Update April 2011. “liberating the NHS” a major policy shift introduced by coalition government...
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Clinical Commissioning
Update April 2011
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“liberating the NHS” a major policy shift introduced by coalition government
Significant change for NHS and local authorities
We will all be involved- whether we like it or not!
Clinical commissioning
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Introduction
Major shift in government policy, transferring responsibility for commissioning care to GPs
Ongoing political disquiet- model likely to change to involve other parties- secondary care, other health professionals, patients
Improving care , saving money, transferring responsibility and /or blame?
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Effective commissioning
Should be based on: Improving outcomes for patients; prioritises
demand over supply, innovative approaches to delivery of services
Patient empowerment; promotion of shared approaches to care, keeping patients fully informed, power to shape their own healthcare, and support to care for themselves
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Effective commissioning
Evidence based practice ;draw on research expertise to use evidence to assess needs, design services and monitor outcome
Community mobilisation ; values of public service, harnessing the power of patients to determine their own health outcome- community engagement. Integrating with public health agenda, promoting wellbeing, preventing ill health
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Effective commissioning
Ensuring the needs of the vulnerable, overlooked or ignored are addressed
Sustainability ; commitment to the sustainable use of resources – natural environment, NHS finances and the time and spirit of staff
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commissioning consortia
Organisations that will take on the task of commissioning
Pathfinders ; current model to develop ways of making it work locally, shadowing PCT work
Will need to partner with clinicians and the public, true collaborative working
Major challenge for leadership- breaking down barriers between primary and secondary care
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commissioning consortia
Breaking down barriers between health and social care and professionals and the public
Engagement across traditional boundaries Who will do it , and what support will they
get? Currently volunteers , locally elected by
peers
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GPs in consortia
Do they have the requisite skills? Leadership Knowledge Vision Priorities and context Negotiation skills Managing change Respect
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GP consortia
Health needs assessment Contracting skills Financial and budgetary understanding
……..ie a major undertaking!
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What support is available?
New role of Associate Dean for commissioning in Surrey, Kent and Sussex
Taps in to deanery support, links to university
Planned commissioning development groups to tackle practical skills acquirement, understanding and knowledge, along the lines of the existing appraisal development workshops
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What support is available?
National support through RCGP , LMC, BMA Planned diplomas , academic modules via
universities to develop commissioning skills , possible portfolio careers for GPs
GP Tutor network tasked with helping everyone to understand the process- protected learning time
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Grass roots GPs
Why should I be interested? ALL GPs are involved in commissioning Every prescription and referral is a
commissioning act It will never work without the support and
understanding of grassroot GPs QOF will encourage you!
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QOF and commissioning
Re allocated points for 2011-2012 96.5 points for quality and productivity
indicators Encouraging increasing efficiency in use of
NHS resources Cost effective prescribing Reducing emergency admissions and
hospital referrals by use of alternate pathways
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QOF and commissioning
2011-12 indicator changes: http://www.bma.org.uk/images/summaryqof
guidance2011_v3_tcm41-204734.pdf
Local initiatives and the way forward
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Case Scenarios
You are a newly qualified GP and have been asked to lead on delivery of the QP QOF in the practice- how will you do this , and what skills will you need?
Your practice has been approached by the consortium to be told you are an outlier- how will you manage this situation?
Your senior partner is refusing to change his/her prescribing or referral habit- and they use the Brompton as the local hospital is “not up to scratch” how will you address this?
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NHS commissioning board NHS outcomes framework will set
expectations for performance- within resource parameters set by government
This board will manage GP contracts and set practice level budgets for the new CCGs
Board will monitor and hold CCGs to account
SHAs and PCTs will go – PCTs from april 2013
Structure
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GP practices will have to belong to a CCG Part of GP budget likely to go to CCG for the
delivery of commissioning outcomes Current local example in funding practices
to participate in “high risk” patient reviews with CMHT and Social Services- and to actively review referral processes
Structure
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Local authorities will form a new relationship with the NHS and CCGs
Public health will move to Las and be subject to new health improvement programmes
Healthcare providers will be subject to dual monitoring and licensing system
Monitor will become the new economic regulator
Structure
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• Care Quality Commission will monitor delivery and infrastructure – all practices will have to be CQC registered
• Two key principles- putting patients first “no decision about me , without me”
• Proposed information revolution- allowing an extended range of informed choice
• Improving healthcare outcomes, Quality improvement programme supported by NICE
Structure
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HealthWatch England collates national information, acts as consumer champion
Structure
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1-Planning Assessing health needs Reviewing current provision Capacity planning Identifying gaps and priorities
So what is commissioning?
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2- procurement Service design / redesign Defining contracts Procuring appropriate services Demand management
So what is commissioning?
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3- monitoring Monitoring activity and quality Invoicing, data validation and payment User and local authority views , choice Feedback All clinically driven, with patient . Public and
LA input
So what is commissioning?
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Significant unhappiness with The Health and Social Care Bill- RCGP , BMA etc
However , Bill now through The Lords- Royal Assent expected before Easter
More savings needed- if current target met in 2015 , a further £20 billion savings needed “ a decade of no money” Richard Douglas, DoH director of policy, strategy and finance
Where are we now?
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Essential part of MRCGP- community orientation, teamwork, maintaining trust, safety and quality
We are all involved in micro-commissioning New skills of enquiry, analysis, collaboration
, negotiation and presentation needed for all
CPD needs to change to recognise the cultural shift
Your involvement
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Five P model for cpd Personal needs – what do I need to further
my career? Practice needs- what do I need to learn to
help develop my practice? Patient needs- what do I need to learn to
provide good care for my patients?
Your involvement
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Population needs- what do I need to learn to reflect the needs of my CCG population?
Political needs- what do I need to learn to reflect the needs of the NHS?
And maybe some of you will wish to become commissioners/ board members
Portfolio careers
Your involvement