Respiratory Futures webinar: Creative commissioning, the future is local (with Professor Mike Morgan)
Many people in England have yet to grasp that there has been a major shift in how and where decisions about their healthcare are made. NHS reforms have resulted in a wholesale transfer of responsibility for commissioning decisions from the Department of Health (DH) to individual Clinical Commissioning Groups (CCGs) via NHS England. Accountability for the majority of commissioning decisions that relate to respiratory disease now sits with CCGs and is not directed by either DH or NHS England. The NHS in England is therefore a federation of over two hundred local commissioners who have effective autonomy over their commissioning priorities. In some areas, such as dementia or cancer, there are clear directives from NHS England, and a supporting structure in the form of strategic networks, to deliver standard service improvement. For disease areas where these do not exist, CCGs have much greater choice in the nature and scale of service that they should provide. This has already led to variations in provision according to local need or simply by interest. It is fast becoming clear that, unless there is a major political shift in emphasis, respiratory disease will not be prioritised specifically by NHS England, and CCGs will need to be influenced more explicitly by local need. To a limited extent this is already happening where local stakeholder groups are interacting with CCGs in the form of an informal network and some individuals or groups of CCGs have already identified COPD as a priority in their five-year strategic plans. This is good news and likely to be successful, particularly if their proposed intentions fit in with the models suggested in the recently published Five Year Forward View which favours vertical integration and specialist interaction with primary care – see http://www.england.nhs.uk/ourwork/futurenhs/ for more details. Whilst there is likely to be sufficient intrinsic justification for CCGs to develop sustained interest in respiratory conditions, this won’t happen automatically. There is still much to be done by us, as specialist healthcare professionals, to communicate consistently the importance of developing clinically led, patient-centred quality respiratory care to the 200 or so CCGs in England. Health and Wellbeing Boards and local networks are an obvious conduit for influence. And around the country there are examples of patient organisations and stakeholder groups already having a positive influence on local commissioning policy, such as in Leeds and the South East Coast region. Read more and continue the debate at http://www.respiratoryfutures.org.uk.
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Respiratory Futures webinar: Creative commissioning, the future is local (with Professor Mike Morgan)
Similar to Respiratory Futures webinar: Creative commissioning, the future is local (with Professor Mike Morgan) (20)
Recently uploaded
Recently uploaded (20)
Respiratory Futures webinar: Creative commissioning, the future is local (with Professor Mike Morgan)
- 1. www.england.nhs.uk 30/01/ 2015 The future is local Webinar No1 30th January 2015
- 2. www.england.nhs.uk General Practitioner Specialist Patient Public funding and public provision Public funding Increasing marketisation
- 3. www.england.nhs.uk • Funded through general taxation • Free at the point of need • Mixed economy of providers • Principles • Choice • Quality • Safety • Transparency of outcomes • Value
- 4. www.england.nhs.uk Constant change! • 2012 Health & Social Care Bill • 2013 NHSEngland • 2014 Five Year Forward View • 2015 NHSE, NHSIQ, SCN, Senates etc • 2015 General Election 30/01/ 2015
- 5. www.england.nhs.uk Respiratory diseases • COPD • Lung Cancer • Pneumonia • Asthma • Bronchiectasis • ILD (Pulmonary fibrosis) • TB • Respiratory failure and obstructive sleep apnoea
- 6. www.england.nhs.uk Why is COPD important? • A common long term disabling condition • One of the top five causes of premature mortality • Frequent cause of hospital admissions • Most cases remain undiagnosed in primary care • Large variations in care account for avoidable mortality • Rehabilitation and self-management work • Integrated, anticipatory care is cost effective
- 7. www.england.nhs.uk Years of life lost PYLL rate, England
- 8. www.england.nhs.uk Strategic Clinical Networks Focus on priority areas to improve outcomes and bring together users, providers and commissioners. • Cancer • Cardiovascular (inc Cardiac, Stroke, Diabetes ) • Maternity and children • Mental health, dementia and neurological conditions
- 9. www.england.nhs.uk COPD: Long term care Primarily CCG responsibility Delivered by Primary Care & Acute Trusts Some specialised commissioning (transplantation, LVRS, home ventilation)
- 11. www.england.nhs.uk How to influence the system? • CCGs (no national priority) • Thematic priorities (early diagnosis etc) • Programme Boards (rehabilitation) • Quality and financial levers/incentives (CQIN, QOF, BPT) • NICE, HQIP, NHSIQ,PHE etc • Local Networks • Patient organisations • Professional Societies • Colleges
- 12. www.england.nhs.uk Key Targets and organisational agendas • Public and political awareness • Early diagnosis • Long Term Conditions • Acute care • Integrated care • Population level commissioning • Year of care • Commissioning for value • Personal healthcare budgets
- 14. www.england.nhs.uk Delayed or inaccurate diagnosis • Estimated nearly 3.7 million sufferers • Only 900,000 diagnosed • 85% patients with COPD have had missed diagnostic opportunities up to 20 years prior to diagnosis • Approximately 10-30% of COPD patients admitted to hospital have new diagnosis
- 15. www.england.nhs.uk How do you get spirometry in to practices? QOF Case finding?
- 17. www.england.nhs.uk Multiple LTCs 0% 20% 40% 60% 80% 100% Asthma Hypertension IHD Diabetes COPD None 1 2 3 plus South Somerset Symphony project
- 20. www.england.nhs.uk Long term conditions “House of Care” LTCs are those conditions that cannot, at present, be cured, but can be controlled by medication or lifestyle modifications.
- 21. www.england.nhs.uk Definitions • Self care………What patients do all the time • Action plans……Written instructions and medication for self management of exacerbations alone • Self management training……Providing the necessary skills, knowledge and confidence to self-manage whole condition • Pulmonary rehabilitation……A structured opportunity to provide self management training. • Integrated Care ……The commissioning framework for delivery
- 22. www.england.nhs.uk 30/01/ 2015 • Integrated acute and community Trust • Clinical Leadership across the spectrum • Commissioning incentives (LES & CQUIN) • Focus on education • All components of care joined up
- 23. www.england.nhs.uk 5 year forward view • Realistic financial analysis • Above inflation investment and 4% CIP • Focus on prevention and multi-morbidity • More individual responsibility for health care budgets • Removal of primary/secondary care barriers • Less direct commissioning • Mixed models • Local prioritisation
- 24. www.england.nhs.uk New models of care • Greater devolution • More co-commissioning • Maximising local planning • Encouragement to develop new models of care • Revitalising small hospitals • Getting serious about prevention • Empowering patients (PHBs etc) • Focus on success not failure • Parity for mental health • Greater efficiency 30/01/2015
- 25. www.england.nhs.uk Barriers to access Primary care Acute Trusts GP Specialist Care New commissioning models Multispecialty Community Providers (MCPs) Primary and Acute Care Systems (PACS)
- 29. www.england.nhs.uk Problem High undiagnosed COPD population Above average COPD spend High admission rate Poor audit results Process Right Care methodology Deep Dive pack Stakeholder engagement Redesign of care pathways Result 30% reduction in admissions Exceeded QIPP target by £164k
- 30. www.england.nhs.uk Population level commissioning • “Year of Care” • Stratification for: • Risk • Need • Service provision • Capitated budgets • Pilot sites ongoing
- 31. www.england.nhs.uk Local respiratory networks can be a catalyst for change • Working with CCGs to develop local strategy • Improve early diagnosis • New commissioning models (system wide) • Acute CQUINs (COPD, Asthma, Pneumonia, Smoking cessation) • Generic diagnostic/therapeutic approach to breathlessness • Improving rehabilitation capacity
- 32. www.england.nhs.uk Kent, Surrey, Sussex Respiratory Network
- 33. www.england.nhs.uk The future is local • The NHS will develop from the bottom up • Local prioritisation • Common standards but local implementation • Focus on early and accurate diagnosis and case finding • Use practice informatics • Risk stratification allows population level commissioning • True integrated care requires new commissioning models • Specialists will need to work across the spectrum • These models require wide stakeholder (including patients) involvement
Editor's Notes
- Mike Morgan Asthma and COPD are exemplars' of Chronic Conditions – Lessons learnt valid for other LTCs. Main ambitions for all would be around a) early and accurate diagnosis b) better outcomes c) improved quality of care