UK Health Sector Update 2010

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This presentation was developed in the fall of 2010 following on from the UK Government's publication of "Equity & Excellence: Liberating the NHS". Whilst much has changed since then, a number of the key elements and challenges remain the same. For an up-to-date view on the risks and opportunities these changes represent, please contact Simon Morioka or Jonathan Ellis in our UK Health team.

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UK Health Sector Update 2010

  1. 1. Overview of “Equity and excellence: liberating the NHS”<br />This presentation was developed in 2010 following the UK Government's publication of: <br />"Equity & Excellence: Liberating the NHS"<br />Whilst much has changed since then, a number of core elements and challenges remain the same. <br />For an up-to-date view on the risks and opportunities these changes represent, please contact Simon Morioka or Jonathan Ellis in our UK Health team.<br />www.privatepublic.co.uk<br />
  2. 2. Overview of “Equity and excellence: liberating the NHS”<br />Parliament<br />Department for Health<br />NHS Commissioning Board<br />GP Consortia<br />Monitor<br />Providers<br />Patients, Citizens,<br />Customers, Voters<br />Care Quality Commission<br />Local Authorities<br />Local HealthWatch<br />HealthWatch England<br />Public Health Service<br />Regional Partnerships<br />Greater London Authority<br />The White Paper Equity and Excellence: Liberating the NHS sets out the Government’s strategy for the NHS. Our intention is to create an NHS which is much more responsive to patients, and achieves better outcomes, with increased autonomy and clear accountability at every level.<br />Department of Health Consultation Document July 2010<br />
  3. 3. NHS Commissioning Board and GP Consortia<br />The Board will have five main functions:<br />Providing national leadership on commissioning for quality improvement<br />Promoting and extending public and patient involvement and choice<br />Ensuring the development of GP Commissioning consortia<br />To take responsibility for commissioning certain services<br />To allocate and account forNHS resources<br /><ul><li>The NHS Commissioning Board will be accountable to the Department for living within its annual NHS revenue limit and subject to clear financial rules.
  4. 4. The NHS Commissioning Board will allocate resources to GP consortia on the basis of need.
  5. 5. Practices will have flexibility to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality.
  6. 6. The NHS Commissioning Board will have a duty to ensure comprehensive coverage of GP consortia, and we envisage a reserve power for the Board to assign practices to consortia if necessary.
  7. 7. a maximum allowance to cover management costs
  8. 8. ...a proportion of GP practice income should be linked to the overall outcomes that practices achieve collaboratively through their role in a commissioning consortium
  9. 9. This means practice-level budgets combined at consortia level, separate from GP practice income but affecting it based on consortia outcomes
  10. 10. Changes and responsibilities will be reflected in GP’s primary medical care contracts</li></li></ul><li>Commissioning<br /><ul><li>GP Consortia and the NHS Commissioning Board will be statutory public bodies
  11. 11. Replacing 151 Primary Care Trusts (with 80% of the NHS’ budget) and 10 Strategic Health Authorities
  12. 12. New shadow organisations from April 2011, with full responsibility from April 2012
  13. 13. All GPs required to join a Consortium or will be assigned to one by the NHS Commissioning Board</li></ul> The GP Consortia will be responsible for commissioning “the great majority” of NHS services:<br /><ul><li>elective hospital care and rehabilitative care
  14. 14. urgent and emergency care
  15. 15. out-of-hours services
  16. 16. most community health services
  17. 17. mental health and learning disability services.</li></ul> The NHS Commissioning Board will be responsible for commissioning the following:<br /><ul><li>primary medical services (GP practices as providers)
  18. 18. other family health services
  19. 19. dentistry, community pharmacy and primary ophthalmic services
  20. 20. national and regional specialised services
  21. 21. maternity services
  22. 22. and prison health services.</li></li></ul><li>Identified Enablers from the White Paper<br />In addition to these practical steps, we think there will be a number of areas where it is essential that early progress is made in preparing for the challenge of future commissioning arrangements. These include:<br /><ul><li>clinical leadership: we will work with the National Leadership Council and professional representative groups to explore how best to provide support and development for GPs and other clinicians who would like to take on leadership roles within commissioning consortia
  23. 23. information: we will work with the profession and the wider NHS to identify how best to support consortia in the significant challenge of accessing accurate, real-time data that can be translated into information to support efficient and effective care along the patient pathway and to understand the relationship between patient needs, service provision, health outcomes and financial expenditure
  24. 24. financial transactions: we will work with the profession and the NHS to ensure effective systems that enable consortia to track expenditure, reconcile activity and expenditure, and minimise transaction costs.</li></li></ul><li>Regulation: The Board, Monitor, CQC and HealthWatch<br />NHS Commissioning Board<br /><ul><li>The NHS Commissioning Board will have a contract from DH to lead on achievement of health outcomes.
  25. 25. The NHS Commissioning Board will ensure that commissioning decisions are fair, transparent and with Monitor will promote competition.</li></ul>Care Quality Commission (CQC)<br /><ul><li>The CQC will be the “quality regulator” of all health and adult social care services across the public, private and voluntary sectors.</li></ul>Monitor<br /><ul><li>Monitor will be the “economic regulator” – promoting competition, setting maximum prices, ensuring access and continuity of services.
  26. 26. Monitor will retain responsibility for the performance management of the expanded network of NHS trusts.</li></ul>Patient Groups<br /><ul><li>Local HealthWatch organisations and HealthWatch England will operate as “the independent consumer champion”, the responsibility of local authorities and the CQC respectively to setup and develop.
  27. 27. These will develop from existing Local Involvement Groups made upof individuals and community groups working together to improve health and social care services, and existingGP Patient Participation Groups.</li></li></ul><li>Local Authorities and Public Health<br />
  28. 28. Local Authorities and GP Commissioning<br />“Doctors are a powerful professional group whom councils will need to approach with both firmness and care.” <br />Tony Travers, Director, Greater London Group, London School of Economics, LGC July 2010<br />Survey Source: LGC 29 July 2010, Survey of Adult Social Services Directors, 22 respondents<br />
  29. 29. Primary Healthcare Provision<br /><ul><li>Complete split of commissioning and provision
  30. 30. All NHS trusts to become Foundation Trusts (social enterprises)
  31. 31. No more private patient cap on income
  32. 32. It will be made easier for Trusts to merge
  33. 33. There will be an “any willing provider” model for community services
  34. 34. Providers will be jointly licensed by the CQC and Monitor</li></ul>Primary Healthcare Provision<br /><ul><li>Implies significant new opportunities for private, public and third sector organisations, both those already operating as providers and those new to the UK / new to the sector
  35. 35. Implies some organisations will be successful, including current NHS providers which will be able to grow both the public and private sector sides of their businesses
  36. 36. Implies some organisations will fail, as a result of a failure to compete and as a result of new models of service delivery coming to the fore – this suggests hospital closures and “acquisitions” of failing organisations as well as mergers</li></li></ul><li>Patient Choice<br />GPs will be gaining new powers to commission but are also providers and small businesses in their own right, currently commissioned through their local Primary Care Trusts, and may find themselves affected by increased competition and choice in the sector as a whole...<br /><ul><li>Patient choice in diagnostic testing from 2011
  37. 37. Choice of named consultant-led teams and treatment by April 2011
  38. 38. Choice of treatment and provider for certain mental health services by April 2011
  39. 39. Choice of practice - patients to register with any GP “with an open list” from 2012
  40. 40. Choice of care for long-term conditions and end-of-life care</li></ul>Patient choice of treatment and provider for the “vast majority” <br />of NHS services should be the norm no later than 2013-14<br />Source: Department of Health White Paper, “Equity and excellence: liberating the NHS”<br />
  41. 41. GP Commissioning – Department of Health’s intro to the consultation<br /><ul><li>Most commissioning decisions will now be made by consortia of GP practices, free from top-down managerial control and supported and held to account for the outcomes they achieve by the NHS Commissioning Board...
  42. 42. Our proposed model will not mean all GPs, practice nurses and other practice staff having to be actively involved in every aspect of commissioning... It is likely to be a smaller group of primary care practitioners who will lead the consortium and play an active role in the clinical design of local services, working with a range of other health and care professionals.
  43. 43. ...consortia will be able to employ staff or buy in support from external organisations, including local authorities, voluntary organisations and independent sector providers, for instance to analyse population health needs, manage contracts with providers and monitor expenditure and outcomes.
  44. 44. We want implementation to be bottom-up, with GP consortia taking on their new responsibilities as rapidly as possible and early adopters promoting best practice.</li></li></ul><li>GP Commissioning – Some reactions and comments<br />The Guardian, 16th July 2010<br />Executives at Capita, the UK's largest outsourcing firm, said the number of opportunities for local authority contracts has already doubled this year and they see the healthcare market as "vast and potentially lucrative".<br />The US health giants Humana, UnitedHealth, Aetna and MCCI are all understood to be interested in healthcare contracts that could flow from a new commissioning system in which GPs may be given the power to buy in services from any health group or hospital that is properly accredited.<br />Minnesota-based UnitedHealth has already become a key adviser to primary care trusts and is running two GP practices in Derbyshire and three in London.<br />BMA News, 21st July 2010<br />In a letter to GPs in England, BMA GPs committee chair Laurence Buckman says: <br />‘While this is clearly a potentially huge opportunity for GPs, we recognise that it could also be a major threat both to the current form of general practice and even to the NHS as a public service.’He stresses: ‘We continue to believe that, wherever possible, GPs should ensure that NHS providers are the providers of choice.’<br />Chemist & Druggist, 16th July 2010<br />Ash Soni, contractor at Copes Pharmacy, London, and PEC chairman, demanded safeguards to stop GPs monopolising funds on BBC’s Newsnight this week...Mr Lansley, who also appeared on the programme, stressed that GP consortia would involve other NHS clinicians.He said: “It will be general practice-led commissioning, not general practitioner-led commissioning… the delivery of primary care depends on a multidisciplinary team.”<br />
  45. 45. Current projections for PCT provider arms<br />Vertical Integration<br />Acute Trust<br />Vertical Integration<br />Mental Health Trust<br />Brent<br />City & Hackney<br />Barking & Dagenham<br />Croydon<br />Bexley<br />Ealing<br />Camden<br />Haringey<br />Enfield<br />Harrow<br />Greenwich<br />Islington<br />Community<br />Foundation Trust<br />Havering<br />Lambeth<br />Social<br />Enterprise<br />Hillingdon<br />Lewisham<br />Westminster<br />Newham<br />Southwark<br />Bromley<br />Kensington & Chelsea<br />Redbridge<br />Sutton & Merton<br />Kingston<br />Waltham Forest<br />Wandsworth<br />Hammersmith & Fulham<br />TBC<br />Richmond<br />Barnet<br />Tower Hamlets<br />Hounslow<br />
  46. 46. Areas of community healthcare focus<br />social<br />care<br />mental<br />health<br />rehabilitation<br />services<br />minor<br />injury<br />district<br />nursing<br />nursing<br />homes<br />podiatry<br />family<br />planning<br />respiratory<br />nursing<br />child<br />protection<br />offender<br />health<br />specialist<br />nursing<br />diabetes<br />TB<br />nursing<br />rapid<br />response<br />health<br />visiting<br />occupational<br />health<br />school<br />nursing<br />sure<br />start<br />respite<br />nursing<br />24 hour<br />nursing<br />physio<br />continence<br />dietics<br />dental<br />dermatology<br />learning<br />disability<br />speech<br />therapy<br />anti-coagulation<br />copd<br />tissue<br />viability<br />
  47. 47. Potential competition to existing providers and competitive factors<br />NHS Commissioning Board<br />GP<br />Consortia<br />Buyers<br />Local Authorities<br />Introduction of Tariffs<br />GPs<br />Local Authorities<br />European<br />Union<br />Charities<br />Social Enterprises<br />Private Sector<br />
  48. 48. contact details<br />Private Public Ltd<br />The Pyramid<br />31 Queen Elizabeth Street<br />London SE1 2LP <br />Tel 020 7692 4851<br />Fax 020 7788 3455<br />Web www.privatepublic.co.uk<br />Email info@privatepublic.co.uk<br />For furtherenquiries, please contact:<br />Simon Morioka, Managing Director simon.morioka@privatepublic.co.uk<br />Jonathan Ellis, Senior Consultant <br />jonathan.ellis@privatepublic.co.uk<br />Private Public Ltd is a limited company registered in England and Wales no. 6405704 <br />VAT Registration no. 924 1781 25<br />

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