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					                                                                                                                                                                                                                           Harness DM - Ophthalmology




Objective Area: Demand Management .
2009/10 Target: reduce new Ops by 811 and DEMAND MANAGEMENT: Develop four workstreams (two PCT-wide and two specific to your cluster)
reduce emergency admissions by 397. All
                                                                                                          Outcomes
workstreams must improve services for                                      2009 / 10                                    2010/11  2011/12                                                                                           2012/13
patients locally with some of the outcomes
demonstrating a working towards this
quantified reduction in secondary care
attendances. The demand management sub-
group of the PBC Exec has been mandated
to oversee this work to ensure reductions
are achieved.
                                                               Purpose                       Baseline 1/4/09                   Q. 1                         Q. 2          Q. 3          Q. 4
conduct a one year poilot to provide an imporved community     Provide care closer to        First out paient attendance
based primary care service for patients with common eye        home avoiding referral to     between January 2008 and
problems and effective management of optician generated        out patients and              December 2008 for all                                                                         Service
referral                                                       increasing the level of       providers was 1547 at a cost      Submit business case to                                     continues
                                                               current primary care          of £163300 and FU                 NHS Brent. We will work                                     to reduce
                                                               management prevent            attendance of 4918 at a cost      with the demand                                             1st OP and
                                                               unnecessary referral          of £239800 with total activity    management sub               Finalise  Service              FU with
                                                               based on optician referral    of 6465 costing £403100. The      Committee to assign          service   commence Service     futher 6
                                                                                             cluster will commit to the        realistic targets towards    spec and  s-        cintinues  month
                                                                                             PCT quartetrely performance       achievement of the CSP       governanc reduction with 6     review      Successful
                                                                                             monitoring process.               demand management            e and     of 1st OP month      against     pilot rolled Service spec
                                                                                                                               assumptions.                 staffing  and FU    evaluation projections out to AWP extended

 Benefits to patients and how this meets local health needs:   Access to specialist ophthalmology care closer to home for patients with common problems which can be managed in the primary care setting
                                                               Clinical audit of current referral - multi disciplinary process mapping of converting appropriate care to primary care setting - discussing with GPs at GP Forum - presentation
 Clinical, patient and public involvement process:             to patient forum and focus patient consultation - discussion with consultant ophthalmologist and optometrist
 Risks:
                                                               Appropriate evaluation of the pilot is not embedded into process delaying roll out of service - facility costings not known preventing comparison of cost to acute care - patient
  - To Success of the workstream                               choice for acute referral in preference to service
                                                               Failure to safely achieve demand management targets for an area of high activity - failure to build local knowledge of delivering ophthalmology services outside hospital
  - To the PCT if workstream is not successfully delivered     setting
  - To the PCT of undertaking the workstream                   Business case costs incorrect and more expensive to delivery than acute equivalent care - patient preference still for acute provision
  - Clinical Risks                                             Agreeing appropriate consultant cover for GP specialist - difficulty in accessing use of necessary equipment or facilities
 Costs:

  - Spend on existing service if known                         For the year Jan 08 to Dec 08 the current first out patient appointment spend was £163300 and for follow up was £239800 with a total spend of £403100
  - Estimated costs of redesigned service                      will be available in the business case

  - Anticipated savings                                        will be available in the business case - initial estimate 10% reduction inoverall spend of £40310
  - Use of savings                                             To develop the capacity and capability of primary care to manage appropriate common eye problems in the primary care setting at spoke, specialist spoke and / or hub level
 Additional PCT support required:                              Costings for use of facilities at Willesden hospital - support in access to approprite equipment




Commissioning Plans 2009-10 Harness resubmission 30 06 09                                                       Page 1 of 10                                                                                                                 4/12/2010
                                                                                                                                                                                                                      Harness DM -: Gynaecology



Objective Area: Demand Management .
2009/10 Target: reduce new Ops by 811 and DEMAND MANAGEMENT: Develop four workstreams (two PCT-wide and two specific to your cluster)
reduce emergency admissions by 397. All
                                                                                                         Outcomes
workstreams must improve services for                                     2009 / 10                                  2010/11   2011/12                                                                                                    2012/13
patients locally with some of the outcomes
demonstrating a working towards this
quantified reduction in secondary care
attendances. The demand management sub-
group of the PBC Exec has been mandated
to oversee this work to ensure reductions
are achieved.
                                                                        Purpose                         Baseline 1/4/09                 Q. 1                         Q. 2        Q. 3          Q. 4
conduct a one year poilot to provide an imporved community              Provide care closer to home     First out paient referral                                                                            Service
based primary care service for patients with common                     avoiding referral to out        between January 2008            Submit business case to                                              continues
gynaecological problems including dysmenhorrea                          patients and increasing the     and December 2008 for all       NHS Brent. We will work                                              to reduce
                                                                        level of current primary care   providers was1837 with          with the demand                                                      1st OP and
                                                                        management                      1615 actual attendances         management sub               Finalise    Service                     FU with
                                                                                                        at a cost of The cluster        Committee to assign          service     commence      Service       futher 6
                                                                                                        will commit to the PCT          realistic targets towards    spec and    s-            cintinues     month
                                                                                                        quartetrely performance         achievement of the CSP       governanc   reduction     with 6        review      Successful
                                                                                                        monitoring process.             demand management            e and       of 1st OP     month         against     pilot rolled Service spec
                                                                                                                                        assumptions.                 staffing    and FU        evaluation    projections out to AWP extended

 Benefits to patients and how this meets local health needs:            Access to specialist gyaecological care closer to home for patients with dysmenhorrea
                                                                        Clinical audit of current referral - multi disciplinary process mapping of converting appropriate care to primary care setting - discussing with GPs at GP Forum - presentation
 Clinical, patient and public involvement process:                      to patient forum and focus patient consultation - discussion with consultant gynaecologist

 Risks:
                                                                        Appropriate evaluation of the pilot is not embedded into process delaying roll out of service - facility costings not known preventing comparison of cost to acute care -
 - To Success of the workstream                                         patient choice for acute referral in preference to service

 - To the PCT if workstream is not successfully delivered               Failure to safely achieve demand management targets for an area of high activity - failure to build local knowledge of delivering gynaecolgy services outside hospital setting

 - To the PCT of undertaking the workstream                             Business case costs incorrect and more expensive to delivery than acute equivalent care - patient preference still for acute provision

 - Clinical Risks                                                       Agreeing appropriate consultant cover for GP specialist - difficulty in accessing use of necessary equipment or facilities and access to diagnostics

 Costs:

 - Spend on existing service if known                                   For the year Jan 08 to Dec 08 the current first out patient appointment spend was £242400 and for follow up was £215600 with a total spend of £458000

 - Estimated costs of redesigned service                                will be available in the business case

 - Anticipated savings                                                  will be available in the business case - initial estimate 10% reduction inoverall spend of £45800

 - Use of savings                                                       To develop the capacity and capability of primary care to manage dysmenhorrea in the primary care setting at spoke or specialist spoke level
 Additional PCT support required:                                       Costings for use of facilities at Willesden hospital - support in access to approprite diagnostics




            Commissioning Plans 2009-10 Harness resubmission 30 06 09                                                    Page 2 of 10                                                                                                 4/12/2010
                                                                                                                                                                      Harness DM - Fed gastro pathway




Objective Area: Demand                 DEMAND MANAGEMENT: Develop four workstreams (two PCT-wide and two specific to your cluster)
Management . 2009/10 Target:                                                                                                 Outcomes
reduce new Ops by 811 and                                                            2009 / 10                                                2010/11 2011/12 2012/13
reduce emergency admissions            Purpose             Baseline 1/4/09           Q. 1                    Q. 2       Q. 3      Q. 4
Workstream : Brent Wide                To improve          Gastroenterology OPD Establish a cross
Gastroenterology Pathway               services for        referrals are increasing. cluster workgroup to
                                       patients with       Many of these are in      develop pathway and
                                       common gastro patients with non ulcer identify current
                                       conditions by       dyspepsia and GOR.        activity and
                                       development of      The majority of these     costs.We will work
                                       an evidence         conditions can be         with the demand
                                       based pathway.      managed in the            management sub
                                       To use resources commuity following           Committee to assign
                                       more effectively evidence based               realistic targets
                                       with provision of guidelines NICE.            towards                 Final
                                       service closer to Diagnostics can be          achievement of the pathway
                                       home and to         provided locally an       CSP demand              to be
                                       reduce referrals The cluster will commit management                   complete Draft
                                       to OPD              to the PCT quartetrely assumptions.               d and      protocols Impleme Impleme
                                                           performance                                       approved circulate ntation of ntation of
                                                           monitoring process.                               by PBC d Brent       protocols protocols
                                                                                                             Federatio wide by 50%            80%
                                                                                                             n.         clusters practices practices
Benefits to patients and how           Standardised treatment of a common condition across all practices following evidence based guidelines. Access to local diagnostics.
this meets local health needs          Reduced referrals to Secondary Care.


 Clinical, patient and public          Clinical input on working group, Run out to practices via cluster meetings when pathway fully developed, Information given to patients
involvement process:                   when being treated and accessing service
 Risks:
  - To Success of the                  Need to ensure buy in by all the clusters and individual practices. Need to ensure correct diagnostics are made available as needed in
workstream                             community
  - To the PCT if workstream is
not successfully delivered             Potential overspend on budgets
 -To the PCT OF undertaking            New stool test will need to be commissioned form NWLH lab as this cannot be provided through In health diagnostics- costs currently
the workstream                         being worked on, but are less than the current cost of GP prescribing the diagnostic test
  - Clinical Risks                     Pathway must be robust and evidence based, patients not meeting guideline criteria should be referred via alternative routes
 Costs:
  - Spend on existing service if       Not known, Will need data on current spend on FP10 of prescribing the testing kits, direct access Gastroscopy currently being used and
known                                  data for Gastroenterology referrals for this condition
  - Estimated costs of                 Cost of provision of stool testing for Helicobacter currently not provided by NWLH, Use of Inhealth diagnostics budget to provide
redesigned service                     Gastroscopy by direct access.
  - Anticipated savings                Will need to be projected when referral data known
  - Use of savings                     Increased capacity in primary care
 Additional PCT support                Activity and cost information as required. Public health information. Finance. Support with commissioning of diagnostics. Prescribing data
required:                              and input for treatment protocols.



Commissioning Plans 2009-10 Harness resubmission 30 06 09                                    Page 3 of 10                                                                                  4/12/2010
                                                                                                                                                                                                              Kilburn Brent 2nd pathway




                                                                       DEMAND MANAGEMENT: Develop four workstreams (two PCT-wide and two specific to your cluster)
Objective Area: Demand Management .
                                                                                                                                                                         Outcomes
2009/10 Target: reduce new Ops by 811 and                                                                             2009 / 10                                                            2010/11       2011/12       2012/13
reduce emergency admissions by 397. All
workstreams must improve services for
patients locally with some of the outcomes
demonstrating a working towards this
quantified reducti


                                                                       Purpose                   Baseline 1/4/09      Q. 1               Q. 2                   Q. 3         Q. 4
Workstream : Second Brent wide workstream                              To improve services       The clinical area
                                                                       for patients by more      covered by this
                                                                       effective use of          workstream has
                                                                       resourses and             not yet been         Establishment
                                                                       provision of services     agreed by the        of a cross
                                                                       closer to the patients    clusters. We will    cluster work
                                                                       home. The cluster will    work with the        group to agree     Detailed workplan
                                                                       commit to the PCT         demand               clinical area to   with agreement on
                                                                       quartetrely               management sub       be covered.        area to be covered.    Draft
                                                                       performance               Committee to         Will be working    Data on cost and       protocols    Implement
                                                                       monitoring process.       assign realistic     on an initial      activity identified.   circulated   ation of
                                                                                                 targets towards      assumption of      We will work with      Brent wide   protocols
                                                                                                 achievement of       a 1%-5%            the demand             by           50% sign
                                                                                                 the CSP demand       reduction in       management sub         clusters.    up. Kilburn
                                                                                                 management           referrals.         Committee to           Kilburn is   is
                                                                                                 assumptions.         Kilburn is         assign realistic       committed    committed
                                                                                                                      committed to       targets towards        to the PCT   to the PCT
                                                                                                                      the PCT            achievement of the     quarterly    quarterly
                                                                                                                      quarterly          CSP demand             performanc   performanc    Implementa
                                                                                                                      performance        management             e            e             tion of
                                                                                                                      monitoring         assumptions.           monitoring   monitoring    protocols
                                                                                                                      process.           Kilburn is commi       process.     process.      80% sign up

 Benefits to patients and how this meets local health needs:           Reduces potential inequalities in service provision and access. Links into the CSP and the plans to transfer services into primary care

 Clinical, patient and public involvement process:

 Risks:

 - To Success of the workstream                                        Need to ensure buy in by all the clusters and individual practices. Lack expertise. Lack of training/infrastructure/premises

 - To the PCT if workstream is not successfully delivered              Potential overspend on budgets

 - To the PCT of undertaking the workstream

 - Clinical Risks                                                      Clinical supervision / Contractural standards / Governance issues




           Commissioning Plans 2009-10 Kilburn resubmission 30 06 09                                               Page 4 of 10                                                                                              4/12/2010
                                                                                                                                                                   Kilburn Brent 2nd pathway




Costs:

- Spend on existing service if known                                 Not known

- Estimated costs of redesigned service                              Not known

- Anticipated savings                                                Not known
- Use of savings                                                     Increased capacity in primary care
Additional PCT support required:                                     Activity and cost infrmation as required. Public health information. Finance. Commissioning




         Commissioning Plans 2009-10 Kilburn resubmission 30 06 09                                              Page 5 of 10                                                      4/12/2010
                                                                                                                                                                                        Harness WCC - Vascular risk assessment



Objective Area: WCC - Select one of the                                WORLD CLASS COMMISSIONING: The nine strategic initiatives within the CSP are: Improve primary care services,
nine strategic initiatives that your cluster                           improve childhood immunisation rates, improve vascular health, reduce premature mortality from cancer, improve
will work on during 2009/10 and develop a                              intermediate care, improve mental health and wellbeing, improve maternity services, give children and young people
                                                                       the best chance in life and support healthy behaviours.
workstream in alignment with the direction
already established in the CSP. Your PBC                                                                                                                                  Outcomes
manager will assist connection with the                                                                                        2009 / 10                                                  2010/11        2011/12         2012/13
relevant SRO for your chosen initiative
within the PCT to ensure this alignment is
achieved.                                                              Purpose                       Baseline 1/4/09           Q. 1         Q. 2            Q. 3          Q. 4
Workstream : Participate in implemation team and marketing
campaign to implement screening and interevention services.
As the VRA programme will be initated in the Harlesden
locality and the public health data relating to health
inequalities and poorer cardio vascular health outcomes of
our patients we will focus on working with NHS Brent to                                                                                      Screening
maximise the benefit of this programme. As four Harness                                                                                      service in
practices are based in the north of the borough we will work           To reduce premature                                     Skills        place.
with them and NHS Brent to ensure equity. Harness are in               deaths from                                             identified    Evidence of
agreement with the proposed VRA rollout to all PBC groups              cardiocvascular events and Nil screens and no           and mapped. participation                                TBA xx,000 TBA yy,ooo TBA zz,000
on an equity basis as described in the feedback letter dated           diagnose patients with     interventional               Specification in social      Screening     14,000 people people     people     people
5.6.2009                                                               diabetes earlier           programme                    agreed        marketing      commenced     screened      screened   screened   screened


                                                                       Reduce inequalities through identification of undiagnosed diabetes and prevention of cardiovascular events. Assessment of cardio vascular risk with
 Benefits to patients and how this meets local health needs:           primary and secondary intervention. No of reduced events and premature deaths across Harness by year 5.

                                                                       Conduct a series of focus groups / workshops to identify market segments of where people at risk live and test messages with different focus groups in
                                                                       different communities. Provide educational programme to skill up primary care workforce and agree Harness wide protocol for primary and secondary
 Clinical, patient and public involvement process:                     intervention. Appoint a cardio vascular clinical lead and support team to undertake governance and marketing.

 Risks:

 - To Success of the workstream                                        Increased work for primary care : 11% increase in identified hypertension, 3% increase in diabetes, 20% risk of CV disease needing statins.

                                                                       If don't get a high uptake this could widen the inequality gap - and result in yet more spend in secondary care due to increased admissions and longer
 - To the PCT if workstream is not successfully delivered              LOS due to co-morbidities. Failure to reduce SMR for cardio vascular disease

 - To the PCT of undertaking the workstream                            Failure to achieve WCC priorities and ojbectives of CSP and JSNA.    Poorer health of population of Brent

 - Clinical Risks                                                      Clinical risks will be reduced.

 Costs:

 - Spend on existing service if known                                  Obtain figures from public health

                                                                       £2.2m set up cost for Harness Cluster. - this is a PCT costing Harness are working on a project plan to gain maximum benefit from the programme and
 - Estimated costs of redesigned service                               will present costings to next PBC review meeting
                                                                       There will be a net increase in spend due to costs of set up although there will be some reduction in secondary care spend ( est. £200k) in year 1
 - Anticipated savings                                                 Harness will work with NHS Brent public health to estimate the impact on the Harlesden locality
                                                                       To increase access to community health trainers based in spokes and neighbourhood networks liaising with community and education to continually
 - Use of savings                                                      increase the health and well being of the community. Investment into nursing to support health promotion and cardio vascular care
 Additional PCT support required:                                      PH, finance, PBC management.




           Commissioning Plans 2009-10 Harbess resubmission 30 06 09                                            Page 6 of 10                                                                                         4/12/2010
                                                                                                                                     Harness DM - Fed comm nursing




Objective Area:                   WORLD CLASS COMMISSIONING: The nine strategic initiatives within the CSP are:
                                                                                                            Outcomes
WCC - Select one                                                         2009 / 10                             2010/11 2011/12 2012/13
of the nine                       Purpose      Baseline 1/4/09           Q. 1      Q. 2 Q. 3        Q. 4
To re-commission                  to improve   patchy
community nursing                 primary care inadequate
services(District nursing         services for provision of
and Health visiting) to           patients     community
work in a model attached                       nursing
to locality mini-clusters                      services(see
                                               review)
 Benefits to patients and   Better more co-ordinated care. Reduction in unplanned admissions.Better care of long term conditions.Higher
how this meets local health immunisation rates.Safer multidisciplinary communication in child safeguarding issues.Better nutritional and weaning
needs:                      advice and reduction in child

                                  This workstream is primarily as a result of the large and vocal local patient outcry and complaints received across all
                                  the practices at the deterioration in community nursing services and lack of joined up working with the practices.
 Clinical, patient and            Harness acknowledge and support the work undertaken by NHS Brent in relation to the community nursing SLA
public involvement                service specification and the on going work in conjunction with PBC. We wish to reserve the right to review current
process:                          service provision if the implementation timetable proposed is unreasonably slow.
 Risks:
  - To Success of the
workstream                        Local provider resistance or inability to deliver which could necessitate an external tender process.

  - To the PCT if workstream
is not successfully delivered Continue to be responsible for a "high risk " service.

   - To the PCT of
undertaking the workstream
   - Clinical Risks               will be reduced in this model because of the co-operative working across practices and community nursing and
  Costs:
   - Spend on existing service
if known                          available from primary care commissioning directorate
   - Estimated costs of
redesigned service                same as existing budget(after staff increases already agreed as a result of the external nursing review)
   - Anticipated savings          potential reduction of 10% in unplanned admissions in elderly as a result of more collaborative and focused working.
   - Use of savings               investment in front line primary care staff (nursing ,skill mix and support)



Commissioning Plans 2209-10 Harness resubmission 30 06 09                   Page 7 of 10                                                                    4/12/2010
                                                                                                                                   Harness DM - Fed comm nursing



 Additional PCT support
required:                         Commissioning support to enable us to deliver this model internally or via external tendering.




Commissioning Plans 2209-10 Harness resubmission 30 06 09                   Page 8 of 10                                                                4/12/2010
                                                                                                                                                                                                                                             Harness Indicative Budget




                                                                       Manage within indicative budget.

                                                                                                                                                                                                Outcomes
Objective Area: Ensure financial balance                                                                                                   2009 / 10                                                               2010/11         2011/12         2012/13



                                                             Purpose                                      Baseline 1/5/09                  Q. 1            Q. 2              Q. 3             Q. 4
Workstream : Harness will work with all member practices to To achieve financial balance                  Harness PBC PBR budgets          Practice        Practice level    Budget           Budget
understand their practice level budget and demand            within the allocated resources               confirmed and agreed -           plans for       review meetings   performance      performance
                                                                                                          prescribing budget managed in    demand          held by           and targets      reviewed at GP
management targets. Through accurate monthly reports
                                                                                                          shadow form.                     management      management        reviewed and     forum level and
against practice level plans and peer review at the GP forum                                                                               agreed and      team and          recovery plans   recovery plans
Harness aim to stay with in the agreed consortium budget for                                                                               presented to    Harness           instigated if    evaluated as
PBC and prescribing.                                                                                                                       clinical        directors         required         required
                                                                                                                                           forums
Structure and system for monitoring and managing spend                 The Harness office will work in partnership with Brent PCT to provide each practice with a PBC reporting template for the year consisting of budgetry information, PBC objectives and
                                                                       targets, practice profile in terms of activity and spend set against current Harness and practice level budget. The report will be presented and minuted in the Harness GP forum to
                                                                       inform clinicians of the total budget expenditure and will include practice level over/under performance against agreed commissioning objectives. During Quarter 2/3 all practices will be
                                                                       visited by the Harness team (including the 3 newly appointed governance board members) to ensure practice understanding and support in development, planning and support needs to
                                                                       achieve practice contribution to consortium success.

PCT Support                                                            As detailed above, Harness would wish to work closely with the finance and informatics team to ensure the robustness of both our planning assumptions and reporting arrangements.
                                                                       This includes the format of information from the PCT (not PDF) so it can be uploaded directly into our systems and not require manual data entry. We will also seek assistance from the
                                                                       ICT department to develop a tailored training program for clinicians and managers in the use of the Dr Foster application and other national tools to benchmark clinicial and financial
                                                                       performance. We will also require pharmaceutical advisor input in assessing appropriate actions to 'shadow' manage the prescribing budget. The aim of Harness is to reduce inequalities
                                                                       and improve the health outcomes of our patients and would wish to work closely with public health. Harness maintain their committment to the success of the Brent Federation of
                                                                       Practice Based Commissioners. We wish to continue our collaborative working with the PCT PBC support team, specifically in the development of business cases where there are
                                                                       opportunities to redesign services to achieive financial savings to reinvest in patient care through improved primary care led services.




           Commissioning Plans 2009-10 Harness resubmission 30 06 09                                                            Page 9 of 10                                                                                                                4/12/2010
                                                                                                                                                                                                                           Harness PBC Syst complete




                                                                    DEVELOP PBC BUSINESS SYSTEMS AND PROCESSES: DEVELOP 5 WORKSTREAMS 1) Actively engage in the
                                                                    PBC Development Programme; 2) Ways of working (PCT/PBC leaders - May-July); 3) Data and Information (June-
                                                                    Sept); 4) Managing the Market (Jul-Oct); 5) Patient and Public Engagment (Oct-Dec). Workstreams 2-5 will need to
                                                                    be developed in-year in tandem with the roll out off the PBC Development Programme. For the purposes of plan
Objective Area: Develop PBC systems and                             submission on 8 May, therefore, a plan for Workstream 1) only needs to be completed and this has already been
processes in line with agreed actions from                          written for cluster agreement.
the PBC development programme
                                                                                                                                                                                 Outcomes
                                                                                                                             2009 / 10                                                           2010/11         2011/12         2012/13




                                                                    Purpose                     Baseline 1/4/09              Q. 1          Q. 2              Q. 3              Q. 4
Workstream 1 : Actively participate in the PBC development
Programme ensuring a range of engagement at both cluster
and GP level.
                                                                                                                                           Evidence of       Evidence of
                                                                                                                                           attendance at     attendance at     Evidence of
                                                                                                                             1 contact     workshops.        workshops.        attendance at
                                                                                                                             point per     Evidence that     Evidence that     workshops.
                                                                                                                             cluster       agreed            agreed            Evidence that
                                                                                                                             identified.   actions           actions           agreed actions
                                                                                                                             Completed     undertaken.       undertaken.       undertaken.
                                                                                                                             template of   Relevant          Relevant          Relevant          Identify        Identify        Identify
                                                                                                                             participation workstreams       workstreams       workstreams       further areas   further areas   further areas
                                                                    To strengthen PBC systems Diagnostic feedback            at each       of plans filled   of plans filled   of plans filled   for change /    for change /    for change /
                                                                    and processes             received                       workshop.     out.              out.              out.              development     development     development
Benefits to patients and public:
                                                                    A stronger PBC comissioning system resulting in more and better local services for patients.
Benefits to cluster :
                                                                    More streamlined systems and processes - reduced volume of work for invididuals with greater spread across cluster and upskilled staff.

Benefits to PCT                                                     Stronger PBC system to drive necessary service transformaiton wihtin primary and communty care

Clinical, patient and public engagement strategy :                  To be re-visited as part of the development programme.
Organisational Structure:                                           Articulate current cluster configuration and management arrangements and areas for strengthening / development within year.




        Commissioning Plans 2009-10 Harness resubmission 30 06 09                                                   Page 10 of 10                                                                                                          4/12/2010

				
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