This PSNC presentation is provided to LPCs for local use. Any queries relating to this presentation should be addressed

1. This PSNC presentation is provided to LPCs for local use. Any queries relating to this presentation should be addressed to: alastair.buxton@psnc.org.uk Presentation last updated 30th January 2011

2. The NHS White Papers Changing the NHS!

3. Presentation overview Key proposals in Liberating the NHS The fall of PCTs The rise of GP consortia and local government Key points for pharmacy in Healthy Lives, Healthy People The NHS Operating Framework 2011/12 The implications for pharmacy at a local level

4. The NHS White Paper Equity and Excellence: Liberating the NHS

5. Background to the White Paper 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

6. 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

7. The White Paper sets out a vision where the NHS: Is genuinely centred around patients Achieves quality and outcomes that are among the best in the world Refuses to tolerate unsafe and substandard care Eliminates discrimination and works to tackle inequalities Puts clinicians in the driving seat Is more transparent, with greater accountability for results Gives citizens more say in how the NHS is run Works much better across boundaries, for example with local authorities Is more efficient and dynamic with less bureaucracy Is free from frequent and arbitrary political meddling.

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

9. Wide ranging proposals... Reduction in management costs (-45%) SHAs abolished 2012/13 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

10. 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) Patient focus(NHS information revolution)

11. 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�)

12. 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

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

14. 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

15. 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 52 announced in December 2010 (1860 practices, ?25% of population)

16. 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

17. 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

18. 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

19. 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

20. Developing the healthcare workforce Health Education England Providing national leadership on planning and developing the healthcare workforce Ensuring the development of healthcare provider skills networks Promoting high quality education and training that is responsive to the changing needs of patients and local communities 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?

21. Functions of HPSNs Managing and coordinating workforce data and workforce plans for the local health economy that respond to GP consortia strategic commissioning plans Developing on behalf of healthcare providers a local skills and development strategy Consultation with patients, local communities, staff and service commissioners to ensure that their views are reflected in the local skills and development strategy Improving the quality of local workforce data, and providing the Centre for Workforce Intelligence with that data Holding and allocating funding for the provision of education and training and accountability for education and training funding from the national education and training levy Contracting for the provision of education and training with education providers and healthcare providers Responsibility for ensuring value for money throughout the commissioning of education and training

22. Functions of HPSNs Taking a multi-professional approach to managing the provision of clinical placements and post-registration and postgraduate education and training programmes and continuing professional development, including the current deanery functions, against quality and cost metrics Partnership working with universities and other education providers; Working with local authorities and Health and Wellbeing Boards in taking a joined-up approach across the health, public health and social care workforce Ensuring continuous quality improvement and assurance of educator standards (in particular relating to postgraduate education) Contributing, as appropriate, to the development of national policies and issues � The size and governance structure of local networking arrangements would be determined locally in response to local need.

23. The impact on pharmacy services... Core contract � Essential and Advanced � NHS Commissioning Board �pharmacists, working with doctors and other health professionals, have an important and expanding role in optimising the use of medicines and in supporting better health. Pharmacy services will benefit from greater transparency in NHS pricing and payment for services� Enhanced service options: NHS Commissioning Board GP consortia Local authorities Foundation Trusts

24. 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

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

26. 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

27. 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

28. Quotes from the White Paper Community pharmacies are a valuable and trusted public health resource. With millions of contacts with the public each day, there is real potential to use community pharmacy teams more effectively to improve health and wellbeing and reduce health inequalities. Public Health England will influence development of the community pharmacy contractual framework through the NHSCB.

29. Quotes from the White Paper Alongside identifying strategic health needs through JSNAs, local authorities, through proposed health and wellbeing boards, will have responsibility for producing pharmaceutical needs assessments, which will inform the commissioning of community pharmacy services by the NHSCB and local public health commissioning decisions. We will build on this as we establish the new system, with the Chief Pharmaceutical Officer working closely with the public health community. This will include the role of pharmacies as local businesses and employers.

30. Consultations - Transparency in Outcomes The framework will sit alongside the health and social care outcomes frameworks Principles for development of framework: use indicators which are meaningful to people and communities focus on major causes and impacts of health inequality, disease, and premature mortality take account of legal duties in particular under equalities legislation and regulations take a life course approach as far as possible, use data collated and analysed nationally to reduce the burden on local authorities

31. Consultations - Transparency in Outcomes To improve and protect the nation�s health and to improve the health of the poorest, fastest.

32. Indicators sit below the 5 domains

33. 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

37. The NHS Operating Framework 2011/12 December 2010

38. NHS Operating Framework Continued focus on QIPP, but extra year to achieve �20bn efficiency savings Formation of PCT clusters (by June 2011) Some PCT staff allocated to emerging GP consortia

39. Key priorities for PCTs include: Reducing emergency admissions Ensuring good and timely cancer screening services Maintaining quality in public health Continuing to progress NHS Health Checks Ensuring good services for people with diabetes Delivering good respiratory disease services And...

40. Key priorities for PCTs include: It is important that NHS organisations continue to maintain and develop pharmaceutical services, including local enhanced services to meet pharmaceutical needs. Optimising the use of medicines in people with newly diagnosed long term conditions, and targeting of Medicines Use Reviews are areas that SHAs and PCTs should actively engage in. In addition, evidence continues to build for the provision of public health services through community pharmacies, as highlighted in Healthy Lives, Healthy People: Our strategy for public health in England.

41. Timeline for reform

42. Next steps For LPCs and pharmacy contractors

43. 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

44. 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

45. 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

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

47. Supplementary slides

48. New Structure