Clinical commissioning and the voluntary and community by malj

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									Engaging with Emerging Health
         Structures
           Dr Peter von Eichstorff
              City Locality Lead 
  Oxfordshire Clinical Commissioning Group
                      A system focused on
                      improving outcomes



                    Economic regulation and
                       quality inspection

            Enhanced                       Clinically-led
            local voice                  commissioning &
                                        payment by results

                          Empowered
                     professionals working
                   in autonomous providers


                          Informed patients
                          exercising choice



Summary of NHS reforms
                                   Parliament
  Funding
  Accountability

                                 Department of
Reformed NHS                        Health




                                     NHS
                                 Commissioning                       Monitor                 Care Quality
                                    Board                          (economic                 Commission
                                                                    regulator)

                                                                                 licensing

                      local          GP                 contract
       Local       partnership   Commissioning                                   Providers
     Authorities                   Consortia


                                                 accountability for results

    Local Health
       Watch                                     Patients and Public
              Finance:


   How much are we funded in 
Oxfordshire to provide all the health 
 care for one person for one year ?
         £1300 (per patient) to provide:
•   GP services
•   Community health services 
•   Mental health services
•   All drugs/medicines provided
•   All hospital services 
•   All NHS dentistry
      Hip replacement £5500 Heart Bypass £7400
                 £1300 per Patient
•   7th lowest in Country out of 154 PCTs
•   Lowest 5% funding 
•   This applies to all hospital departments
•   All providers..
       The Nicholson Challenge
• Take 4% per year out of secondary care
• 20% over 5 years 
• £200 million locally
               The Good News
•   £200 million reinvested more effectively
•   In primary care 
•   Community care
•   Voluntary Third Sector
•   Private Sector 
              The Bad News
• Debts £20 million+ predicted
• Primary Care, Dentistry, Public Health make 
  yearly surpluses 
• These budgets move to National 
  Commissioning Board
                Summary
• We have never needed voluntary sector more
• There has never been less money
• There has never been more opportunity for 
  the voluntary sector to contribute
Difficult Planning


A huge number of voluntary organisations are currently
delivering health related outcomes that are funded from within
the health system – mainly through PCTs.

Many of these organisations are looking to deliver more services
but are currently struggling to come to terms with what clinical
commissioning will mean for them.

Planning in the sector is proving incredibly difficult in the current
environment with so many uncertainties and organisations are
struggling to make sense of how clinical commissioning will
evolve.
               Emerging Themes
New landscape is confusing for voluntary sector and we
might lose really valuable assets if we’re not careful – 
NHS and DH need to help voluntary sector interpret new 
landscape and make sense of it
GPs don’t necessarily understand distinct contribution
of voluntary sector – hearts and minds awareness raising 
needed based on GP reality, not moral high ground
How might voluntary organisations work together and
with other sectors to make themselves easier to
commission
            Any Qualified Provider
EU law
Level playing field – out to tender
Complexity requires certain size
         Any Qualified Provider
How will the Government make sure smaller 
providers are not disadvantaged?  
          Any Qualified Provider
•Smaller providers, including charities, social 
enterprises and other not for profit and for 
profit organisations are central to our vision for 
Any Qualified Provider. 
          Any Qualified Provider
•The standards to be an Any Qualified Provider 
will be proportionate and appropriate to the 
market for a particular service.  …
• we know that there is considerable interest 
amongst smaller providers in offering their 
services through patient choice of provider – 
•our process is simpler for all providers and as 
such should be more accessible for smaller 
providers. 
         Any Qualified Provider
•Smaller providers (both not for profit and for 
profit) often better understand the needs of 
their local population and can deliver 
specialised, tailored and innovative service 
models. This means they should be well placed 
to secure patients under Any Qualified Provider. 
 What is a LINk?


Local
Involvement   LINk
                            a tch
Network                  thW
                   H eal
           A short history of 
       “The independent patient 
                voice” 
1974               2003      2008     2012……?




 Community          PPI                Health
                              LINks    Watch
 Health Councils    forums
        Who is the LINk?

ü   Patients
ü   Faith Groups
ü   Older People
ü   Frontline staff
ü   Tenants' Groups
ü   Community Groups
ü   User groups
ü   Black and minority ethnic
    communities
                                   “A network of
ü   Carers' networks
                                     networks”
ü   Patient groups
ü   Patient Participation Groups
ü   Individuals
ü   Voluntary Groups
ü   Rural communities
ü   Neighbourhood groups
ü   Children's groups
ü   Transitory populations
               ….. etc….
The future: Local HealthWatch

          Clinical               Health &
       Commissioning             Wellbeing
         Consortia                Boards



                        Local
                     HealthWatch




PPGs    Voluntary      Carers’     Third
        / user-led                           Patients
                       groups      Sector
          groups
Local HealthWatch will :

Build on existing LINk functions :

ü Be volunteer-led
   
ü Gather views of local people

ü Identifying problems and gaps in services

ü Work with third sector, volunteer and user-
  led organisations
          How Can You Help
• Encourage your members to use service 
  responsibly
• Encourage self care
• Manage expectations
• Representation 
• Avoid duplication 
• Combine resources
• Measure outcomes
             How Can You Help
•   Identifying need
•   Feeding into HWB board
•   Devising the JSNA
•   Remembering JSNA priorities – inequalities…
•   Deprivation / Ethnicity and many more
            How Can You Help
•   Identify waste
•   Move from secondary care Eg
•   Redesign patient pathways
•   Avoid admissions
•   Treatment at home
•   Planning in advance
•   Bid for contracts
                  Summary
•   There is no more money
•   There are opportunities
•   The NHS is shrinking
•   The other sectors must expand
•   But we need to prevent fragmentation
•   We need to work together
                  Summary
•   There is no more money
•   There are opportunities
•   The NHS is shrinking
•   The other sectors must expand
•   We need to work together
                  Summary
•   There is no more money
•   There are opportunities
•   The NHS is shrinking
•   The other sectors must expand
•   We need to work together

								
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