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National GP Federation Showcase 2015

Thursday 15th October 2015

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Overview of developments in the health service –

opportunities and threats for general practice and

federations

Dr James Kingsland OBE

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Thank you to our supporters

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All that glitters is not gold

Scott McKenzie

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All that glitters is not gold

“the attractive external appearance of something is not a reliable indication of its true nature”

Agenda

• Identifying opportunities

• Understand your motive

• How to cost the work and assess whether it is viable

• Negotiation (not conceding things unnecessarily, knowing when to say no/stand firm)

“The definition of insanity is doing the same thing over and over

again and expecting a different result.”

~ Albert Einstein

Major change failure…….

• Embedded behaviours (culture) from the past prevents the new strategy from delivering.

• You need an agreed strategy that will change the culture – Deliver the outcomes and objectives set within your

business plan.

• Requires you working daily to change behaviours, – Most importantly the deeply embedded behaviours,

learned over many years. – If not addressed likely to prevent the Federation from

flourishing as a ground upwards organisation.

Existing Outcomes

Existing Mindset

Existing Work Practices

Changed Mindset

New Work Practices

Desired Outcomes

Level of COGNITION

Continuum of resistance to change (P.Scholtes)

Where to start - Identifying opportunities?

Small and grow?

• Slower to get to full scale

• Often small income

• Less dramatic

• Engagement more straightforward

• Easier and quicker to implement

• Hub and spoke

• Lead by example

Go large?

• Engagement often challenging

• One giant leap is hard to achieve

• Membership often don’t want

• Immediate scale

• Significant income

• Lead by example

Where to start - understand your motive

• Expanding your existing service

• Expanding or improving capacity

• Reducing waste

• Improving value for money

• Developing a new service

• Generating income for Practices

• Providing staff for Practices

• Shifting care from in to out of hospital

• Service integration

• Etc.

Selecting the right services

• Data and skills analysis

• Local priorities – Public Health

– Local Development Plan

– Local Health Needs

• Look for the procedures – Delivered in hospital

– Could be delivered in Primary Care

• Outside the scope of GMS / PMS – Where scale and pace are

required to implement

• Sustainability – Does the volume tie to the skills

available to you?

– Can you buy in new skills

– Train and develop

• Best plans (at this stage) focused at; – Capacity

– Patient Choice

– Access

– In hospital to out of hospital shift

• Who will commission? – CCG?

– FT?

– Public Health?

– Other?

Costing the service

• Legal • HR • Insurance • Training • IT • Premises • Equipment • Communications • Engagement • Delivery costs • Director costs • Profit

• All have a number of sub sets

• All are required to run a service

• Some standards costs exist within the NHS

• For profit or not for profit; what level do you set – You cannot run at cost

Negotiation

• Adopt four positions 1. Your ideal 2. Where you may start with

agreed steps to reach ideal

3. A start point but no more 4. Breakdown

• Never negotiate on price only ever negotiate on work – If the commissioner wants

to pay less….. – If the money is not right…..

• Demonstrate how you will achieve: – Improved outcomes

– Pathways and minimum standards

– Patient, practice and health economy benefits

– Patient, practice and health economy outcomes

– Efficiencies

– Reduced variation – Etc.

Other key learning

1. Key Performance Indicators (KPI) – Tell you what to do to increase performance

dramatically (day in day out performance)

– A monthly, quarterly or annual measure cannot therefore be a KPI

2. Key Results Indicators (KRI) – Confirm how you have done in relation to the

critical success factors

– Ties to results indicators, which tell you what you have done

"In business, words are words, explanations are explanations, promises are promises, but only

performance is reality."

Harold Geneen

Industrialist

Summary

What’s worked for others?

• 24 Hour ECG

• 24 Hour ABPM

• 12 Lead ECG

• Front door to A&E

• Extended Access

• Remote Monitoring of INR

• FT subcontract

• FT subcontract

• FT subcontract

• FT subcontract

• CCG direct contract

• Federation choice to replace LES delivery

"Ideas are a dime a dozen. People who implement them are priceless.”

Mary Kay Ash,

Entrepreneur

Summary

• E+R=O

• Identifying the right opportunities

• Understand your motivation

• Cost correctly

• Negotiate firmly

• SYSTEM AND PROCESS ARE THE KEY!

"The only difference between successful

people and unsuccessful people is extraordinary

determination.”

Mary Kay Ash, Entrepreneur

TELEPHONE Scott – 07980 973 596

scott@scottmckenzieconsultancy.com

WEBSITE

EMAIL

www.scottmckenzieconsultancy.com

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Subcontracting

Dr. Antony Moore

Director, Newcastle General Practice Services Ltd

antonymoore@nhs.net

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The Background

» Formation of a Federation in Newcastle upon Tyne in late 2013 to facilitate

Practices working together.

» Deliver services that individual members could not provide.

» Powerful, successful and prominent FT in Newcastle, NuTH

» Historical suspicion about the motives of the FT evidenced by takeover of

some Practices in/about Newcastle by another organisation, Freeman

Clinics, with links to the FT

» Sense of lack of engagement with Primary Care from PCT days onwards.

24 Hour ABPM

» Originally existed as a LES in Newcastle.

» Part of NICE guidance on the diagnosis of hypertension.

» Delivered in Practices and well liked by patients and clinicians.

» On expiry of the LES Newcastle CCG opted not to continue it.

» Strong desire to maintain the service in the Community.

» Referral in to the FT, via the Renal Department, posed capacity issues for

the FT.

» NGPS entered in to (reasonably) complicated negotiations with the FT

about subcontracting with a split tariff.

Subcontracting – benefits

» Allowed the continued delivery of a well liked and clinically relevant

service.

» Generated income for Practices and NGPS.

» Flexibility to add new members through contract variation.

» Led to further subcontracts, ECG, GPs in ED.

» Ongoing work on further proposals, these include DVT pathway, 24 hour

ECG.

» FT deals with a single Provider responsible for governance.

Subcontracting – cautions

» Complex agreements not familiar to nascent Federations or to GPs.

» Very familiar to the FT.

» Contain complex commitments around Governance.

» Legally binding with clear implications regarding the responsibilities of

Directors.

Subcontracting – lessons

» Importance of legal advice.

» Certain elements and questions are not easily resolved with “round robin”

emails.

» NGPS seen as a more business like entity for surviving the process.

» Member Practices DO NOT (always) read them.

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Refreshment break

Text your questions for the

speakers and expert panel to:

07872 062 259

Or fill out the slip in your pack

and hand it in at the registration

desk before the end of the

afternoon break

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Contracting and staffing considerations for federations Alison Oliver, Associate, Ward Hadaway

Stuart Craig, Partner, Ward Hadaway

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Outline of session

1. Contracting to provide services

2. Staffing – some common pitfalls and how to avoid them

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Contracting to provide services

Alison Oliver

Associate, Ward Hadaway

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Contracting overview – where federations fit in

P3 P1 P2 P3 P4 P5 P6 P7

GP Federation Ltd

Shares CCGs LAs NHSE

GM

S/P

MS

AP

MS

/DE

S

Typical contracting routes

» Competitive tender

» Qualified provider

» Subcontractor

What is a contract?

» Agreement between two or more parties

» Giving rise to enforceable obligations

» May or may not be in writing

» Specific terms

» Express

» Implied

» Valuable consideration

NHS contracting

» GMS

» PMS

» APMS

» NHS Standard Contract

The NHS Standard Contract

» General conditions – national terms

that apply in all contracts

» Service conditions – national terms

that apply where specific services are

being commissioned

» Particulars – set out who the

contracting parties are and schedules

with locally agreed detail

Contracting – some common issues and pitfalls

» Unclear or uncertain terms

» Who holds the contract

» Entire agreement

» Variations & implied terms

» Termination

» Subcontracting

Uncertain terms

» Is it clear exactly what has to be done, by

whom, when, where and to what standard?

» Watch out for:

» Ambiguity

» Conflicting terms

» Vagueness

Who holds the contract?

• Alliance

• Network

• Partnership

• LLP

• Company limited by

shares or guarantee

Entire agreement

» This contract constitutes the entire

agreement between the parties and

supersedes any previous agreement

relating to the subject matter of this

contract.

» Check that all the main points negotiated

prior to contract are included.

Variations v implied terms

» All variations to this contract must be agreed in

writing by all the parties.

» But NB in NHS Standard Contract, variations

mandated by NHS England to give effect to

changes in the standard contract can be

imposed.

» Terms might be implied by conduct.

» The Coordinating Commissioner may terminate this contract

by giving the Provider written notice of not less than the

Commissioner Notice Period, expiring no earlier than the

Commissioner Earliest Termination Date

» Various other circumstances in which the commissioner can

terminate

» Provider default vs no fault

» The Provider may terminate this contract by giving the

Commissioner written notice of not less than the Provider

Notice Period, expiring no earlier than the Provider Earliest

Termination Date

» Various other circumstances in which the commissioner can

terminate

» Commissioner default vs no fault

Termination

Consequences of termination

» If as a result of termination the Commissioner procures any service from

an alternative provider the Commissioner (acting reasonably) can recover

excess costs from the Provider for six months after termination.

» Various other provisions including succession plan.

Subcontracting

P3 P1 P2 P3 P4 P5 P6 P7

GP Federation Ltd

Commissioner(s)

Foundation Trust

Subcontracting

» Subcontracting must be permitted under the head contract

» As head contractor:

» Obtain consent or ensure that permitted subcontractors are named in

the head contract

» Ensure that your obligations are passed on in the subcontract

» Ensure that if subcontractors fail to deliver, you can:

»Step in/re-allocate the work

»Recover your costs/losses

» As subcontractor:

» Check that your obligations are limited to those applicable to the

particular services that you are providing

» Check that your obligations are no more onerous than those of the

head contractor in relation to the services that you are providing

Contracting overview – alliance contracting

Commissioner(s)

GP Federation Ltd Foundation Trust Other Providers

Alliance Contract

Contracting overview – joint venture organisations

GP Federation Ltd Foundation Trust Other Providers

Joint Venture Co

Commissioner(s)

In summary

» Read the contract!

» Take advice if required

» Are the provider's and the commissioner's

obligations clear and unambiguous?

» Is anything missing?

» Can you fulfil your obligations?

» What are the consequences of breach?

» Do you have a "get out" clause?

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Staffing – considerations for federations and how to avoid

risks

Stuart Craig

Partner, Ward Hadaway

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Staffing – How will a federation take on staff?

» TUPE – if a federation wins a contract or is awarded a sub-contract

» Directly takes on new employees

» "Employs"/engages staff from the practices that form the federation

Staffing – TUPE issues

» Often staff could be coming across on public sector terms and conditions

of employment – either transferring directly from the public sector or having

had the benefit of those terms for a number of years despite them

transferring out of the public sector a while ago.

» Pensions – fair deal

» Agenda for change

» Two tier workforce

» Does TUPE always apply?

Staffing – recruiting new staff

» Who is going to be the employer?

» Which contract of employment should you use?

» Are they going to be offered the same terms as the employees of the

practices?

» Who is going to manage the employees on a day-to-day basis?

» Payroll

» Dealing with disciplinary and grievance issues

Staffing – sourcing staff from the practices

» At the moment most common way of sourcing staff to undertake the work

of the federations is through existing staff at the practices.

» If they are employees of the practice what should they be?

» on secondment?

»pension considerations

» self-employed consultants?

»genuinely self employed?

» employees of the federation

» issues with duel employment?

Staffing – deciding status

» At the moment no current consensus as to what status people should have

and therefore it has to be assessed on what is right for each federation

» Importance of documenting relationship correctly

» However, just because an individual and an organisation enters into a

relationship that is defined in a document does not mean that an

Employment Tribunal and/or HMRC are going to agree that is an accurate

description of the relationship

» What happens on a day-to-day basis is key

Any questions?

Alison Oliver

Associate | Ward Hadaway

E: alison.oliver@wardhadaway.com

T: 0191 204 4240

Stuart Craig

Partner | Ward Hadaway

E: stuart.craig@wardhadaway.com

T: 0191 204 4381

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Wigan Borough Federated Healthcare – a case study Dr David Humphreys

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Ashton, Leigh and Wigan

Ashton, Leigh and Wigan

Population of 320 000 Largest borough by population in Greater Manchester

High deprivation High levels of chronic disease

63 practices 5 Localities

Getting Started

• Long-term discussion of ‘federated working’

• Suggestion from CCG to work collaboratively

• Change in European law regarding bids

Two Existing Groups

• CIC

• Set up by new CCG lead

• Breathlessness Service

• 12 member practices

• Private company

• Large buy-in to individuals

• Links to other organisations

• Cross border work

The Decision

• 17 practices- 1 vote per practice

• 140 000 patients

• Limited company funded by loans

• Mainly north and central Wigan but some outliers

• Board of 5: 3 GPs and 2 PMs

• CQC Registration

Work with the CCG

• Bid for ‘Better Care’ money for over 75s

• Business case for INR monitoring

• Business case for ABPM

• All came to nothing

• Collaboration around PMCF

• LES for INR monitoring

Work with Foundation Trust

• Initially really positive

• Talk around several subcontracts

• Offer of practice on site of hospital

• Number of projects

• Held up with secondary care restructuring

• Now very quiet

Work with Community Provider

• Now an FT

• Initially really positive

• Then quiet

• Then positive

• Struggling to engage beyond their board

Other Projects

• PMCF wave 2

• Local private providers

• Local Authority projects

Hopes for the Future

• Stronger links with community trust

• Links with private hospitals

• Better grouped working

• Push the CCG!

• Collaborative working with other feds

• Work out of the Greater Manchester Devolution Project

Fears

• Continued brick wall working with the CCG

• Local Foundation Trust looking towards primary care

• Lack of engagement

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A View from a Trust

Helen Byworth, The Newcastle upon Tyne Hospitals NHS Foundation

Trust

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Context of a Trust like NuTH

» One of the largest teaching hospitals in the UK

» Millions of patients through the doors each year

» Substantial contracts with 11 CCGs, Specialised Commissioners, Local

Authorities and other UK Health Boards

» Complex network of outreach, subcontracting, shared care etc. Possible

up to 500 such service arrangements

» Restricted capacity (like all NHS) up against increasing demand plus

£££s and expectation

» Less corporate/administrative staff than a small CCG

What have we Achieved so Far?

» Established relationship with local Federations

» Three formal contracts in place and others in the pipeline

» Engaged law firm to draw up contract

» Basis for future services (with same or other Federations)

» CCG acknowledges role of Federation to ‘make things happen’

Ambulatory Blood Pressure Monitoring

NUTH

Federation

Device

Supplier

GP Practice GP Practice

GP Practice GP Practice

Contractual Relationship

NuTH’s Community

Services Directorate

CCGs

Added Value

» Patients and System as a Whole

» Joint working between primary and secondary care

» Good use of scarce resources

» Saving unnecessary trips to hospital

» Building up clinical dialogue/shared expertise

» Federation

» One body to manage the GP practices, politics etc

» Single negotiation (prices etc)

» Quick turnaround

» Trust

» Existing contractual relationship with commissioners with entitlement to

subcontract

» Clinical oversight/governance/expertise

» Potential to scale-up procurement etc

Challenges

» Cash-restricted CCGs and an increasing reluctance to see Federations

taking a share

» Lines of communication not always clear

» Fluctuating tariffs and changing payment systems

» Trusts are not able to provide services on the basis of whether they are

“profitable”

» Managing Federations’ expectations given current pressures

» Data flows, processes, reconciliation

» Managing multiple Federations with differing cultures

The Way Forward

» Mutual benefit important

» Keep things as simple as possible

» Invest in getting it right the first time

» Keep the right individuals in the Trust involved – contracts will not be

agreed without them

» Working across boundaries

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Collective purchasing

Peter Masters

Caradoc

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Caradoc Medical Services

Buying Group

Peter Masters

Business Manager

October 2015

Caradoc

Buying Group

• Not for Profit NHS aligned organisation

• FREE membership

• 100+ approved suppliers

• £25m+ turnover

Represents over 2000 GP surgeries, over 50% of OOH organisations, GP Federations etc.

Finances

• Not for Profit

• On average 1% commission paid

• Surplus re-invested into NHS

Supporting GP Federation

launches around the country

GP Federations

• Telephony

• Insurance

– Surgery / Locum

– Indemnity

• Printers

Telephony

– Created Network (VOIP)

• Rental cheaper than traditional ISDN lines

• Free calls to other networked practices/NHS organisations

• Disaster recovery / business continuity

• In hours central appointment answering

aracalls

Vision

• Telephony / IT

– One telephony network

– One IT system

• Advantages

– Savings

– Future work streams/tenders

Caradoc Insurance

• Insurance - Federated approach

• Surgery / Locum

– Extra discount if federated practices join together

• Indemnity

– GP Indemnity Scheme for federations

• PMCF

• Federation contracts etc…

● Great deals on printers

● Full range of consumables

● Contract options on supplies/hardware/service

● Warranty extended to cover you printer

● Next day delivery

● 100% satisfaction guarantee

CALL 08450 500620

www.practicesupplies.co.uk

Product code: TN3330 Product code: RBTN3380

Cost: £56.95 Cost: £54.95

Supplied by: Brother Supplied by: PSL

Prices correct at time of going to press and are exclusive of VAT

Contact Us

Visit: www.caradocmedicalservices.co.uk

Email: info@caradocmedicalservices.co.uk

Call: 01743 454 900 /

Peter Masters 07817 556 883

Thank you to our supporters

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Lunch, exhibition and

networking

Text your questions for the

speakers and expert panel

to:

07872 062 259

Or fill out the slip in your

pack and hand it in at the

registration desk before the

end of the afternoon break

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Keith Taylor FCA Head of Medical Services / MD www.bw-medical.co.uk

• Partnership Vs Limited Company

Financial Management & Record Keeping

• Partnership

– Minimal accounting regulation

– Best accounting practice still applies

– Partnership Agreement compliance

– No accounts filing requirements

– Not in the public domain

Financial Management & Record Keeping

• Limited Company

– Onerous accounting regulation

– Statements of Standard Accounting Practice – SSAPs

– Financial Reporting Standards – FRSs

– Companies Act 2006

– HMRC requirements

Financial Management & Record Keeping

• Partnership

– Partners are the business owners

– Partners make all financial and business decisions

• Limited Company

– Distinction between shareholders and directors

– Shareholders own the company

– Directors are appointed by the shareholders to manage the business

– Memorandum and Articles of Association

– Shareholders’ Agreement

Financial Management & Record Keeping

• Directors’ Responsibilities

– Filing documents at Companies House • Annual accounts

• Annual Return

• Appointment/resignation of directors

• Allotment of share capital

– Keeping adequate accounting records

– Ensuring financial viability

– Safeguarding the assets of the company

– Prevention and detection of fraud

Financial Management & Record Keeping

• Adequate Accounting Records – Section 386 CA 2006

a. To show and explain the company’s transactions

b. To disclose with reasonable accuracy, at any time, the financial position of the company at that time

c. To enable directors to ensure that any accounts required to be prepared comply with the requirements of the Act

Financial Management & Record Keeping

• Accounting records must, in particular, contain

a. Entries from day to day of all money received and expended by the company and the matters in respect of which the receipt and expenditure takes place, and

b. A record of the assets and liabilities of the company.

Financial Management & Record Keeping

• Accounting transactions

a. Allotment of share capital

b. Receipt of loan funding

c. Receipt of contractual income

d. Expenditure 1. Company formation costs

2. Employment costs

3. Overheads

4. Taxation – Corporation Tax/VAT

SUPPORTING DOCUMENTATION!!!

Financial Management & Record Keeping

• Accounting records, what is required?

• Federation provider companies are not complex multi-national entities

• Basic accounting software – Sage 50

– Xero

– Quickbooks

– Spreadsheets

Financial Management & Record Keeping

• Financial Management

– Bank mandates • Control

• Signatories

– Board meetings • Regular finance report

• Presentation of management information/KPIs

– Compliance with deadlines

• Accounts

• Taxation

Financial Management & Record Keeping

Purpose of Accounts

COMPANY PARTNERSHIP • To report results/profits to

shareholders • To collate the results for the

Partners

• Shareholders need assurance that directors are meeting their responsibilities

• Basis for determining Income Tax payable

• Basis for determining Corporation Tax payable

• Medical Partnership – determine superannuable profits

Thank you

Any Questions?

Keith Taylor FCA Head of Medical Services keith.taylor@bw-medical.co.uk

Contact us

Keith Taylor FCA Head of Medical Services / Managing Director BW Medical Accountants Keith.taylor@bw-medical.co.uk / 0191 500 6930

Keith is a chartered accountant and has worked in the profession for over 32 years, latterly specialising in the delivery of specialist accountancy and taxation services to GP Practices and healthcare professionals. With a proven track record in medical finance and a wealth of experience, Keith is a leading expert in accountancy services for the healthcare sector. His vision was to create a niche firm which raises the bar in terms of medical accountancy service provision. By recruiting a talented team with proven track records, our depth and breadth of knowledge is unrivalled. BW has the largest and most experienced medical finance team and we currently act for over 75 GP Practices and over 700 medical professionals across England

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1st Care Cumbria – a case study

Sarah Cousins

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1st Care Cumbria

• Formed December 2014

• 34 Practices

• 211,500 patients

• Broad geography and demographics

• Mission:

– “General Practice at the heart of healthcare in Cumbria”

• Success Regime

Why we formed 1st Care Cumbria Ltd

• To keep General Practice at the heart of healthcare in Cumbria

• GP Practices in Copeland, Allerdale and Eden recognised the need to work at scale due to the challenges of: • the Health & Social Care Act 2012 • Aging population with complex morbidities • Increased demand on General Practice • Reduction of funding in General Practice

• In order to work at scale and in greater collaboration with other local providers • 1 contract instead of 34

• Company limited by shares, but with the ethos of a Community Interest Company

Above all else:

1st Care Cumbria is locally run, by local General Practice, to the benefit of the local population,

remaining sensitive to the different needs of different parts of our population, while

protecting NHS Services and keeping care as close to home as it possibly can be.

Engagement

• Practices

• Community/Mental Health Provider – Engagement from the outset – Now subcontracting

Pulmonary Rehabilitation and Falls

– Exploring a number of ideas

• Out of Area Providers

– Now in discussion with other providers who provide care to Cumbria patients

• LA – Initial positive meetings – Better use of health checks

• CCG – Regular meetings

– No contracts

• Acute Trust – Ongoing discussion around

subcontracting properly resourced work to 1st Care Cumbria

Remote Monitoring of Anticoagulation

• A new innovative approach to anticoagulation – use of remote monitoring, which frees capacity in the

Practices – In line with national and clinical policy – Saves patients having to come in to Practices – Reduction in strokes – Improve patient care for those on anticoagulants

• Evidence from pilot demonstrates more patients in therapeutic range

• AF Project – review of registers and identification of patients with AF through use of Alivecor

• Blocked by the CCG on the basis of increased prescribing cost

The GPC list of unfunded work • 24 hour ambulatory blood

pressure monitoring • Alcohol & drug misuse • Asylum seekers & refugees • Bank holiday working • Cardiovascular health checks • Chlamydia screening

• D-Dimer / DVT management in the community to avoid hospital admissions

• Shared care / specialist drug monitoring

• ECG recording • Extended hours • Flu immunisation • Gonadorelin analogue treatment • HIV in primary care • Homeless patients • Insertion of contraceptive devices • Insulin initiation or conversion

• Minor injuries • Nursing Homes – enhanced services

• Phlebotomy • Post-op suture removal • Pre and post ops • Primary care sexual health scheme

• Prostate cancer follow up • Provision of immediate and first

response care • Referral review scheme

• Ring pessary insertion • Sigmoidoscopy • Smoking cessation programmes

• Spirometry • Student Health • Alcohol and substance misuse • Vasectomy • Violent patients

• And others not on this list

Unfunded Work • 1st Care Cumbria unfunded work audit

– Figures extrapolated indicate £1.4m (approx £7 per patient)

• Majority from Local Acute Trust • Engagement and discussion from February 2015 with both

CCG and Trust • Notice given on 8th May that the following work would be

returned unless appropriate sub-contracted arrangements were in place: – Results for tests/investigations not requested by the practice – Re-referrals within the Trust for the same condition/symptoms – Patient enquiries, including fitnote requests – Pre-op and post-op care

• All parties now around the table to find a solution

Summary

• There needs to be engagement from either the CCG or a main Provider and willingness to contract/sub-contract

• Geography/demographics don’t matter

• Like-mindedness from member practices – Better to start small and grow

• Think broadly about services and service-delivery

• Don’t give up!

Any Questions?

@WardHadHealth

#GPFed

@BWMedical

#GPFed

@ScottMcKenzieCo

#GPFed

Competition and procurement rules

Optimising success and avoiding pitfalls

Sarah Podesta, Associate, Ward Hadaway

Wifi

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Password: internet

Primary Care Community Care Acute Care

Primary Care Community Care Acute Care

The effect of the competition and procurement rules

Setting up a federation

» Principle: collaboration should not

adversely restrict patient choice and

competition between practices

» Risk: interventions including i) merger

control and ii) competition

investigation: setting aside of unlawful

arrangements

» Solution: planning a structure and

constitution that achieves objectives

and benefits in the least restrictive

way

Operating as a federation

» Principle: federations wishing to bid

for contracts will need to follow

procurement processes

» Risk: bids that do not meet the rules of

a procurement (including the

specification) risk being rejected by the

commissioner. Non-compliant contract

awards can be challenged by third

parties.

» Solution: careful reading of the spec

and the rules; training bid team in

tendering processes

Primary Care Community Care Acute Care

The future?

1. Identify

objectives and

benefits 2. Demonstrate value

3. Preserve

choice

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Thank you!

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Refreshment break

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Primary Care Cheshire – a vanguard site case study

Dr Jonathan Gregson

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Jonathan Gregson jonathangregson@nhs.net @PrimCareChesh

Primary Care Cheshire

•Community interest company •Federation of 34 practices and an associate member practice. •Covers the whole of West Cheshire CCG. •250,000 patients •3 Localities •9 Clusters

If West Cheshire was a village of 100 people….…

People aged over 85

People aged 19-65

Children and young people aged 5-19

Children aged under 5

£1243 Spent on each person’s healthcare

70

2

9

3

14

18

People drink alcohol to levels described as binge drinking

THEIR HEALTH

2 People with three or more long term conditions

25 People with raised blood pressure

People with depression

1

Person with severe mental illness

Person with dementia

2

People with cancer

5 People with diabetes

4 People with heart disease

Live in areas described as “most deprived”

16

People aged 66 - 85

100 peopl

e

12

1

10

People who are carers

What will the West Cheshire Way do?

Five Year Forward View

•Multi-Speciality Community Provider •GP registered list •Primary Care Cheshire will work collaboratively across all 3 localities •Partnership with West Cheshire CCG, Cheshire and Wirral Partnership Trust, Countess of Chester Hospital, Cheshire West and Chester Council, Patients

•Starting Well 54,550 people (21.2%) preventing ill health and releasing savings but over a longer time period

•Living Well 51,349 people (19.8%) preventing deterioration of ill health (and associated savings) in the medium term.

•Ageing Well 23,726 people (9.2%) improving health outcomes and releasing efficiencies.

Care Model

Cornerstone of MCP

•9 GP Practice Clusters •3-4 Practices •Integrated Community Team

•District Nurses •Physio/Occupational Therapist •Pharmacist •Social Worker •Well Being Co-ordinator

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Panel discussion / question and answer session

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Chair's closing remarks

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