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Transforming our health care system: Ten priorities for commissioners
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Transforming our health care system: Ten priorities for commissioners


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Candace Imison, Deputy Director of Policy at The King's Fund talks through the ten priorities that GP consortia should keep in mind to help transform our health care system.

Candace Imison, Deputy Director of Policy at The King's Fund talks through the ten priorities that GP consortia should keep in mind to help transform our health care system.

Published in: Health & Medicine, Business

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  • 1. Transforming our health care systemTen priorities for commissionersCandace ImisonDeputy Director of Policy, The King’s Fund
  • 2. Overview Challenge for commissioners– spend resource in way which maximises outcomes and value for money – sustainable health care system Identified ten priorities for commissioners drawing on research done by The King’s Fund and others Striking – degree to which change is called for in primary care
  • 3. Key themesA more systematic approach to chronic diseasemanagementThe empowerment of patientsA population-based approach to commissioningMore integrated models of care
  • 4. 1. Support for self-management 15m+ with long-term conditions - 70% inpatient bed days Level 1 Level 2 Level 3 ~ 20% 2% Particularly helpful for the large majority (70-80%) of people with long-term conditions that have relatively low needs. A small percentage increase of self-care in this group can have a significant impact on demand for professional services.
  • 5. 2. Primary prevention 80% cases of heart disease, stroke and type 2 diabetes and 40% cases of cancer could be avoided
  • 6. 3. Secondary prevention Systematic disease management SAVES LIVES NNT to Deaths Treatment Intervention postpone 25% of patients with history postponed population one death Secondary prevention following CVD event Four treatments (beta blocker, aspirin, ACE inhibitor, statin) of coronary heart disease– Currently untreated: CVD deaths averted 31 4,335 136 undiagnosed and untreated Currently partially treated: CVD deaths averted Additional treatment for hypertensives 61 15,335 253 Additional hypertensive therapy 62 38,053 425 Statin treatment for hypertensives with high CVD risk 27 Warfarin for atrial fibrillation >65 years Stroke deaths averted 17 609 35 Improving diabetes management Reducing blood sugars (HbA1c) over 7.5 by one unit 13 3,092 232 Treating CVD risk among COPD patients Statins for eligible mild & moderate COPD patients 45 1,833 40 Total 258 - -
  • 7. 4. Reducing admissions for people with ambulatory care sensitive conditions £1.3bn – cost to NHS from ACSCs More than two-fold variation between practices in rates of admission for ACSCs
  • 8. 5. Improving management of patients with mental and physical health needsDepression => 4xrisk heart disease + costs diabetes 4.5x greater 30% patientsattending generalpractice – mentalhealth component
  • 9. 6. Better co-ordinated & integrated care TORBAY Emergency bed day use for people 75 + fell by 24 per cent between 2003 and 2008 Beds fell from 750 in 1998/99 to 502 in 2009/10
  • 10. 7. Support for end-of-life care Spending on palliative care varies from £154 to £1,600 per patient2 out of 3 people wouldprefer to die at home – 1 out of 3 do so
  • 11. 8. Effective medicines management £m Community prescriptions Standardising prescribing 1,000 9,000 practices could save £200m 900 8,000 Number Numbers Millions 800 7,000 of per annum 700 600 6,000 prescripti 5,000 ons 500 4,000 400 Total net 300 3,000 ingredient 200 2,000 cost 100 1,000 0 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 4-5% emergency admissions are medicines related and preventable
  • 12. 9. Managing elective activity Up to ten-fold variation in rates of referral Referrals trigger £15bn NHS spend
  • 13. 10. Systematic approach to urgent care20.5 million attendances per annumEmergency admissions grew 11.8% 2004/5-2008/9
  • 14. Getting the right things done • Governance Organisational • Accountabilities development and structures • Shared vision •Managing change •Strategic leadership Leadership •Influencing skills competences •Negotiation •Facilitation skills •Managing meetings •Stakeholder management Transformational Transactional skills skills• Redesigning pathways • Contracts – competition rules• Managing demand and regulation• Joint working with local • Information – analysis and authorities and PPI benchmarking • Finance – allocations, statutory reporting 5
  • 15. In the words of Stephen Shortell ‘The Community Healthcare Management System is a complex set of inter-organisational relationships that requires extensive collaboration and co-ordination as well as subordination of individual organisational interests to achieve a larger common good’ (Shortell et al, 2000, p275)