Clinical Commissioning : What does it mean for you?

1. Clinical Commissioning: What does it mean for you?

2. What are the main things to change? • Scrap PCTs and SHAs in April 2013 • Slash NHS management costs by 45% • Hand majority of commissioning budgets Clinical Commissioning Groups, headed up by GPs and Practice staff, not managers • Public Health to move to Local Authority – overseen by new body ‘Public Health England’ • Patient to be at the heart of all decision-making – ‘no decision about me without me’ .

3. Funding Accountability Funding/accountability Future NHS Structure following NHS Reform Parliament DH NHS Commissioning Board Public health service Monitor (economic regulator) CQC Regional outposts Licensing ~250 foundation providers 250+ GP commissioning consortia Health and well-being boards2 Local partnership GPs Local HealthWatch Governors Patients and public 2 Local authority link and representation

4. Key Changes – why is it changing? • No more ‘top-down approach’ – less bureaucracy • Make NHS more responsive to patients • Stimulate provider market – increased competition leading to increased quality and productivity • GPs are best placed to understand patients’ needs • Save £5bn by 2014/15 and £1.7bn per year thereafter • More investment in clinicians, not on managers

5. What’s happening locally? Old Structure PCT (Commissioner) Provider Arm Wallasey BWW Birkenhead Localities CWP CCO WUTH GP Practices Providers

6. What’s happening locally? Current Structure Commissioners Wirral CCG GP Practices Cheshire, Warrington and Wirral WGPCC WHCC WNHA Clinical Commissioning Groups (formerly Consortia) WUTH CWP CCO CT Providers

7. Why one CCG? • Department of Health requirement for a CCG to be ‘geographically defined’ • The three consortia will work independently and plan services that are in line with their own patient needs. • Will retain own arrangements for patient engagement and involvement. • will do things Wirral-wide where more appropriate – like ambulance services, and emergency care

8. Wirral Consortia

9. Our responsibilities We will retain our autonomy as a Consortium Our Consortium • Most hospital activity • Prescribing • Community Services • Clinical Engagement • Patient Engagement • Training and Development • Primary Care Mental Health • Local commissioning schemes Wirral CCG • Secondary Care Mental Health • Children’s Services Governance / Corporate Management • Continuing Healthcare • Out of Hours • Ambulance Service • Secondary Care Cancer • Hospices & end of life care • Specialist Commissioning

10. Our duties - Improve access and choice • Focus on quality and safety • Outcomes not processes • Patient-centred approach • Make best use of resources

11. Definitions NHS Providers can be healthcare Trusts, voluntary sector and community groups, private sector companies, charities.... Any organisation that PROVIDES healthcare services FREE at the point of delivery “Commissioning in the NHS is the process of ensuring that the health and care services provided effectively meet the needs of the population.  It is a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services, and managing service providers.”

12. Clinically led Commissioning Engagement with our patients and stakeholders is integral to every stage of our commissioning process Horizon-scanning Service review and development of service specifications Contract monitoring

13. Our Approach • Innovative – work with a range of providers • Commission through Any Qualified Provider • Services in the community, on patient doorsteps wherever possible • Engage with patients and practices in all that we do

14. Innovation in Services

15. What is Peninsula Health? • Former government encouraged development of different providers • Partnership between 25 practices and Virgin Care • Developed range of community services greatly improving access and choice • No profit to practices – any profit made invested into Patient Trust – for use on patient care by 5 Patient Trustees • Is one of many providers that delivers services to our patients

16. Our Achievements Patient Engagement Newsletter Website Council and Executive Board Service Development Minor Injury and Illness ECG Additional Investment in Physio Podiatry, Mental Health Admissions Prevention Clinical Engagement Clinical Leads and Portfolio Bulletin GP, Practice Manager, Nurse forums Online forum and website Management of Resources Track record of staying within 1% of total budget allocation Through effective commissioning we have freed up £5m in 2011/12

17. Integrated Care Committed to working with our partners to ensure integrated and seamless journeys for our patients

18. Our Challenges • Levels of deprivation with health inequalities • Need patients to take responsibility for resources – eg DNA appointments and medicines waste • Ensuring all practices engaged so that commissioning is clinically driven • Reaching the unreachable patients

19. What’s next? • Unplanned and Elderly Care • More funding for dementia care and identification of dementia • Nursing home visiting • Extension of Minor Injury sites • Community Services • Gynaecology • Dermatology • Diabetes • More investment in Physiotherapy and Podiatry • Access to diagnostics • Long Term Conditions • Support for housebound patients • Telehealth • Integration between health and social care • Mental Health and Substances • Increase funding in Primary Care Mental Health in practice • Explore complex case service involving drug and alcohol services • Community Alcohol support