Delivering Out-of-Hours Services

1. Delivering Out-of-Hours Services David Carson

2. My Presentation Policy Framework Who will deliver OOH services? The role of PCTs and SHAs Some cross-cutting issues

3. Background Policy Framework OOH Review REC NHSD Review nGMS Choice and Plurality

4. Policy I : OOH Review Standards Clinical Leadership Integrated OOH services Network of providers Joined up planning and commissioning

5. Policy II: Reforming Emergency Care Same principles as OOH Current focus on A&E headline figure Integrated response to Minor Illness and Injury Solutions may reside outside A&E within network provision Chronic disease management - real opportunities in contract

6. Policy III: NHS Direct Review Technical Links Capacity in 2004/5 and 2005/6 Clear set of criteria being developed for joint operational arrangements Ensure that developed arrangements are consistent with NHSD direction and key role in emergency care. NHSD commissioning framework out for consultation Must be in the development process - integration of clinical processes

7. Policy IV : nGMS Opt out is not partial Specific notice periods OOH will provide mechanism to meet in-hours nGMS Challenge Opportunity to build PC capacity and volume

8. Policy V: Plurality NHS Mutual / Voluntary Sector Private Sector All have a role PCT provision is perhaps backstop choice

9. Who will deliver OOH Services? GP Opt-Out and re-provision Capacity Information Providers Mutuality Commercial Providers The Ambulance Service NHS Direct

10. Delivery I: GP opt-out & re-provision. Relevant yes but perhaps not in terms of re-provision 2 Different things Opt out is Practice decision Look beyond this question Services staffed by GPs and others attracted to work in services and providers

11. Delivery II : Capacity Information Urgent need to collect and collate existing information Should be mapped by: Case mix Geography Time Competencies Use as basis of planning integrated service All data should be shared with all providers (including acute and ambulance service)

12. Delivery III : Providers Limited view of opportunities by some Providers stop competing on all aspects – cooperate and build on your strengths (none are good at everything) More opportunity for joint development More attention to planning process At scale versus local Provider development process is needed in every area

13. Delivery IV : Mutuality COOP to COOP Basis of COOP membership changes from those with responsibility to those working within COOP and beyond. Will require support as per guidance from PCTs Working on governance models Provider development Further papers coming Mutual Transfer - January Model Constitution - March

14. Delivery V: Commercial Providers Strengths Resilience due to size Clinical governance structures Logistics and management capacity Often complementary services to local COOPs

15. Delivery VI: Ambulance Service Also Strengths Part of network Have increasing role Must be at the table Time to develop effective PC Capacity

16. Delivery VII: NHS Direct Technical Links Capacity in 2004/5 and 2005/6 Clear set of criteria being developed for joint operational arrangements Ensure that developed arrangements are consistent with NHSD direction and key role in emergency care. NHSD commissioning framework out for consultation Must be in the development process - integration of clinical processes

17. PCTs Networks Inter-PCT Co-operation Self-provision

18. PCTs I : Networks Have you achieved contestability and sustainability? A network gives more options than a single preferred provider Yet to see an area in which a single provider has all the answers Support providers (or establish new providers) Support change Give OOH the priority it requires

19. PCTs II: Inter-PCT Co-operation Potential for one PCT solution to destabilise others Agree on what development activity could be shared Inter PCT process requires proper attention (probably at Board level) Single PCT options will be very rare

20. PCT III: Self-Provision OOH Volumes within individual PCTs are low - few economies to be gained Enough service volume to have senior professional and operational leadership? Track record? Delivers contract but what next? Aspects of provision at scale do not exclude local initiatives Question the perception that PCT provision is the only way to control costs

21. Role of SHAs Key role Overview of PCT process Review of plans and hot spots Key role in ensuring plurality and adequate provision Overview of capacity and market No of providers Capacity of providers Assure overall provision is adequate Benchmark and support PCT action

22. Other Issues Workforce Clinical Leadership Procurement and tendering Accreditation and the Quality Standards

23. Other Issues I : Workforce Significant number of WF initiatives in Agency and in WDCs Important for SHAs and PCTs to ensure OOH and PC issues are on WDC agenda now No magic bullet but skill mix and flexible roles are key

24. Other Issues II : Clinical Leadership Effective clinical leadership underpins effective team working Clinical leaders key role in developing brokering network / inter provider operational arrangements Employed skill mix workforce (even GPs may be employed in new OOH organisations) The organisational structure requires capacity and competency to attract, develop and support senior clinical leaders

25. Other Issues III: Procurement & Tendering Procurement is not the same as tendering It is legitimate to include providers in process Providers should identify strengths / weakness & the benefits of joint working Then working co-operatively We do not have excess capacity We need to build capacity

26. Other Issues IV: Accreditation & Standards Under review Process of accreditation potentially within contracting Standards will apply to all providers (including practices who do not opt out) Revised Standards in April

27. A Unique Opportunity Best opportunity in a generation to build on the best of current practice Will require focussed work and investment. More complex but worth the effort

28. OOH Challenges • Providers • Networks • Joint operations • Clinical leadership • Making most of opportunities • Short medium and long term arrangements • Immediate priority not the enemy of the next stage • Workforce