1. Medlinc GP Commissioning Consortia Dr Peter Stott MA FRCGP Tadworth Medical Centre Executive Lead GP Medlinc GPCC Neighbouring groups in East Surrey Mid Surrey Commissioning Group Dorking Elmbridge Total population 320,000

2. New NHS Structure Regional Health Authority (8) South Thames Strategic Health Authority (10) South East Coast PCT NHS Surrey PBC Groups 14 in Surrey GP Commissioning Consortia (500 in the UK - Av pop 120,000) 14 in Surrey

3. Acute Hospital Trusts ESHUT, KH, SASH GPs Dentists Opticians Pharmacies Community Nurses School Nurses, Podiatry Dieticians, Family Planning Physiotherapy Community Hospitals (Central Surrey Health) Mental Health Trusts Surrey Borders Foundation Trusts RMH Charities Princess Alice Relate Social Services

4. NHS Commissioning Board (Commissioning) Monitor (Financial accountability) Care Quality Commission (Quality Standards) GP Consortia Local Authorities (now including Public Health) Hospital Providers GP Practices Community Services Alternative Providers STATUTORY BODIES PROVIDERS COMMISSIONERS The 2013 NHS Landscape: roles and responsibilities Budget-sharing

5. 2009-2010 (Total 1.6B)

7. The QIPP Agenda Quality, Innovation, Prevention, Productivity £38M overspent – historic deficit Requirement for 8% savings year on year against expected spend Cost pressures: inflation; ageing; technology Rising expectations Evaluation by QIPP will the basis for introducing change 3 QIPP areas: Prescribing; long-term care; urgent care

8. Joint Commissioning Intentions Spend set at a historic level 2011-2012 contract to include strategies for change in 2012-2013 (SDIP) Repatriation of long-term conditions into community (eg diabetes, glaucoma, rheumatology, COPD) Development of ‘virtual ward’ Community alternatives to acute hospital admission Developing efficiencies by removing overlaps in care pathways Introducing health outcome measures to aid patient choice Working with others to develop EGH site into a health campus with a mixed economy

9. Key projects Project M ilestone Medlinks GPCC ASign up to LTC QIPP plan by June 2011. BRisk stratification implemented in practices and vulnerable patients at risk identified by GP practices. June 2011 CDefine and agree enhanced Virtual Ward model for Medlinks July 2011 DDevelop and implement revised COPD pathway - date EDevelop and implement AF pathway FDevelop and implement Diabetes pathway GEnhanced Virtual ward in place by September 2011 HMid Year review - October IIntegrate Telehealth into primary care pathways December 2011 JImplement Summary Care records - date KEvidence of Care plans in place for 75% of those on LTC registers in primary care by end of 2011/12 LReduction in Surrey Heath GPCC Emergency admissions for COPD, HF, CHD and Diabetes by 0.5 per 1,000 population end of 2011/12 MReduction in Surrey Heath GPCC Emergency admissions for COPD, HF, CHD and Diabetes by a further 1.0 per 1,000 population by end of 2012/13

10. New responsibilities of GPCC Commission NHS services Determine healthcare needs Determine service requirements to service needs Enter into contracts with providers Monitor and improve quality of healthcare Provide an oversight of provider training and education Manage budgets and establish priorities on meeting healthcare needs Meet all necessary reporting and audit responsibilities Promote equalities of work with local authorities Engage patients and the public

11. The Local Authority Perspective Health and Well-being Board Healthcare Commissioning Social Care Commissioning Providers

12. The Local Authority Perspective Health and Well-being Board Healthcare Commissioning Social Care Commissioning Providers If we get it right, we can combine global NHS values with local strategies “Think global – Act local”

13. NHS Surrey Governance Plan 4 levels – Aware/Active/Arbitrate/Accountable 3 realms Structure/Relationships/Performance

14. Service Development Improvement Plan (SDIP) – EGH and CSH Collaborative, transparent working to achieve overall governance of the transition –Referral numbers –Knowledge of waiting times and current activity by practice –Financial control –Defined clinical pathways (QIPP) –Move some LTCs into community (diabetes, rheumatology, ophthalmology, paediatrics) –Develop alternatives to A&E attendance –Reduce fragmentation between health and social care –Focus upon quality of care

15. Transformation Board 8 coordinated workstreams lead by an executive and a coordinating board 1.Continuing Care/ Long term conditions 2.Frail and elderly (King’s Fund Project) 3.Unplanned care 4.Women and Children 5.NEECH working group 6.Leatherhead Working group 7.Information (Community care) 8.Information (Acute care)