DacCom PbC Ltd Where are we now?

1. DacCom PbC LtdWhere are we now? Mark Jones 27 March 2007

2. Payments for 2006/7The DES • The PCT proposes an achievement payment to reward us for work done. • As agreed, we need to set aside 25% of this for DacCom, to pay outstanding invoices. • We will use any surplus to fund new projects pending agreement of funding for 2007/8. Mark Jones

3. The year ahead:New game / New rules • West Herts PCT is more dynamic and powerful than its predecessors. • They clearly want to work in partnership with us to achieve key objectives. • But they are prepared to make other arrangements if necessary. • So the incentive for us is to take control: • Over the services provided to our patients • Over our own futures in the local health economy Mark Jones

4. The key to the game is fundingThe proposed LES: • Funding to the practices for taking responsibility and being involved • £1 per patient • Funding to the practices for data validation • £0.50 per patient • Funding to the locality organisation (DacCom) for improvement projects • Linked to achievement of targets defined in a Framework document • Minimal funding at Level 1 • About £90k at Level 2 • About £180k at Level 3 Mark Jones

5. What do we have to do for the money? • More than just a sign-up: • Individual GPs to dedicate time to PbC • Data validation and monthly reports • Support for the locality (DacCom) Examples of targets at Level 3: • DacCom has formal agreements with 90%+ practices • Latest QOF scores 900+ for 90% of practices • 90%+ of practices meeting EoE prescribing indicators • 80% of practices meeting PCT prescribing indicators • Systems in place to routinely scrutinise referral levels by individual practice with agreed action plans • Evidence of demand being managed by 75%+ of practices Mark Jones

6. So what does this mean? • There is a lot of money available • Could be over £300k in Dacorum • But we have to work for it • The Framework is ‘coercive’ – it is very easy for a minority of practices to destabilise the locality • On the other hand it does give us the resources we need to make a real impact on patient care Mark Jones

7. Next steps:Practice agreement • A simple statement along the lines of an enhanced service specification. • Key points to include: • Sign up to the business plan • Provide a monthly status report (format defined) • Provide admin time up to a specified limit for data analysis • Strive to meet prescribing objectives agreed with DacCom • Implement process changes in the practice as required to deliver service redesign projects • Qualify for the LES payment • Review after 6 months to ensure the agreement remains effective Mark Jones

8. Next steps:Defining deliverables • We must be absolutely clear about what we will deliver in 2007/8. This is what we will be paid for. • We have to do this for each of the following: • Prescribing • Out patient activity • In patient activity • Community nursing services • Diagnostic services • Unscheduled care – Out of Hours • Unscheduled care – A&E / Urgent Care Centre • Counselling • Other community and mental health services • Tertiary care • We need to ensure Clinical Leads are in place to deliver this analysis Mark Jones

9. Next steps:Defining deliverables • It is just as important to define what we do not expect to deliver. • Avoid “mission creep” • Avoid diversion of effort • Ensure we remain able to deliver what we have promised • We have designed a simple process for formal initiation of projects • If it has gone through the process, we are doing it • If it has not gone through the process, we are not doing it • This decision point releases funding for the project • Using this process, anybody can propose a new project Mark Jones

10. Next steps:Progressing projects • Counselling • We have a clinical lead • We have a management lead • We need to feed this project into the process and secure funding • Physiotherapy • Identify clinical and management leads • Urgent care remains a very high priority • Work with other West Herts PbC groups and identify what we need to do Mark Jones

11. Next steps:Introducing project management • Track projects through 4 key milestones: • Milestone 1 – Agree Business Case • Milestone 2 – Plan Agreed • Milestone 3 – Ready to Go Live • Milestone 4 – Did it work? • Programme Management Group: • Mark Jones, Mary McMinn, Suzanne Novak, Chris Waldron • Funding and resources • Who does what by when • Working intimately with the DacCom Exec: • Clinical leadership and direction • Decision making Mark Jones

12. Key Issues: • The Deficit • We cannot separate service redesign from financial accountability • Referral Management • We must address the strategic demand for a CATS • How will we deliver this in Dacorum? • Provider Organisation • How do we proceed with this? • Urgent Care • Integration with West Herts or Herts • What model of service? • Resourcing this locally • Prescribing • Finding a more effective model for budgetary control Mark Jones

13. Finally: • At last, we have a vision of PbC that can deliver substantial results • We have access to significant funding, and real support from the PCT • We have sensible plans in place for funding, resourcing and progressing projects • We are beginning to have an impact – we have delivered sensible spending decisions for counselling and physiotherapy • Retaining our engagement and cohesion as a group of practices is still the key to success Mark Jones