Improving NHS Productivity

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Improving NHS Productivity

• Dr Donal M Hynes
• Vice-Chair NHS Alliance
• PEC Chair NHS Somerset

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No reduction in resources
Gap
NHS Resource
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Self
Community
Primary
Hospital
Tertiary
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Self
Community
Primary
Hospital
Tertiary
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GP ownership

• Express the size of the problem in recognizable
  terms

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Bridgwater Quipp

• Urgent care
• Elective
• LTCs
• Meds
• Primary
• Mental
• LD
• Non-clin

3,443,000 7,634,000 2,395,000 599,000 2,096,000 15
0,000 3,892,000
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Bridgwater Quipp

• Total 20,209,000
• 50 GP one less referral to OPD per week

250,000
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Bridgwater Qipp

• Total 20,209,000
• Need to reduce emergency admissions by 130 per
  week every week

90
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Fundamental cultural change

• Population
• - active participant
• 2. Clinicians
• - proactive in health

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Size matters

1. Rearrange services
2. Change core concepts

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Form follows function
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Size matters

• Delegating up is easier than delegating down
• Risk Management options
• Monopoly Commissioners

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Golden rules for consortia

1. Come within budget
2. Hit Quality Targets
3. No noise in the system

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Population engagement

• Provide governance
• Open and transparent
• Vested interests
• Voluntary Organisations and commissioning

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Population engagement

• Democratic Legitimacy
• Tough decisions
• Choice traded for Voice
• Community responsibility ethos

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Clinicians

• Primary Care Clinicians Generalists
• Patient in context of community
• Responsibility for health maintenance
• Local peer pressure/support

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Clinicians

• Specialists
• Non hospital-based
• Not at the end-stage crisis point only
• Not remote from patients environment

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COSS Clinicians

• Community Orientated Specialist Services
• Develop community services
• Become more closely engaged with Primary Care
  clinicians
• Follow patient into community

More of the same
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CBSS Clinicians

• Community Based Specialist Services
• Manage patient as part of community
• In-reach beds
• Integrated with other clinicians

Radical Change
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CBSS Clinicians

• Emergency admissions
• Clinician to Clinician

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Making it happen

• Conversations with local authorities
• Start looking at spend on a weekly basis within
  practice
• Clinician to clinician discussions

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Why bother?
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In any circumstances where there are concerns
that an individual practice is causing
ineffective or wasteful use of NHS resources, the
consortium of which it is a part would be
expected to work with that practice to address
the relevant issues. If problems persisted and
there were concerns that a practice was
not meeting its contractual duties, the NHS
Commissioning Board would need to address this as
part of its responsibility for managing primary
care contracts.