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Commissioning a Patient-Led NHS – Consultation

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This presentation will cover:

Why consult?Context and the need for changeRoles of the new organisations ( SHA, PCT and Ambulance)Proposals, decisions and outcomes Learning and areas of concernBenefits/disadvantagesFinancial issuesBoundary issuesHow you can have your say

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Why consult?

We want to listen to those who use, fund

(as tax payers) or are partners working with the NHS, in order to enhance the decision making process and make the NHS work for you

Your views are important to us

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ContextPart of an ongoing reform process In line with the NHS Plan Shifting the balance of power and Creating a Patient-Led NHS and‘Taking Health Care to Patients’‘Choosing Health’Purpose of changes - improvements in health and in servicesOrganisations - ‘fit for purpose’

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The need to changeIn order to:

strengthen commissioning and health improvement and free up resources to invest in front line services

Adapt to the formation of Foundation Trusts and New ways of paying for health services (Payment by results)

Forge strong partnerships with Local Authorities, Voluntary Sector and other key agencies.

Realise a Patient Led NHS

Improve the health of the population

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What do we mean by ‘Commissioning’?

How the NHS spends its moneyPlanning and paying for services whilst assuring quality, fairness and value for moneyDeveloping services in response to the preferences, lifestyles and needs of the local population

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Practice Based Commissioning

GP practices ( or groups of practices) commissioning services on behalf of their local population Designing patient pathways Working in partnership with the PCT to

create local convenient community services Responsible for a delegated budget which

will cover acute, community and emergency care

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Role of the ambulance service

‘….. from a service focusing primarily on resuscitation, trauma and acute care to becoming a mobile health resource to the whole NHS’Patients receive improved careMore treated in the communityMore effective use of NHS resourcesGreater job satisfaction for staffImprovements in self care and health promotion

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Role of new SHA‘Builders’ – commissioning,organisations and systemsMaintaining a local strategic overview of the NHSPerformance Management Responsible for ensuring services are high quality safe and fair Working with Department of Health,Regional offices & Learning and Skills Council Leading Emergency and Resilience Planning

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Role of new PCTStronger Commissioning bodies

Particular focus on Practice based commissioning

Integrated commissioning of health and social care

Health Improvement /partnership working

Clinical engagementPublic engagement/involvementEmergency planning

National Criteria Local Considerations

Secure high quality services Provision of clear/consistent patient pathways; Compliance with Standards for Better Health; Clinical Governance. Clinical Networks. Integration opportunities

 

Improve the engagement of GP’s and rollout of Practice Based Commissioning with demonstrable practice support

Relationship maintenance. Improved clinical engagement. PEC considerations. Working in partnership to create community based services 

 

Improve health Public Health Capacity. Congruence with Local Authority/Social Services boundaries. Local Strategic Partnerships. Opportunities for joint working/posts. Long Term Conditions management. Children’s Trust plans. Mental Health Services. Alignment of health needs and access to services

Improve public involvement Zone/patch/neighbourhoods arrangements. Management Capacity/ Critical mass. Maintaining the local Face of the NHS/sense of identity the public can understand. PPI forum relationships

 

Improve commissioning and effective use of resources

Management capacity/Critical Mass. Commissioning and Public Health Expertise. Local Area Agreements and LSP’s, joint working opportunities. Potential for pooled or aligned budgets with key partners

Manage financial balance and risk Management capacity. Scale of budget. Risk management arrangements

Improve co-ordination with social services through greater congruence of PCT and Local Government boundaries

Boundary/Geographical considerations of new organisation.

Deliver at least 15% reduction in management and administrative costs

 

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Proposals – Decision making process

SHA - Joint SHA decision for 2 SHAs to be replaced by one PCT - option appraisal process and multi-stakeholder event SHA Board decision - 29th SeptMinisterial review of proposals and decision on consultation options - 30th Nov Ambulance service - outcome of a national review of ambulance services

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Outcome – SHA and Ambulance

We are therefore consulting on:

1 SHA for the East Midlands (combining Leicestershire Northamptonshire and Rutland

SHA with Trent SHA)

1 Ambulance Trust for East Midlands(combining Lincolnshire, East Midlands and Half of Two

Shires Ambulance services)

Each new organisation is coterminous with the government regional office boundaries

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Outcome PCTs – 2 options

Option 1 One PCT for the city of LeicesterOne PCT for the counties of Leicestershire and RutlandOne PCT for the county of Northamptonshire

Option 2 One PCT for the city of LeicesterOne PCT for the counties of Leicestershire and Rutland Two PCTs for the county of Northamptonshire

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For Leicestershire and Rutland

1 PCT for Leicester City (combining the current 2 PCTs - Eastern Leicester PCT and Leicester city West

1 PCT for Leicestershire and Rutland(combining Charnwood and North West Leicestershire,Hinckley and Bosworth, Melton Rutland and Harborough and South Leicestershire PCTs and Bottesford, Croxton and Kegworth)

Each new PCT will be coterminous with its respective

Local Authority which provides Social Services

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Northamptonshire 1

One PCT for Northamptonshire - combining Northampton, Daventry and South Northamptonshire plus Brackley and Byfield and Northamptonshire Heartlands PCTs plus Oundle and Wansford

This solution provides complete co-terminosity with Northamptonshire County Council Social services and all

7 Borough/District Councils

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Northamptonshire 2

or 2 PCTs 1 PCT for South Northamptonshire combining

Northampton and Daventry and South Northamptonshire PCTs (inc Brackley and Byfield)

1 PCT for North Northamptonshire Northamptonshire Heartlands PCT plus Oundle and

Wansford

Each PCT would be co-terminous with its respective borough/district councils

Geographical area

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Option 1

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Option 2

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Learning points - from the engagement and option appraisal processes

Generally importance of: ‘Localness’Clinical and public engagement/involvementPartnership working

Particularly in Northamptonshire: Equitable resource allocation

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Potential benefits of fewer PCTs

Stronger commissioning functionsIncreased support to General practice for Practice Based CommissioningCoterminosity with local authorities providing social services (esp. LSPs and LAAs)Stronger more effective public health functionEnhanced opportunities to achieve 15% cost savingsMinimisation of financial risk

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Potential disadvantages

Loss of ‘localness’Risk to clinical engagementPotential inequitable application of funds – for those areas that experience the greatest public health challengeImpact on relationships with District/Borough Councils

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Financial issuesTarget of 15% saving in management and admin HR applied in accordance with national frameworkFor LNR savings required= £7 millionSavings recurrent from 2008/09

Where will the money come from?£4.5m PCT reconfiguration£2.5m SHA reconfiguration

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Boundary issues

Realignment of GP Practices whose contracts are administered by PCTs outside of their respective county boundaries to enable co-terminosity with Social Services.

Brackley and Byfield Oundle and Wansford Kegworth Bottesford Croxton

This is an administrative change and will not affect the services that your GP provides.

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What are your views?

On:The proposed creation of a single SHA for the East Midlands?The proposed reconfiguration of new Ambulance Trust for the East Midlands?The proposed PCT reconfigurations?

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Please also consider

How can PCTsMaintain their local touch?Maintain and develop

Clinical Engagement and Involvement Public Engagement and Involvement Partnership working

Ensure equitable resource allocation

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How you can have your say

In writing – by March 22nd 2006 using the reply sheet in the consultation documentVia the website – from the Consultations section at www.lnrsha.nhs.ukor email direct – Robert.Walker@lnrsha.nhs.uk

Or now - through questions/sharing of views

For further copies of the proposal either contact Robert Walker on the e mail above or download a copy from the website or tel: 0116 295 5801

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Following the consultationWithin 21 days for SHAs and PCTs from the end

of the consultation period:Responses analysed and presented to the LNR SHA Board for a decisionOnwards to the Department of Health and Ministerial approvalIf agreed the Secretary of State authorises the dissolution of the current organisations and the formation the new, with associated asset transfer (inc staff)

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Following the consultation

Ambulance consultationWithin 14 days from the end of the consultation process, the results will be analysed and submitted to the Secretary of State (on whose behalf the SHA are consulting)

If agreed the Secretary of State authorises the dissolution of the current organisations and the formation the new, with associated asset transfer (inc staff)

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Time scale

If recommendations accepted:

Shadow SHA Chief Executives - Jan/March 06

PCTs, SHAs and Ambulance services established towards latter end of 2006

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Remember

The aim is to deliver a better, more responsive health service that gives people the control and choice they have a right to expect as patients and taxpayers

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Any further questions