Liberating the NHS: GP Consortia

South West Forum conference9/10 November 2010

The themes in the White Paper Putting patients and the public first: ‘no

decision about me without me’ Focusing on improvement in quality and

health care outcomes Shifting power and accountability closer to

patients, with greater democratic legitimacy Transparency of information and choice for

patients Empowering clinicians: liberating the NHS Cutting bureaucracy and increasing efficiency

Liberating the NHS:

Commissioning for patients

Gateway reference: 14833

Devolving power and responsibility for commissioning of most health services to groups of GP practices will empower health professionals as leaders of a more autonomous NHS

Commissioning by GP consortia would bring decision-making much closer to patients and local communities, and ensure that redesign of patient pathways and local services is always clinically led

GP consortia will have a duty of patient and public involvement and will be held to account for this by the NHS Commissioning Board

GPs will work in partnership with secondary care, other health and care professionals and with community partners to decide how to use NHS resources to get the best health care and outcomes for patients, through well designed, joined-up services that make sense to patients and the public

The intention is to put GP Commissioning on a statutory basis, with powers and responsibilities set out through primary and secondary legislation

What does it propose?

DH will work with the NHS and other health and care professions to promote multi-professional involvement in commissioning

GPs will work with local authorities, who will have a lead role in ensuring services across the NHS, social care and public health are joined up and meet the needs of local people

All GP practices will be required to be part of a consortium, and ensure provision of services that support high-quality outcomes and efficient use of NHS resources

Not all GPs, practice nurses and other practice staff will have to be actively involved in every aspect of commissioning. Their main focus will continue to be on providing high-quality care to their patients. A smaller group of primary care practitioners are likely to lead the consortium.

What does it propose?

Consortia will not have to do all the commissioning work on their own. They will have freedom to decide the best resourcing approach for them, (e.g. direct employment, collaboration across consortia, or external, paid-for specialist support (local authorities, private and voluntary bodies))

Consortia will receive a maximum management allowance for commissioning costs

A quality premium (proportion of GP practice income) will be linked to the outcomes practices achieve collaboratively through their consortium and the effectiveness with which they manage NHS resources

Primary Care Trusts will cease to exist from April 2013 - it is important to capitalise on progress made and to harness their existing expertise and capability in the transition period

Implementation will be bottom-up, with GP consortia taking on new responsibilities as rapidly as possible, with consortia fully operational from April 2013. Consortia may grow from existing PBC groups

What does it propose?

Sufficient geographic focus will be necessary to commission for locality-based services, unregistered patients and to fulfil duties such as safeguarding of children

GP consortia will commission most NHS services including elective hospital and rehabilitative care, urgent and emergency care (including out-of-hours), most community health services, and mental health and learning disability services

To support GPs in their commissioning role, an independent NHS Commissioning Board - duties will include leading on quality improvement, promoting patient choice and patient involvement, and allocating and accounting for NHS resources.

What does it propose?

The NHS Commissioning Board, supported by NICE, will develop a commissioning outcomes framework

The NHS Commissioning Board will be responsible for commissioning primary medical services, family health services (dentistry, community pharmacy, primary ophthalmic services), national and regional specialised services, maternity services and prison health services

The NHS Commissioning Board will be accountable to the Secretary of State for managing the overall commissioning revenue limit and for delivering improvements against health outcome measures. The Board will hold consortia to account for their performance

What does it propose?

The proposed implementation timetable is:

In 2010/11: GP consortia to begin to come together in shadow form (building on Practice based Commissioning consortia, where they wish)

In 2011/12: a comprehensive system of shadow GP consortia in place and the NHS Commissioning Board to be established in shadow form

In 2012/13: formal establishment of GP consortia, together with indicative allocations and responsibility to prepare commissioning plans, and the NHS Commissioning Board to be established as an independent statutory body

In 2013/14: GP consortia to be fully operational, with real budgets and holding contracts with providers

When will this happen?

Establishing GP Consortia

Development of a Commissioning Outcomes Framework to focus priorities

Approach to achieving change across the system

Variety of GP views about commissioning role Approach to formation of GP consortia Development of capability of GP consortia Transition for Primary Care Trust functions and

staff Approach to commissioning support

Process and progress in the South West Early stages – GPs have met together twice to

think through their approach Levels of commissioning and options re

consortia size Getting authorised – what will it require? Commissioning competencies – how to get

them? Pathfinder process – encouraging applications Working with Primary Care Trusts and

supporting QIPP implementation – looking after the inheritance!

Commissioning ProcessAssessing Health Needs

Establish local priorities against Outcomes Framework

With patients and full range of health and care professionals , decide what services will best meet those needs.

Review service provision

Design services

Create clinical service specifications

Publish commissioning plan / intentions

Establish contracts

Monitor and manage performance

Review of commissioned services

Impact on Outcomes

(and reporting)

Patients

Public

Early implementation tasks? Forming Consortia Developing a Consortia health and healthcare

quality (and outcome) based strategy Demonstrating arrangements to commission at

all levels – for authorisation Demonstrating access to competencies:

clinically led / assured – for authorisation Identifying added value of GP Consortia (Do /

Assure) Getting started - sorting out all the practicalities

Commissioning provision – early challenges? Need for strong fit-for-purpose delivery system in each

health community More choice for service users and provider income

dependant on those choices! Potential for increased use of third and independent

sector provider – Any Willing Provider model Transforming Community Services: take forward

opportunities for improving services as well as organisational change

Develop approach to support integration of care delivery Promote opportunities for development of strong social

enterprise sector Develop approach to financially challenged trusts and

recognise need for review of viability for certain organisations

Conclusion Key tests for GP consortia to deliver as

part of the wider changes: Improved outcomes Improved productivity High standards of quality and safety