Collaborative Working A Local Experience

1. Collaborative Working A Local Experience Gerald M Mc Lean

2. Practice Collaboration “ A criminal is a person with predatory instincts, who has not sufficient capital to form a corporation” Howard Scott Mac2 consulting

3. Why we formed a collaborative. • How we formed a collaborative. • The Issues for us. • What it looks like now. • The Impact of PBC and Government policy. • What happens next. Mac2 consulting

4. What we wanted to do.... • Improve the quality and quantum of care. • Foundation for network of like minded GPs. • Utilise our expertise. • Be in a position to respond and influence policy change. • Promote greater consensus around good medical practice. • Respond to primary care developments. • Facilitate change. • Isolation. • Professional development. • Improve communication / share clinical and managerial knowledge. • Improve training and development for support staff. PRE-PBC Mac2 consulting

5. Our Timing... • Had completed Practice Audit. • Practice Based Commissioning. • Government Thinking. Mac2 consulting

6. What it means.... Practice • Action plan agreed and understood. • Facilitators appointed. • Action against an agreed timeframe. • Progress review template. • Ability to monitor progress. For Us • In depth knowledge of strengths and weakness of each practice. • Detailed knowledge of training needs. • Insight into practice aims and objectives.

7. The Luton Project • July 2004 three practices break the mould. • August 2004 formal meeting held with all 3 practices to explore collaborative working. • September October 2004 work with practice staff to explain direction of travel. And carry out additional reviews of action plan issued in phase 1. • September 2004 approach PCT and explain practice desire to collaborate. • November 2004 Practices form informal grouping to test theory. • December 2004 Healthcare Collaborative is formed as a limited not for profit company. • December 2004 Luton Healthcare Collaborative meet with PCT to register their interest in Practice Based Commissioning.

8. The Luton Project • Jan/ Feb 2005 LHC formulate ideas and plan which services we wish to commission. • March 2005 Present to Department of Health.

9. DRIVERS FOR CHANGE • choice • plurality • health inequalities Pbr + Foundation Trusts +PBC+PC Commissioning. Innovation and Competition Mac2 consulting

10. Choice PBR Practice Based Commissioning Joined up policy Mac2 consulting

11. What is PBC ? • An opportunity for service redesign • A shift of focus to Primary Care delivery • An attempt to involve all PHC professionals in commissioning services for their patients • A drive to improve equity in the deployment of NHS resource usage Mac2 consulting

12. What PBC is Not... • A return to fundholding • An NHS management reorganisation • An opportunity to increase practice profits • A larger PEC • A new idea • Time to get your own back! Mac2 consulting

13. How it Fits With Us.. • Devolution and Choice agendas • Secondary to Primary care shift • Encourages plurality • Make services responsive to individual patient needs as identified by practice, particularly for supporting patients with LTCs • Use collective experience and knowledge to change services and move resources to new services Mac2 consulting

14. The Strategic Fit... • Devolution and Choice agendas • Secondary to Primary care shift • Encourages plurality • Make services responsive to individual patient needs as identified by practice, particularly for supporting patients with LTCs • Use collective experience and knowledge to change services and move resources to new services • None of the bureaucracy of fundholding

15. What is Commissioning ? • “the assessment of the health needs of a population, the contracting for the services which meet these needs (including NHS plan targets) and the accountability for the associated health outcomes” • “PBC is led by PC clinicians who determine the provider service, with the PCT acting on behalf of those clinicians in the contract documentation and financial monitoring”

16. What We Did.. • Clear understanding of policy context. • Read the guidance. • Information given to full PHCT. • Discussed why we would do it. • Informed PCT. Mac2 consulting

17. Data Management • Practice specific • Referral data, elective, OP and emergency • Interrogate and validate • Need to understand all practice patient activity (including private)

18. Service Redesign • Start discussions about what can be done differently • Involve full PHCT and patients • How can efficiency in waiting and access, choice and cost be improved ? • Links with enhanced services, QoF and premises

19. What the guidance says about costs.. • Legitimate and necessary costs to clinical and management time to start PBC • Recurring costs to manage waiting list at practice level including choose and book • HR support from PCT at both practice level and administration of contracting • IT requirements

20. Our Thoughts on Budgets • What are the target areas for service re-design ? • What are the long term plans ? • Staged approach without “cherry picking” moving from indicative/partial to real/total over defined period of time

21. Service design • Practice specific • PBC group – self determined by need and ability to work collaboratively • PCT – what should be blocked back? • Cross PCT commissioning • PARTNERSHIPS at all levels

22. Hey..Are You New Here? • PCT in deficit • GP change fatigue • Where’s the financial incentives • Not enough resources • New Ministerial Team

23. Risk of Clinicians not engaging • Status Quo – not an option. Concrete will set and PCTs will determine service design and choice. • Competition for resources to increase – ring fencing enhanced services ends 2006 • PbR – incentives for Secondary Care to suck work and money in. • Loss of influence/control in service design and PC-led NHS finally dead and buried

24. Risks for PCTs resisting • Uncertainty in managing financial risk increases with PbR • Practices more likely to challenge details of what hospitals provide • Loss of control of referrer activity (of prescribing incentive schemes) • Responsibility for overspends remains with PCTs anyway • Health agenda becomes more difficult and PBC will become a target

25. So.. where are you NOW!! Mac2 consulting

26. Organisational Issues • GET IT SORTED WHILE WE ARE ALL STILL FRIENDS ! • THE WORST CASE SENARIO. • MAKE IT LEGAL. • SORT OUT CASH ISSUES. MAC2 Consulting

27. RELATIONSHIPS HAVE AN AGREED ORGANISATIONAL SET UP WE ARE ALL STILL INDEPENDENT ! THE SYSTEM CONTROLS ! WHAT HAPPENS IF? MAC2 Consulting

28. ORGANISATIONAL MODEL EXECUTIVE BOARD IT CDM PRESC PM NF INTERNAL MAC2 Consulting

29. ORGANISATIONAL MODEL EXPERTISE & KNOWLEDGE PATIENT SERVICES PCT LUTON PRACTICE COLLABORATIVE JOINT WORKING PHARMA OTHER ??? EXTERNAL MAC2 Consulting

30. end game • Educator internal and external. • Responding to change agenda. • Working with educators. • Working in the NHS system and outside. • Conferences. • Negotiator. • Influence. • Membership services. • Membership representation. MAC2 Consulting

31. Some Thoughts..... It’s about.. • Knowing the practice. • Forming a relationship that promotes trust. • Understanding what the practice wants. • Knowing the practice strengths and weakness. • Understanding that when it comes to the negotiations (PCT Department) they have expectations too! • Forming a relationship with the PCT and the Department and understanding their game plan.

32. We Think.. • We have someway to go. • We will take the risk. • Sometimes it’s easier to get forgiveness than permission. • It is sometimes better to go first. • WE CAN MAKE A DIFFERENCE FOR OUR PATIENTS. Mac2 consulting

33. Thankyou.... Mrs Bernie Naughton Secretary Healthcare Collaborative 01582731083 Mr Gerald Mc Lean Facilitator 07712931336 mac.2@btconnect.com Mac2 consulting