Advent of New Era forNHS

Maniac or Visionary??

George BoulosCCG LeadN & W Reading

Father of the NHS 1948

£60 Billion

Overt Aim

• Management of services by commissioning “from bottom up”

Covert possibilities (our fears)

• Pot emptied by escalating cost of medical care

• GPs in firing line from all angles for ‘squandering’

Heads together

108,000 POPULATION108,000 POPULATION

So what is GP Commissioning really about

Rod SmithChair North and West Reading

Clinical Commissioning Group and West Berks Federation of CCGs

The challenge ahead - Increased spend Labour

Planned Changes NHS spend/head 2011-15(= £20 Billion Saving)

So how is it shaping up in NHS Berks West

• Currently all care is commissioned by NHS Berks West PCT with £658,474,000

• PCT proposed 1 GPCC -GPs have chosen to develop 4 federated GP groups– Wokingham -

South Reading– North West Reading - Newbury

• Government gave GPs right to choose group size• Small size chosen to foster GP ownership• Could end up as Federation or Merged Organisation

So who are North & West Reading GPCC

• 10 practices

– Balmore Park,Priory Ave,Peppard Road,Emmer Green, Western Elms, Tilehurst Potteries, Circuit Lane

– Pangbourne, Theale, Mortimer

– And each practice has a lead GP & Manager who meet monthly

• Working closely with borough Councils and developing Health and Well being boards– Mainly Reading BC working with S Reading

– 3 Practices mainly West Berks Council

• And who are the Leaders

– 4 elected GPs Drs Smith (Chair)Boulos Rock Ciecierski– 1 elected practice manager– PCT link and PCT Pharmacist– PCT Director of Commissioning– PCT Non Executive Director Wendy Bower – Transition Director – Janet Fitzgerald former CEO NHS Berks West and Bucks PCTs– Nurse already appointed. Consultant vacancy already advertised

Impact of the listening exercise (the Pause)

• No longer GP Commissioning now Clinical Commissioning

• Will need 2nd lay member as Chair or Deputy chair• And nurse member• And Hospital Specialist member (to please BMA)• Our group at risk from LA Boundary Issues

– Putting diplomatic effort in to reduce risk

• Competition as a tool not as backbone of policy (as would have probably happened anyway)

14

Our Patron – Wilkins Micawber "Annual income twenty pounds, annual

expenditure nineteen pounds nineteen and six,(£19.97) result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought

and six(£20.03), result misery.”

We can’t just wait for something to turn up we have to generate efficiency savings to improve services and rise to David Nicholson’s £20 billion challenge

Elective care -3 year trend data improves insight in to cost control

3 year rolling trends

0

20

40

60

80

100

120

140

160

180

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10

-2 Y2

-1 Yr

Year

Con-M

PCT-M

Monthly Referrals

0

50

100

150

200

250

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Ref

erra

ls

08-09

09-10

10-11

11-12

Specialty Focus

Practice PCT MedTrauma & Orthopaedics 23.04 23.67

15.45 12.399.66 7.734.33 7.546.99 8.785.33 6.667.19 5.924.33 5.024.99 5.303.20 3.235.73 4.503.66 3.071.13 1.052.13 1.481.93 1.691.80 1.371.53 1.95

Paediatrics 9.86 10.37Rate per 1,000 is for cumulative year to date, to last completed month. Populations weighted.Ranking from lowest per 1,000 to highest. 1 represents lowest in PCT 55 is highestNegative figures indicate below PCT median.

-2.66% 25

Rate per 1,000 Distance from PCT Median % Rank in PCT

Ophthalmology 24.70% 43

Dermatology -42.57% 11Gynaecology 24.97% 43

Gastroenterology -20.39% 14ENT -19.97% 16Audiological Medicine 21.45% 36Urology -13.75% 17Cardiology -5.85% 25General Surgery -0.93% 25Neurology 27.33% 46Rheumatology 19.22% 38Oral and Maxilofacial 7.62% 30Respiratory / Thoracic Medicine 43.92% 44

-4.92% 23

Vascular Surgery 31.39% 45Endocrinology -21.54% 25

Pain Management 14.20% 34

What can we learn from practices 1 & 8 15

Monthly Dashboard sent to all practices – aiming to get to each GP

• Practice visits show high referring practices may be just 1 or 2 doctors

• “Name and explain” not “Name and Shame/ Blame”

• Publishing data leads to self awareness & change – no scapegoating

• My consortia agreed transparent individual GP data, other Consortia want practice only access

16

So how will N&W Reading CCG involve you

• Patient advisory Group–probably 1 or 2 reps per practice

• CCG Board 2 Patient Director ? Chair of Chairs• Commissioning decisions subject to your scrutiny /

engagement– Orthopaedic decisions– Diabetic decisions– Ophthalmology redesign– Procedures of limited clinical value– Prescribing decisions– Etc etc

In conclusion – GPs and patients can enrich commissioning

• GPs– By improving their own productivity– By direct dialogue with Specialists

• Who may not want to change but will listen better to GPs• GPs can challenge blocks to change more effectively

– And GPs understand what services/ pathways are really like from day to day experience not reports

– So GP/Commissioning Manager partnership will be better than Manager (or GP) alone

– And you are drawing on 100s of GP’s experience• Patients

– Drawing on 10 patient groups• But Commissioning Group skills will be highly variable

18

The Future?

• ?

Richard (Branson Not Croft) ?

Private care

NHS

BottomsUp =

OR: a chance?

Our Hope

?

OR

George Boulos