Equity and Excellence: Liberating the NHS

1. Equity and Excellence:Liberating the NHS Ian Tipney Chief Executive – NHS Somerset 23 September 2010

2. Timetable for Action (Subject to Parliamentary Approval for Legislation)

3. In Summary • Three year transition in which Primary Care Trusts retain statutory responsibilities whilst GP Consortia emerge There needs to be a recognition that: • Primary Care Trust will not retain current staff during the three year period and recruitment/replacement will be problematic • GP Consortia need to be confirmed/licensed and developed to be fit for purpose • We should assume that with Strategic Health Authorities and Primary Care Trusts being abolished all statutory functions will be transferred to the GP Consortia with the exception of responsibilities of NHS Commissioning Board, Specialist Commissioning and Public Health – all to be defined • Through all the changes the public and patients need to have confidence in the local NHS and reputation management within Somerset is crucial. This will be particularly important for emerging GP Consortia

4. Issues • The development of GP Consortia • Delivering Quality, Innovation, Productivity and Prevention (QIPP) during the three year period • Maintenance of a healthy system • Reducing management costs by over 45% and ensuring that organisations are fit for purpose

5. GP Consortia The Journey: Somerset Health Authority with four Primary Care Groups (2002) Four Primary Care Trusts NHS Somerset (2006) GP Consortium/Consortia (2013)

6. GP Consortium/Consortia • Financial risk (current Primary Care Trust budget £853 million) • The most effective structure to deliver services in the financial downturn (QIPP) • Links with County Council/District Councils • Coherence of commissioning and strategic development versus tactical purchasing - development of Cancer Centre - procurement of Shepton Mallet NHS Treatment Centre - development of 24/7 Primary Angioplasty - Community Hospital rebuilding programme • Management allowance for GP Consortia WHAT IS BEST FOR PATIENTS

7. Delivering Quality, Innovation, Productivity and Prevention (QIPP) • From 2006 – 2010 budget rose by ~9% in each of the four years • 2010 – 2011 budget increase 4.5% • 2011 – 2012 onwards (three year CSR) assume no real increase • To meet the demand for services (population increase, expectation, more dependent elderly care, increase in cost of drugs and new interventions) it is estimated that the NHS will need to save £20 billion over the three year period • Locally QIPP plans are being produced to meet this challenge

8. Quality, Innovation, Productivity and Prevention Workstreams • Shifting settings of care and optimising urgent care • Optimising elective care pathways • Best practice care pathways for long term conditions • Improving prescribing • Improving primary and community care • Improving mental health • Improving learning disabilities • Improving non-clinical productivity

9. Long Term Conditions • End of Life Care - Care pathway and register introduced in seven practices – roll out early 2011 - Care Coordination centre went live in May 2010 - Two in-reach Palliative care nurses - End of Life website went live on 22 July 2010 • Assistive Technology - Telehealth (First 100 kits purchased) - Initial focus in Bridgwater area – plans to roll out - Already evidence of prevented admissions and improved outcomes • Enhanced Care Co-ordination - Bridgwater GP Federation leading the workstream - Testing out a virtual integrated team approach to long term conditions - Roll out across the county • Personalised Care Plans - Web based personalised care planning tool - Roll out commencing with Bridgwater Federation

10. Programme Management of QIPP • QIPP Programme Board (meets monthly) Provider Chief Executives, WyvernHealth.Com, GP Federation Lead, Local Medical Committee, Local Authority • Eight working groups – WyvernHealth.Com representative on each • Finance, Human Resources, Estates and Information Technology working groups QIPP IS OUR MAIN BUSINESS OVER THE NEXT THREE YEARS

11. Maintenance of a Healthy System • Financial management is crucial over the next three years - Prescribing - Contract arrangements with NHS Providers, Private Sector and voluntary organisations - Delivery of cost improvement programmes - Continuing healthcare costs • Abolition of targets - Need to recognise the NHS Constitution (18 weeks) - Most MORI surveys identify access as the biggest concern for patients • Impact of cuts announced by other public sector bodies

12. Management Costs • In 2006 when the four Primary Care Trusts were amalgamated, management savings of £2.3m were delivered with a loss of 65 posts • NHS Somerset has one of the lowest management costs nationally • Targeted savings as part of the 45% national savings is nil for NHS Somerset but £1.0m over three years for Somerset Community Health • Primary Care Trust staff could have opportunities with: - Regional outpost of NHS Commissioning Board (to be defined) - Local Authority (Public Health) - GP Consortia - Community Services • The designation of community services will be the first milestone and biggest impact on staff at the Primary Care Trust • We do not know what the management allowance will be for GP Consortia

13. Transitional Arrangements Statutory Statutory

14. Conclusion • Major re-organisation over a three year period • Financial challenge is unprecedented and clinicians need to lead • Somerset starts from a very sound base - money - service delivery - relationships • Tremendous opportunity to redesign services for patients and provide care closer to home WE NEED TO WORK IN A MORE JOINED UP WAY THAN EVER BEFORE

15. Group Discussions By PCG Locality The Gallery Taunton Deane Directors South Somerset Owners and Trainers Somerset Coast Exmoor Mendip