Peter Hay: Making links with GPs: influencing commissioning
Making Links with GPs – InfluencingCommissioning in the new HealthEconomy Kings Fund, Health and Wellbeing Board Summit 14th July 2011 Peter Hay, Strategic Director, Birmingham City Council, ADASS President
Context• Two systems• Forces against integration?• What good looks like• How we might get there
Context• Largest user (2/3rd of hospital beds)• 167,000 NHS hospital beds• 18,255 care homes provide 459,448 beds• 40% growth in public spending on older people to 1.7% of GDP by 2029/30• The funding gap between care and health “needs to change”• 152 care systems, 250 consortia
Joint/integrated commissioning• Not same market• …nor commissioning skills• …nor approach to market development• …nor use of personalisation• …nor acknowledgement of the above• …and experience of integration is mixed
Less hindrance to integrate than 2010? Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010Performance RegimesFinancial pressuresOrganisational complexityChanging leadershipFinancial complexity
Good looks like• Joint goals• Very closely knit and highly connected networks of professionals• Mutual sense of long term obligation• High degrees of mutual trust• Joint arrangements are core business and are operational and strategic• Shared or single management arrangements• Macro and micro joint commissioning (Source; Rosen, Nuffield after Glenning)
A new model of careand public health Citizen purchased care Citizen purchased – state resources care – own resources Enablement Prevention Support and information offer ‘A wider service offer’ MEANS
So Commissioning…• Will promote resilience in people and communities• Develop risk and return on investment in prevention (and public health?)• Create relationships about evolving practice and best performance in enablement• Shape markets through information• Assist individual budgets where necessary / shown by citizen statement
Resilience in Communities• Spend/influence?• What measures?• How might we hold universal offers to account?• Is starting now the beginnings of a new public health relationship with place?
So Commissioners will…• Understand money – from investors to spend• Consumer information – and intelligence• Prioritise provider relationships – who matters?• Work within a fast changing dynamic environment where the adaptive might survive?
Operationalising integration Source: Rosen et al (forthcoming)
So…• The “architecture” locally needs to support known models of what good looks like• Sort out common language• Agree common models• Clarity of purpose with the urgency of focus on people and outcome
Conclusions• Integrated commissioning, easy to say, tough to deliver• In developing the structures, pay attention to the ways of working• Size of the prize!
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