David ColinThom

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David Colin-Thomé

• National Clinical Director for Primary Care,
  Medical Adviser Commissioning and System
  Management Directorate and clinical lead for 18w
  programme
• Former GP, Castlefields, Runcorn 1971-2007
• Honorary Visiting Professor,Centre for Public
  Policy and Management, Manchester University
• Honorary Visiting Professor, School of Health,
  University of Durham

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Vision for World Class Commissioning

• Better health and well being for all
• People stay healthier for longer adding life
  to years.
• People live longer and health inequalities are
  dramatically reduced and years to life
• Better care for all
• Services are of the best clinical quality and
  evidence based
• People exercise choice and control over the
  services that they access so they become more
  personalised.
• Better value for all
• Informed investment decisions
• PCTs work across organisational boundaries to
  maximise effective care.

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WCCs build on strong foundations to deliver
better health outcomes
Targeted commissioning plans and world class
services in place, to meet locally determined
health needs and the wider national policy
objectives e.g. Lord Darzi review

• Universal coverage
• Efficiency
• Equity/ Fairness

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Our health, our care, our say a new direction
for community services

• Ambition
• Enabling health, independence and well being
• Better access to GP
• Better access to community services
• Support for people with longer term needs
• Care close to home
• Ensuring reforms put people in control
• Making sure change happens

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PCTs not ready to engage people in commissioning
decisions(Picker 07)

• A survey of primary care trusts has shown that
  most are not ready for the new challenges of
  engaging patients and the public in their
  commissioning decisions.
• Few trusts have finalised plans for the new
  elements of PPI they are expected to use (LINks,
  patient-initiated petitions, and a patient
  prospectus). Few have built up experience of
  deliberative processes with the public (as
  opposed to taking snapshots of opinion) few have
  used PPI in parts of commissioning other than
  service redesign -- such as assessing needs,
  determining priorities and evaluating services.
• Moreover the majority of PCTs have low
  expectations of the outcomes of PPI.

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HEALTH AND WELLBEING COMMISSIONING FRAMEWORK

• LAs and the NHS must work better together to
  improve the well-being of their community.
  Keeping people out of hospitals just as important
  as the care they get in them (we are Department
  of Health not of hospitals) maximising
  well-being, promoting independence and tackling
  health inequalities.
• It makes sound financial sense for GPs, primary
  care and social care professionals to work
  collaboratively together to provide more care
  closer to home and invest in preventative
  measures.
• Better management of patients with long-term
  conditions will free-up funds for reinvestment in
  NHS services - early intervention is good for
  individuals as well as better for the taxpayer.
• The NHS can use NHS money for non-NHS activity if
  it is has a health benefit.
• Health providers need to think outside the NHS
  and think about peoples health and well-being.
  LAs have a much stronger tradition the health
  service needs to catch up.

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Choice

• Choice embraces three key components designed to
  improve peoples overall experience by providing
  them with more
• Power to shape their pathway through services and
  keep control over their lives
• Preferences to choose how, when, where and what
  treatments they receive
• Personalised services organised around their
  lifestyles

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Level of Commissioning

• Individuals, carers and their families
• Practitioner
• Practice level potential direct link with GP
  Practice Based Commissioning practice and/or
  locality
• Neighbourhood as part of the wider community
  and inequalities agenda
• PCT / LA area
• City region/area - eg. Manchester
• Region - GOR
• National

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Next Stages review-Darzi (1)

• Journey so far. Improvement but.
• World class NHS-
• -fair-SoS announced strategy for reducing health
  inequalities,
• -personalised now to focus on primary care and
  LTC,
• -effective-Health Innovations Council
• - safe-Patient Safety Direct to support NPSA AND
  reduce rates of Health Care Associated Infections
• -focused relentlessly on improving the quality of
  care

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Next Stages review-Darzi (2)

• Deliver vision across eight areas of care
• -Maternity and newborn
• -Childrens health
• -Planned care
• -Mental health
• -Staying healthy
• -Long term conditions
• -Acute care
• -End of life care

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Provider issues

• What is the usefulness of helping to bankrupt
  the funder?
• Collaboration can improve efficiency.
• Whether to compete or collaborate-the arbiter is
  assessing what would be best for patients and the
  public
• Overall, the skills of collaboration and
  integration in effective networks will be every
  bit as essential to local NHS hospitals as will
  the ability to compete.
• Role of a principal provider
• So must providers leave all this to commissioners
  alone?

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Range of White Paper LTC commitments

• Bigger emphasis on self care and integration
• Requirement for multidisciplinary teams/networks
• Universal case management for VHIUs
• Personal Health and Care Plans
• Assistive Technology
• 24/7 single point of contact for people with
  complex needs

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Care Plans

• In addition the White Paper Our Health Our Care
  Our Say makes a commitment
• By 2008 we would expect everyone with both long
  term health and social care needs to have an
  integrated care plan if they want one. By 2010
  we would expect everyone with a long term
  condition to be offered a care plan. We will
  issue good practice guidance in early 2007.

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Choice in LTC

• At the very minimum, the level of choice for
  people with a long term condition should be
• they have a care plan
• it has been agreed with them
• they can choose from a range of options for their
  care
• commissioners ensure that a range of options are
  available for them to choose from (the current
  best example of this is the Year of Care Model
  described below)

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Choice in LTC

• Care planning
• Support for self care
• Support for those with more complex needs to
  maintain independence (including rehabilitation
  and supported living
• Links with social care
• There are other points where increased choice
  would also benefit people with long term
  conditions, including acute, palliative and end
  of life care.

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Next Stages review-Darzi (2)

• Future strategy on primary and community care

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Primary Care Reform

• GP contracts
• Fairness in PC
• Quality and Outcomes Framework
• Pharmacists contract
• Nurse leadership (other clinicians)
• Practitioners with Special (clinical) Interests
• Practice Based Commissioning
• Capital into primary care

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General Practice

• Good and universal
• Mal-distributed
• Inaccessible to significant groups of people
• Unwarranted and sometimes large variation in
  quality
• Does it lack ambition -for responsiveness, CQI
  and scope?
• Does it need competition or at least
  contestability?

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More health care in the community

• Increasing of healthcare provided locally
  reflecting
• international best practice
• advances in technology
• public preference
• ageing population
• Wanless review

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• Joblessness
• Learning Disabilities
• Prison Health
• Broader primary care

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Keeping it Personal

• Build on the best of traditional General Practice
• Primary Health Care more than general practice
• but registered population and 80 of all NHS
  clinical consultations
• 90 of care solely undertaken in primary care
• Support for self care
• Long term conditions management
• Care Closer to home
• The practice can link the wider publics health
  and bio-clinical care
• The practice as the local micro yet strategic
  health organisation

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21st Century Primary Care

• Multiple information and access points
• Continuing importance of Personal Care
• The potential of the registered list
• Emphasis on Long Term Conditions Management
  including Self Management and especially of
  Co-morbidity
• Public Health oriented Clinicians
• Expanding Ambulatory Care
• Quality Assured
• Active in commissioning of Secondary Care
• Integrated services
• Choice for patients, clinicians and all staff
• Increasing accountability (inc Good doctors,
  safer patients)
• New forms of ownership
• Premises as part of Social Capital