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The White Papers

The White Papers. Changing the NHS. Equity and Excellence: Liberating the NHS. Published in July 2010 Equity and Excellence: Liberating the NHS is a White Paper setting out a vision, strategy and proposals for the NHS It describes a system where:

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The White Papers

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  1. The White Papers Changing the NHS

  2. Equity and Excellence: Liberating the NHS • Published in July 2010 • Equity and Excellence: Liberating the NHS is a White Paper setting out a vision, strategy and proposals for the NHS • It describes a system where: • Patients are at the heart of everything the NHS does • Healthcare outcomes in England are among the best in the world • Clinicians are empowered to deliver results

  3. Background to the White Paper Many consultation documents published: • Commissioning for patients • Transparency in outcomes – a framework for the NHS • Local democratic legitimacy in health • Regulating healthcare providers • An Information Revolution • Greater choice and control • Developing the healthcare workforce And a review of arm’s-length bodies

  4. Its a lot of change! “These changes are so big, you can see them from space.” Sir David Nicholson Chief Executive, NHS

  5. Wide ranging proposals... • Reduction in management costs (-45%) • SHAs abolished 2012 • PCTs abolished 2013 • Reduced and more strategic role for DH • Improved public health • Tackling health inequalities • Reforming adult social care • Public health White Paper (December 2010) • Public Health Service • Public health to shift to Local Government with DsPH • Ring fenced public health budget

  6. Patient focus(NHS information revolution) • There should be ‘no decision about me without me’ • To achieve this: • patients should have access to more information about healthcare, in a range of formats • patients should be able to rate and record their experience and patient experience data should be given more prominence (PROMs) • patients should have greater control of their records and be able to share them with organisations such as patient support groups • patient choice should be extended to include greater choice of provider, choice of consultant-led team, which GP they register with, and choice around diagnostic tests • choice should also be extended in areas such as maternity, mental health, long-term conditions and end of life care (AWP)

  7. Patient and public involvement • LINks  local HealthWatch • Independent consumer champion - national HealthWatch (within CQC) • HealthWatch will represent the views of patients and carers • HealthWatch will be able to suggest which poor performing services should be investigated • Proposed functions of local HealthWatch include: • Helping to shape the planning and delivery of health and social care services • Supporting individuals making complaints • Helping people access and make choices about care (‘Citizens Advice Bureau for health’)

  8. Delivering outcomes • Secretary of State will hold the NHS to account for improving healthcare outcomes through a new NHS Outcomes Framework • NHS Outcomes Framework - five national outcome goals or domains: • Preventing people from dying prematurely • Enhancing the quality of life for people with long-term conditions • Helping people to recover from episodes of ill health or following injury • Ensuring people have a positive experience of care • Treating and caring for people in a safe environment and protecting them from avoidable harm

  9. Delivering outcomes • Outcome goals or domains • Outcome indicators • NICE Quality Standards to support commissioners to understand how better care can be delivered

  10. Empowering clinicians • GP consortia - responsible for commissioning local services • An autonomous NHS Commissioning Board - responsible for commissioning other services such as primary medical services, dentistry and community pharmacy. • A new role for local government - to support local strategies for NHS commissioning and integration of NHS, social care, and public health services • All NHS Trusts will become foundation trusts (FT), or be part of an FT with staff having a greater say in how their organisations are run

  11. GP consortia • Every GP practice will belong to a consortium • Consortia will commission majority of NHS services for their patients • NHS Commissioning Board will allocate budgets to consortia • Consortia will hold contracts with providers, e.g. FTs Original timetable: • Shadow consortia form in 2011/12 • Take on commissioning responsibility 2012/13 • Full financial responsibility from April 2013 • Pathfinder consortia now taking first steps

  12. NHS Commissioning Board • a ‘lean and expert organisation’ • free from day-to-day political interference • Shadow Board set up in April 2011 (in Leeds) • Regional offices? Five main functions: • Providing national leadership on commissioning for quality improvement - including designing model contracts • Promoting and extending public and patient involvement and choice • Ensuring the development of GP commissioning consortia • Commissioning certain services that cannot solely be commissioned by consortia, including community pharmacy • Allocating and accounting for NHS resources

  13. Enhanced role for Local Government • statutory Health and Wellbeing Board • shadow form in 2012 / fully functioning in 2013 • but early adopters being formed in 2011 • leading joint strategic needs assessments (JSNA) to ensure coherent and co-ordinated commissioning strategies • supporting local voice, and the exercise of patient choice • promoting joined up commissioning of local NHS services, social care and health improvement • leading on local health improvement and prevention activity

  14. Regulating healthcare providers • The White Paper proposes that services are provided by autonomous providers who are regulated by: • Monitor; and • the Care Quality Commission (CQC) • Monitor will become an economic regulator for health and adult social care, regulating prices, promoting competition, and supporting service continuity • The CQC’s role will be strengthened and given a clearer focus on essential levels of safety and quality of providers

  15. Developing the healthcare workforce ‘It is time to give employers greater autonomy and accountability for planning and developing the workforce, alongside greater professional ownership of the quality of education and training.’ • Replacement of SHA workforce planning role by Healthcare Provider Skills Networks • Health Education England • Allocating and accounting for NHS education and training resources • Will subsume Medical Education England • Funding changes • Multi-Professional Education and Training (MPET) budget - to fund education and training for the next generation of clinical staff only • Provider levy in the future?

  16. Progress with the reforms • December 2010 - publication of: • Response to Liberating the NHS consultation • Response to Outcomes Framework consultation • Outcomes Framework 2011/12 • Operating Framework 2011/12 • January 2011 – publication of the Health and Social Care Bill

  17. The Public Health White Paper (Nov 2010) Healthy Lives, Healthy People: Our strategy for public health in England

  18. Healthy Lives, Healthy People • Ring fenced funding for public health sits with local government • Public Health Outcomes Framework • ‘Health premium’ – incentivise local government and communities to improve health and reduce inequalities • Public Health England (budget ~£4bn) • Numerous consultation documents to follow

  19. Roles of Public Health England • Health protection • Emergency preparedness • Recovery from drug dependency • Sexual health • Immunisation programmes • Alcohol prevention • Obesity • Smoking cessation • Nutrition • Health checks • Screening • Child health promotion including those led by health visiting and school nursing • Some elements of the GP contract (including the Quality and Outcomes Framework (QOF)) such as those relating to immunisation, contraception, and dental public health

  20. Consultations - Transparency in Outcomes • To improve and protect the nation’s health and to improve the health of the poorest, fastest. • Indicators sit below the 5 domains

  21. Consultations - Funding and commissioning routes for public health • Describes who will be commissioning what, from whom • Public Health England will fund public health activity through three routes: • Allocating funding to local authorities; • Commissioning services via the NHSCB; and • Commissioning or providing services itself • LA and GP consortia share duty to produce JSNA • LA has responsibility to develop PNA

  22. Department of Health (DH) Public Health budget NHS budget Public Health England (within DH) Funding for commissioning specific public health services NHS commissioning architecture (NHS Commissioning Board and GP commissioning consortia) Ring-fenced public health grant Providers (incl GPs) Health & Wellbeing Boards Local authorities

  23. Consultations - Funding and commissioning routes for public health • What will local authorities commission? • Sexual health services • School immunisation programmes • Accidental injury prevention (falls etc.) • Physical activity & obesity programmes • Drug and alcohol misuse • Tobacco control • NHS Health Check Programme • Behavioural/ lifestyle campaigns/ services to prevent cancer, long term conditions, campaigns to prompt early diagnosis

  24. Next steps For LPCs and pharmacy contractors

  25. What should pharmacists / contractors do? • Keep up to date with national and local developments related to the White Papers • Recognise the impact of the White Papers on your pharmacy when revising business plans • Work with your LPC to ensure you are ready to capitalise on opportunities presented by the changes • Strengthen your relationships with local GPs and local councillors and feedback relevant information to your LPC

  26. What should LPCs do? • Keep up to date with national and local developments related to the White Papers • Work with your contractors to ensure they are ready to capitalise on opportunities presented by the changes

  27. What should LPCs do? • Strengthen your relationships with local GPs and the LMC (and other LRCs) • Develop relationships with emerging consortia • Strengthen relationships with LG/councillors • Develop relationships with emerging Health and Wellbeing Boards

  28. Summary - Timeline for reform April 2011 April 2012 April 2013 1st full yr of new system Learning & planning for roll-out Full preparatory year Regional outposts? Winding down towards closure in April 2012 SHAs NHS CB In shadow form Fully operational Clustering (by June) and providing support to pathfinder consortia Supporting consortia & ongoing roles Moving towards closure in Apr 2013 PCTs GP consortia Pathfinder consortia starting to engage with commissioning All consortia fully established with shadow allocations Full commissioning H&W Boards Early implementer Boards start to form Boards in place with shadow budgets Fully operational Public Health England Assumes full responsibility for public health and takes on functions of HPA & NTA Fully operational In shadow form

  29. More information and briefings available at: www.psnc.org.uk/ liberatingthenhs

  30. NHS Community Pharmacy Contract Likely changes in 2011

  31. Likely changes to the contract in 2011 • Targeted MURs • National target groups • Data collection • New Medicines Service • Updates to the Clinical Governance requirements

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