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'Business Opportunities arising from the White Paper' PSMG, 30 th January 2007 Paul Midgley Director The Healthcare Pa

'Business Opportunities arising from the White Paper' PSMG, 30 th January 2007 Paul Midgley Director The Healthcare Partnership Office -0870 2413506 enquiries@healthcarepartnership.com. Overview. Introduction to ‘Our Health, Our Care, Our Say’ Overview of the four key themes

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'Business Opportunities arising from the White Paper' PSMG, 30 th January 2007 Paul Midgley Director The Healthcare Pa

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  1. 'Business Opportunities arising from the White Paper' PSMG, 30th January 2007 Paul Midgley Director The Healthcare Partnership Office -0870 2413506 enquiries@healthcarepartnership.com

  2. Overview • Introduction to ‘Our Health, Our Care, Our Say’ • Overview of the four key themes • Theme one – case study • Theme two – case study • Theme three – case study • Theme four – case study • Issues – knowledge, skills, structural alignment, data • Summary – opportunities for partnership working

  3. The single most important document since the NHS Plan of 2000……

  4. Our health, our care, our say: a new direction for community services www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf • Public consultation Summer /Autumn 2005 • Published January 30th 2006, passed by Parliament Summer 2006 • England only • 240 pages • 10 year reform programme – legally binding

  5. Our health, our care, our say: making it happenHealth and social care working together in partnership October 2006 Progress report from 80 pilot sites www.dh.gov.uk/assetRoot/04/14/00/65/04140065.pdf

  6. Choice and patient involvement Prevention & early intervention Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions

  7. Smoking cessation Reducing incapacity-related unemployment Tackling obesity Increasing resources and planning for prevention and early intervention More homecare using technology Choice and patient involvement Prevention & early intervention Increasing self care and appropriate conditions management Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions

  8. Increased information on, and more input into support package for service users and carers Local service users input/feedback on services to be actioned where problems identified Increased user satisfaction with their care package Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions

  9. Case Study – Individual budgets

  10. Prevention & early intervention Choice and patient involvement Joint working between health and social care communities and authorities to reduce inequalities Increasing range of urgent care services Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions Promoting emotional and physical wellbeing services to prevent mental and physical health problems Easier registration with GPs, and improved access and convenience More community-based services Improved support for patients @ home to prevent admissions including use of technology Improving community support for patients discharged from hospital Shifting services from acute hospitals to community settings

  11. Specialties targeted for Hospital to community shift • Dermatology • Urology • Orthopaedics • General Surgery • Gynaecology • ENT To be addressed in ALL PCTs’ Local Delivery Plans…….and Foundation Trusts’ & Acute Trusts’ business plans – White Paper implementation will be monitored by the SHA & Monitor

  12. PBC Early wins & top tips PBC – early wins and top tips - DoH, February 2006 • Pathways for GPs to consider for redesign: • COPD • Heart Failure • Long term conditions • Mental Health • Ophthalmology • Podiatry

  13. Most chosen clinical specialties in PBC plans* for redesign These cover the obvious “quick wins” as follows: Specialties Number of PCTS % of Total • Dermatology 86 53.4 • Admissions Management Unplanned/ Urgent Care 73 45.3 • Diabetes 56 34.8 • COPD 46 28.6 • Orthopaedics and Trauma 44 27.3 • ENT 43 26.7 • Gynaecology/Obstetrics 37 23.0 • Cardiovascular Disease 34 21.1 • Musculo- skeletal 33 20.5 • Ophthalmology 30 18.6 • Prescribing 30 18.6 • Diagnostics 29 18.0 • Referral Management 28 17.4 • Urology 24 14.9 • Surgery – Minor 23 14.3 • Long-term Conditions 20 12.4 • Mental Health 19 11.8 • Rheumatology 19 11.8 * www.nhis.info - specialist enquiry

  14. Key features of service redesign • Health needs assessment identifies priority clinical area for redesign (e.g. ‘Local Delivery Plan’ priorities, public health) • Existing clinical pathway mapped out and costed • All stakeholders meet to brainstorm options (facilitation!) • Various points of the pathway may be changed – including use of PWSIs & consultants or specialist nurses running community based service, plus voluntary sector involvement – looking for quick wins and cost savings first • Detailed Business Case(s) submitted to PCT outlining clinical and financial benefits of redesign of specific aspects by potential service providers • ‘Contracts’ set up for any new providers to be ‘accredited’ – may be accessible via Choose and Book’ referral system 7. Newly re-designed services will operate via protocols or guidelines including drug use (formularies)

  15. e.g. United Health (Europe) in Derbyshire e.g. Principia in S Notts – combining PBC & community nursing services

  16. Prevention & early intervention Choice and patient involvement Increased support for self care, an increase in ‘Expert Patients’ and ‘Expert Carers’ programme availability Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions Users and carers get choice of services as close to home as possible Prevention of avoidable hospital admissions Local partnerships between health and social care to deliver better services

  17. Services closer to home

  18. Empowering & enabling individuals with long term conditions to take control of their health Regular Secondary care admissions High % of professional care High-risk cases Risk management in primary care e.g. Community Matrons Professional care Equally shared care More complex cases Mainly managed in primary care including GPSI Self care 70–80% of the people with long-term conditions High % of self care Diagnosed by primary care, health maintained by annual disease reviews Patients enrolled into ‘Expert Patient’ schemes

  19. ‘we could expect people who have gained self-management skills to make around 40% fewer visits to their GPs and 17% fewer visits to outpatient clinics. We can also expect 50% reductions in length of stay in hospital, and days off work because of sickness’ http://www.expertpatients.nhs.uk/public/default.aspx?load=publications

  20. Dr Ian Greaves, Gnosall Medical Centre, SW Staffs

  21. What does all this mean to pharma?

  22. Selling in a post-White Paper NHS world • Market Intelligence/Data/Joint business planning • Whole primary and secondary care team need to know what’s on the PCT’s/each PBC cluster’s service re-design agenda and produce an integrated plan for working priority clusters • Networking/Influencing • With key individuals in high potential clusters or high current users • Between secondary care and primary care KOLs • Provide redesign e.g.s from elsewhere • Network your KOLs with innovator KOLs from areas that have already successfully redesigned a similar service • Facilitation/Partnership • Meetings – organising, facilitating, funding – practice/cluster/super-cluster/PCT/SHA/national level • With board/steering group stakeholders • With full service redesign group (multidisciplinary) • With full cluster group ie all practices represented • Evidencefor guideline/formulary inclusion inc. health outcomes data • Medical Information evidence pack for your product • Local/national KOL endorsement in person plus copies of existing protocols • Flexible Pull Through/Data/local marketing capability • once product on guidelines, pull through by publicising guidelines in calls at meetings, etc • Production of locally approved materials

  23. Who are pharma’s customers in a PBC driven market? Other hospital- Based advocates* Area Px committee members Consultant* KOL Product Advocates PBC Cluster* Board Lead GP GPSI* in area of Interest to your product GP PBC* Cluster Board member GP PBC lead* for practice Director of Adult Social Services? GP lead* in disease area PCT PBC Commissioning manager GP Senior * Partner PCT *pharmacist Medicines Management team Director of Public Health (NHS/LA)? PCT educational lead Protected learning time Community Nurse* Specialists inc matrons GP Partner* Salaried GP* Expert Patient Tutors? Other PBC Cluster board members Practice Manager • Prescribing * • Practice Nurse • variety of grades • & specialisations Valued added Service providers – Improve access e.g. training Practice Nurse - non prescribing Community* Pharmacists – (extended service Provider?) * Potential Rxer

  24. Partnering opportunities 90% of practices are part of a PBC group – the new PCGs 95% of practices have a PBC business plan – you need a copy Saving money is a key driver in 2006-7 – beware! Providing more services outside hospitals is a key driver Service redesign is complex, requires excellent networking and communication skills (including local marketing) PHARMA has the skills and resources the NHS needs Patient education is key – a Pharma strength Good intelligence is paramount– you need data sources and skilled manpower to seek out opportunities for early engagement More formularies will result from PBC – evidence based, peer reviewed prescribing will become widespread in primary care, requiring an account management approach

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