Understanding the new Commissioning Landscape Thoughts for future planning Dr Nick Harding

Understanding the new Commissioning Landscape

Thoughts for future planning

Dr Nick Harding BSc MFMLM FRCGP DRCOG DOccMedPGDip(Cardiology)

February 2012

Botanical Gardens

An introduction We are passionate about improving healthcare for the people of Sandwell and West Birmingham.

Our vision is for transforming services to ensure excellence for everyone and in everything we do.

We will not be a PCT in new clothing – this is a different kind of organisation that is firmly ground in its membership, relationships and local knowledge.

We will be using local and clinical knowledge for change and improvement in health for our patients.

2Clinical Engagement Event - February 2012

Numbers of the day…

35025797152 5010 4539 000 000


Our health needs

4Health without boundaries - November 2011

• SWBH commissioning area is 530,560 patientsSWBH commissioning area is 530,560 patients• Heart of Birmingham Heart of Birmingham ranked ranked 1010thth most deprived most deprived

Local Authority in England with Local Authority in England with 68% BME 68% BME populationpopulation• SandwellSandwell ranked ranked 1212thth most deprived most deprived Local Authority Local Authority

in England in England with approx with approx 20% BME 20% BME populationpopulation• Health challenges against rising costs and demands Health challenges against rising costs and demands

for healthcarefor healthcare• Absolute commitment to improving quality of careAbsolute commitment to improving quality of care

4

The journey

2002 PCTs arrive

2003 Right Care Right Here partnership forms

2007 Practice Based Commissioning, ICOF

2008 Primary Care Collaborative Clinical CommissioningDirectors appointed

2009 Partnerships form: Vitality PartnershipStrategic Models of Care

2010 GP Consortia Healthworks, ICOF, Black Country Alliance and Pioneers for HealthCare Pathway Reviews

2011 Sandwell and West Birmingham Clinical Commissioning Group


Our CCGLocal Commissioning Groups* Chair

Practices (approx.)

Population (approx.)

Black Country Dr George Solomon 20 112,228

HealthWorks Dr Nick Harding 22 132,985

ICOF Dr Samar Mukherjee 27 106,953

Pioneers for Health Dr Vijay Bathla 10 46,151

Sandwell Health Alliance Dr Basil Andreou 31 127,519

Clinical Commissioning Group

Sandwell and West Birmingham

Dr Nick Harding(Interim Chair)

111 530,560


CCG Area covered


Our Interim StructureInterim Chair

(Currently Chair of HealthWorks)

Board Secretary

Chair and Vice Chair of HealthWorks

Chair and Vice Chair of Sandwell Health Alliance

Chair and Vice Chair of Pioneers 4 Health

Public Health Representative

Secondary care consultant

Lay Advisors

Nurse Representative

Consortia Development: Non-voting membersFinance Lead

Birmingham

Finance Lead Black Country

Lay Advisor Birmingham

Lay Advisor Black Country

Director of Commissioning Birmingham

Director of Commissioning Black Country

Chair and Vice Chair of Black Country

Chair and Vice Chair of ICOF

Deputy Chair(TBA)

Finance Lead


Our structure

Main SWBCCG Board

Finance & Performance Sub-Committee

Quality & Safety Sub-Committee

Strategic Commissioning & Redesign Sub-Committee

Remit: To have on-going responsibility for the affordability of the local healthcare system, and to receive monthly monitoring reports. This group will highlight concerns to the Board.

Remit: To regularly review providers to ensure that services are safe, and that outcomes are monitored.

Remit: To consider service provision and ensure that services are commissioned for shorter pathways, better value for money, and that provision is appropriate and adequate.


Delivery through membershipChair and Vice Chair of HealthWorks

Chair and Vice Chair of Sandwell Health Alliance

Chair and Vice Chair of Pioneers 4 Health

Chair and Vice Chair of Black Country

Chair and Vice Chair of ICOF

Sandwell and West Birmingham Clinical Commissioning Group


Our RoleBy April 2012 - shadow form as a CCG in readiness for 2013.

We want to:• Be clear on the health needs of our population and how we

are going to improve their health• Get the balance right between local and strategic decisions• Show real clinical leadership and development across the

health economy• Do this new role in the most effective way we can• Create a clinical commissioning group that leads by example• Be effective in communications within our organisations and

the people we serve• Be ready to lead and manage the NHS as a system by April

2013.


12

New NHS

LicensingLicensing

Department of Health

Department of Health

CQCCQCNHS Commissioning

BoardNHS Commissioning

Board

ParliamentParliament

MonitorMonitor

Patients & PublicPatients & Public

2° and 3° Providers2° and 3°

Providers

PartnershipPartnership

SWBCCGSWBCCG ContractsContracts

Accountability

Funding

Key:

Birmingham HealthWatchBirmingham HealthWatch

Sandwell HealthWatchSandwell HealthWatch

Clinical Engagement Event - February 2012

Estimating the Size of the Challenge - CommissionersA Conceptual Model

The scale of the financial challenge has been estimated by applying demand pressure forecasts by service line and price pressure forecasts to current levels of spend. Cost pressures associated with the planned transfer of funds from NHS allocations to social care are also included.

By 20014/15, there will be a recurrent cost pressure of £2.4bn (£1.3bn demand pressure, £1.0bn price pressure and £100m social care transfer). 44% of this will be offset through increases in commissioner allocations, leaving a residual recurrent cost pressure of £1.35bn in 2014/15.

Forecast Demand Pressure (CAGR – 2011/12 to 2013/14)

G/PMS etc 2.7%Prescribing 5.1%Ophthalmology 2.4%Dental 5.0%Community services 4.0%Ambulance 6.0%A&E 3.2%Outpatients 5.3%In-patent emergency 2.4%In-patent elective 2.4%Non- PbR outpatients 5.3%Non- PbR in-patients 2.4%Specialised Services 2.0%Mental Health 1.9%PCT Management Costs 0.0%Other 2.0%

Forecast Price Pressure

2011/12 2.1%

2012/13 2.1%

2013/14 2.6%

2014/15 2.7%

Clinical Engagement Event - February 2012

Emergency Elective Maternity Other

<18

18-54

55-74

75+

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 20% 40% 60% 80% 100%

Beds Days by Admission Method and Age GroupBirmingham Providers 2009/10

Areas we can target

Doing exactly what we should be doing


Secondary caredelivering

specialist services

Improved patient experience And releasing savings

Better primary care delivering more services

Stop doing things

Different place

Increase efficiency

Different provisionDecrease dependency

Keeping local and clinical engagement at the centre of how we deliver – a grass roots approach

Doing the right things right


Improving quality

• Improve patient experience and quality of care• Improve health for our population• Working towards delegation/authorisation in 2012-13• Continue to build on good work done so far (RCRH)• Remain committed to the build of the new hospital and

working in partnership• Through continuous improvement, create rewarding

experience for clinicians wherever they are

Our ambition as a CCG


Getting the best out of services - diabetes


Over to you


Understanding the new Commissioning Landscape Thoughts for future planning Dr Nick Harding

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