Potteries, Circuit Lane –Pangbourne, Theale, Mortimer –And each practice has a lead GP & Manager who meet monthly Working closely with borough Councils and developing Health and Well being boards –Mainly Reading BC working with S Reading –3 Practices mainly West Berks Council And who are the Leaders –4 elected GPs Drs Smith (Chair)Boulos Rock Ciecierski –1 elected practice manager –PCT link and PCT Pharmacist –PCT Director of Commissioning –PCT Non Executive Director Wendy Bower –Transition Director – Janet Fitzgerald former CEO NHS Berks West and Bucks PCTs –Nurse already appointed. Consultant vacancy already advertised

13. Impact of the listening exercise (the Pause) No longer GP Commissioning now Clinical Commissioning Will need 2 nd lay member as Chair or Deputy chair And nurse member And Hospital Specialist member (to please BMA) Our group at risk from LA Boundary Issues –Putting diplomatic effort in to reduce risk Competition as a tool not as backbone of policy (as would have probably happened anyway)

14. 14 Our Patron – Wilkins Micawber  "Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six,(£19.97) result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six(£20.03), result misery.” We can’t just wait for something to turn up we have to generate efficiency savings to improve services and rise to David Nicholson’s £20 billion challenge

15. Elective care -3 year trend data improves insight in to cost control What can we learn from practices 1 & 8 15

16. Monthly Dashboard sent to all practices – aiming to get to each GP Practice visits show high referring practices may be just 1 or 2 doctors “Name and explain” not “Name and Shame/ Blame” Publishing data leads to self awareness & change – no scapegoating My consortia agreed transparent individual GP data, other Consortia want practice only access 16

17. So how will N&W Reading CCG involve you Patient advisory Group–probably 1 or 2 reps per practice CCG Board 2 Patient Director ? Chair of Chairs Commissioning decisions subject to your scrutiny / engagement –Orthopaedic decisions –Diabetic decisions –Ophthalmology redesign –Procedures of limited clinical value –Prescribing decisions –Etc etc

18. In conclusion – GPs and patients can enrich commissioning GPs –By improving their own productivity –By direct dialogue with Specialists Who may not want to change but will listen better to GPs GPs can challenge blocks to change more effectively –And GPs understand what services/ pathways are really like from day to day experience not reports –So GP/Commissioning Manager partnership will be better than Manager (or GP) alone –And you are drawing on 100s of GP’s experience Patients –Drawing on 10 patient groups But Commissioning Group skills will be highly variable 18

19. The Future? ? Richard (Branson Not Croft) ? Private care NHS Bottoms Up = OR: a chance? Our Hope ? OR George Boulos