Planned Care Briefing

1. Planned Care Briefing 22nd September 2011

2. Before we start … • Refreshments • Toilets • Fire escape • Notepaper • Blue cards • Questions • Introductions

3. Dr Umesh Roy Leicester City Clinical Commissioning Group Why do things differently?

4. The high cost of care • While the NHS budget has been protected, it is facing its most difficult financial challenges ever • This is because our year-on-year budget increases will not keep up with the rate at which our costs are rising • There are 4 main reasons for those rises in costs: • The population is changing, with people living longer • People have more complex health needs than before • The cost of many medicines are increasing • New medical developments cost more money

5. The high cost of care • The NHS in England needs to save £20billion over the next four years to: • Continue to improve frontline patient care • Protect essential services • Local NHS bodies are working together to see how we can do things differently, helping us to get the very best value for the money spent on healthcare. • There are also other reasons for doing things differently such as reducing the number of patient visits to different locations as part of a single pathway.

6. The high cost of care • We face some difficult choices about what we do differently to ensure we can support those with healthcare needs • Doctors, including hospital consultants and managers, have come together to identify projects that will help us meet these challenges • The ways we provide treatment for patients with certain known conditions is one of those areas

7. Planned Care What is planned care? • Care and treatment for people with known medical conditions which is planned in advance. For example, being booked in for an operation, and the outpatient visits which may follow. It is also known as Elective care. • Some services are also delivered in other settings such as community hospitals, primary care and a range of independent providers (eg: opticians, chemists)

8. Planned Care Today we are going to talk about two workstreams: • Workstream 1 Community Planned (Elective) Care Services • Workstream 2 Extending Patient Choice of Provider

9. Workstream 1 Community Planned (Elective) Care Services Dr David Briggs – East Leicestershire & Rutland Clinical Commissioning GroupVikki Taylor - Director of Commissioning Development, Leicester, Leicestershire and Rutland Cluster

10. Planned Care ServicesOverview • Outpatient, Day case and Radiography services currently take place in Community Hospitals across Leicestershire County and Rutland. • These services are hosted by Derbyshire Community Health Services NHS Trust as part of ‘Transforming Community Services’ until 31 March 2012.

11. Planned Care Services Review • An extensive review is currently taking place to identify which services will be delivered from Community Hospitals in the future. • Once this review is complete an open procurement process will take place to identify who will provide this service in the future. • The successful provider(s) will start delivering the services from 1st April 2013.

12. Planned Care Services Progress to date… • Clinicians and managers have engaged with the local population to hear their views on the services that they think should be delivered from Community Hospitals • Clinical representatives of the West Leicestershire and the East Leicestershire and Rutland Clinical Commissioning Groups (CCG’s) have considered these views when thinking about which services should be delivered from Community Hospitals. • Discussions with both CCG’s indicated a number of key principles that the review of planned care services should be based upon.

13. Key principles of review • Ensuring that the services available in the community are suitable and cost effective • Where appropriate to offer outpatient appointments closer to people’s homes • Redesigning pathways from beginning to end ensuring that patient care is ‘joined up’ from primary care based interventions to specialist care in hospital. • The CCGs need to agree a priority list of pathways to review, where patients will benefit from having access to more services in a community hospital setting

14. Planned Care Services Progress (cont)… • As a result of the work to date the following pathways have been prioritised by the Clinical Commissioning Groups:   • Ophthalmology • Diabetic Medicine • Respiratory • Dermatology • Gastroenterology

15. Planned Care Services Next steps • Work will start on the development of the specification of these care pathways once GP representatives are assigned to each priority area. • A full market analysis of potential providers for the services identified will be carried out to inform the procurement process. • Full project plans have been developed to ensure all services will be in place by April 2013.

16. Please make a note of any questions for our session towards the end

17. Dr David Briggs – East Leicestershire Clinical Commissioning GroupJane French - Deputy Director, Leicester Leicestershire and Rutland Cluster Workstream 2 Extending patient choice of provider

18. Why extend choice? Allows for a higher and better level of service to be bought by encouraging innovation Keeps waiting times down so that patients are seen sooner Moves services to a lower cost setting Provides more choice on the times of the service, including evenings and weekends where appropriate New service providers will work with current providers to ensure that services are protected and ‘joined up’

19. Where should we extend choice? The extension of patient choice has been shown to work well in other areas of the country. There are a number of existing providers that have shown they can provide an excellent and cost effective service. Some services are especially suitable for patient choice: • The service should not be part of a complicated condition / pathway where continuity is essential • There should be no expensive equipment required that would increase overall cost • The service should not affect other services in a detrimental way

20. Where have we already extended choice? Across Leicester. Leicestershire & Rutland choice has already been extended in a number of services and patients are benefitting from shorter waiting times and services that are easier to access: • Carpel tunnel syndrome • Vasectomies • Minor dental procedures • Specialist orthodontics

21. Extending patient choice of provider • The Government is committed to increasing patient choice and personalisation in NHS-funded services. Since 2010 the government has specifically committed to extending choice of ‘Any Qualified Provider’ for appropriate services. • This means that when patients are referred (usually by their GP) for a particular service, they should be able to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations. • This is expected to improve clinical outcomes and patients’ experience of local services as providers will improve their services to respond to local patient need

22. What is Any Qualified Provider (AQP) ? • AQP is the term given to a contracting process which means multiple potential organisations, including NHS organisations, voluntary organisations and independent providers can bid to provide healthcare services. • The aim of this is to extend patients’ choice of healthcare providers and enable patients and their carers to select the best possible service for their need. • This means that when patients are referred to a specific service they will have the choice of a range of qualified providers who meet specific NHS requirements rather than be limited to one or two providers.

23. Providers qualify and register to provide services via an assurance process that confirms providers’ fitness to offer NHS funded services. Commissioners set local pathways and referral protocols which providers must accept. Referring clinicians offer patients a choice of qualified providers for the service being referred to. Competition is based on quality, not price. Providers are paid a fixed price determined by a national or local tariff. Key principles of AQP

24. Progress so far… Nationally, the Department of Health has already consulted with a range of stakeholders including patient groups, voluntary organisations and service providers to identify a national ‘menu’ of services suitable for AQP.

25. These services are: Musculo-skeletal services for back and neck pain Adult hearing services in the community Continence services (adults and children) Diagnostic tests closer to home such as some types of imaging, cardiac and respiratory investigations to support primary assessment of presenting symptoms Wheelchair services (children) Podiatry services Venous leg ulcer and wound healing Primary Care Psychological Therapies (adults)

26. What happens now… • NHS Leicester, Leicestershire & Rutland is required to select three or more services from the list in which to implement the AQP process. • There is also the option to choose additional local services if necessary. • While a range of services will be subject to patient choice of any qualified provider, this will not be appropriate for all services. For example, we would not expect to offer patient choice of any qualified provider for A&E and critical care.

27. Questions to the panel

28. Panel members Dr Umesh Roy - Leicester City Clinical Commissioning Group Dr David Briggs - Chair, East Leicestershire & Rutland Clinical Commissioning Group Dr Chris Trzcinski - Chair, West Leicestershire Clinical Commissioning Group Vikki Taylor - Director of Commissioning Development, Leicester, Leicestershire & Rutland Jane French - Deputy Director Contracting, Procurement and Performance Leicester, Leicestershire & Rutland

29. What we would like to know from you The Leicester, Leicestershire & Rutland Clinical Commissioning Groups need your views to help them identify and prioritise community and mental health services in which to implement patient choice of Any Qualified Provider

30. How will the views of local people be used? • Your views will be used to help the CCGs determine which services should be opened to the wider healthcare provider market to create greater choice for patients • All views will be anonymously collated and amalgamated into a single report • They will be carefully considered alongside the views of local clinicians, and a range of other, existing patient feedback sources such as survey results and patient evaluation exercises • A list of priority services will then be agreed in October 2012, and the new contracting processes will be taken forward from 2013

31. Summary • Surveys and feedback • Evaluation forms • Next steps

32. Contacts Get involved team: Getinvolved@leicestercity.nhs.uk 0116 295 7571 Customer services: customerservices@leicestersity.nhs.uk 0116 295 7011