1. WESSEX Local Medical Committees Appraisals, commissioning and the new NHS Dr Nigel Watson 21/11/2015 1

2. WESSEX Local Medical Committees Dr Nigel Watson GP Had 9 appraisals CEO Wessex LMCs Has 8 performance reviews GPC – Represent Hants and IoW (1996 – to date) Chair – Commissioning Sub-committee of GPC (BMA) DoH committees GP strategic commissioning GP working group Centre for workforce Intelligence General Practice Advisor

3. WESSEX Local Medical Committees Quality Individual Appraisal Revalidation Practice QoF – Quality performance Quality premium CCG contract – benchmarking/peer pressure

4. WESSEX Local Medical Committees How do we define quality in the NHS?

5. WESSEX Local Medical Committees What is quality? Upper quartile performance? Value for money - VFM? Financial balance? Technical care? Customer service? Improved process measures? Improved clinical outcomes?

6. WESSEX Local Medical Committees Countries whose health systems are more oriented towards primary care achieve better health levels higher life expectancy better health outcomes higher satisfaction with health care among their populations lower overall health care costs lower medication use 21/11/2015 6

7. WESSEX Local Medical Committees Some facts GP consultation£20 Walk in Centre£24 NHS Direct telephone call£15 A&E attendance£74 OPD£100 – 300 21/11/2015 7

8. WESSEX Local Medical Committees NHS Budget in billions

9. WESSEX Local Medical Committees Challenges Flat cash Aging population 17 million people with long term conditions and rising New drugs and technologies Reduce bureaucracy Improve decision making

10. WESSEX Local Medical Committees Issues to resolved Outcomes Patient choice Targets Bureaucracy Lack of clinical involvement in healthcare planning Clinicians – responsibility, accountability Lack of close working with Local Authority Money

11. WESSEX Local Medical Committees Commissioning GPs commission services for the individual patient Prescribe Refer Admit Co-ordinate care Proposals will ensure that GPs are involved in commissioning for a population

12. WESSEX Local Medical Committees Clinical challenge GPs Improve quality Align clinical behaviour with financial accountability Commissioning for individual vs population Reduce variability Greater peer review and peer pressure

13. WESSEX Local Medical Committees Clinical challenge Consultants Work with commissioners Contribute to reform Understand care outside hospital Stop silo working Understand the financial future of the NHS Integration of primary and secondary care

14. WESSEX Local Medical Committees Appraisal The purpose of the appraisal will enable all General Practitioners to participate in continuous quality improvement of the quality of their practice. Although not it’s primary purpose, aspects of appraisal may assist in the early identification of doctors in difficulty so that they can be offered appropriate support.

15. WESSEX Local Medical Committees Quality improvement Reduce the unacceptable variability GP Appraisal – who will commission? Revalidation Procedures for GPs whose performance causes concern –PCT/LMC – the future? Performers list – registration – PCT – NHSCB CSU, CCG, sub-national NHSCB

16. WESSEX Local Medical Committees Quality improvement Reduce the unacceptable variability General Practice QoF CCG Quality Premium

17. WESSEX Local Medical Committees QoF Quality improvement 96.5 points Average practice £12,500 Prescribing Referrals Emergency care Quality & VFM Data, information, peer review Contribute to commissioning process Design, develop and utilise clinical pathways

18. WESSEX Local Medical Committees Clinical Commissioning Groups Improve quality of general practice Peer review and peer pressure Devolved leadership Commissioning Group Lead Board Locality lead Practice lead

19. WESSEX Local Medical Committees Quality premium How much? 5-10% of current GP funding Who will decide on achievement? CCG or Health and Well Being Board How will quality be measured?

20. WESSEX Local Medical Committees Performance of practices Mirror the GP performance procedures What happens to a failing practice? Where will practice contracts be held?

21. WESSEX Local Medical Committees Accountability and Probity All practices part of a Clinical Commissioning Group CCG accountable to NHSCB Practice accountability All GPs in every practice engaged Conflict of interest GP/patient GP role in CCG Role of GP provider companies

22. WESSEX Local Medical Committees Any questions?