Understanding the new
Commissioning Landscape
Thoughts for future planning
Dr Nick Harding
BSc MFMLM FRCGP DRCOG DOccMedPGDip(Cardiology)
February 2012
Botanical Gardens
An introduction
We are passionate about improving healthcare for the people of
Sandwell and West Birmingham.
Our vision is for transforming services to ensure excellence for
everyone and in everything we do.
We will not be a PCT in new clothing – this is a different kind of
organisation that is firmly ground in its membership,
relationships and local knowledge.
We will be using local and clinical knowledge for change and
improvement in health for our patients.
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Numbers of the day…
350
257
97
152
50
10
4
539 000 000
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Our health needs
• SWBH commissioning area is 530,560 patients
• Heart of Birmingham ranked 10th most deprived
Local Authority in England with 68% BME population
• Sandwell ranked 12th most deprived Local Authority
in England with approx 20% BME population
• Health challenges against rising costs and demands
for healthcare
• Absolute commitment to improving quality of care
Health without boundaries - November 2011
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4
The journey
2002
PCTs arrive
2003
Right Care Right Here partnership forms
2007
Practice Based Commissioning, ICOF
2008
Primary Care Collaborative
Clinical CommissioningDirectors appointed
2009
Partnerships form: Vitality Partnership
Strategic Models of Care
2010
GP Consortia Healthworks, ICOF, Black Country Alliance and
Pioneers for Health
Care Pathway Reviews
2011
Sandwell and West Birmingham Clinical Commissioning Group
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Our CCG
Local Commissioning Groups* Chair
Practices
(approx.)
Population
(approx.)
Black Country
Dr George Solomon
20
112,228
HealthWorks
Dr Nick Harding
22
132,985
ICOF
Dr Samar Mukherjee
27
106,953
Pioneers for Health
Dr Vijay Bathla
10
46,151
Sandwell Health Alliance
Dr Basil Andreou
31
127,519
Dr Nick Harding
(Interim Chair)
111
530,560
Clinical Commissioning Group
Sandwell and West
Birmingham
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CCG Area covered
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Our Interim Structure
Interim Chair
(Currently Chair of HealthWorks)
Deputy Chair
(TBA)
Board Secretary
Chair and
Vice Chair of
Black
Country
Chair and
Vice Chair of
HealthWorks
Chair and
Vice Chair of
ICOF
Chair and
Vice Chair of
Pioneers 4
Health
Chair and
Vice Chair of
Sandwell
Health
Alliance
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Finance Lead
Lay Advisors
Secondary care
consultant
Finance Lead
Birmingham
Lay Advisor
Birmingham
Nurse
Representative
Finance Lead
Black Country
Lay Advisor
Black Country
Public Health
Representative
Consortia
Development:
Non-voting
members
Director of
Commissioning
Birmingham
Director of
Commissioning
Black Country
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Our structure
Main SWBCCG Board
Finance & Performance
Sub-Committee
Quality & Safety SubCommittee
Strategic Commissioning &
Redesign Sub-Committee
Remit: To have on-going
responsibility for the
affordability of the local
healthcare system, and to
receive monthly
monitoring reports. This
group will highlight
concerns to the Board.
Remit: To regularly review
providers to ensure that
services are safe, and that
outcomes are monitored.
Remit: To consider
service provision and
ensure that services are
commissioned for shorter
pathways, better value for
money, and that provision
is appropriate and
adequate.
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Delivery through membership
Chair and Vice Chair
of Black Country
Chair and Vice Chair
of HealthWorks
Chair and Vice Chair
of ICOF
Local Commissioning Groups
• Develop Clinical Pathways (local or on behalf of SWBCCG)
• Primary Care Quality inc. Medicines Management
• Membership
• QIPP delivery Engagement Primary Care demand
management
Chair and Vice Chair
of Pioneers 4 Health
Chair and Vice Chair
of Sandwell Health
Alliance
• Commission local services
• Patient Participation Groups / Local Patient Networks
• Engage with Local Authority structures at local level
• Develop Commissioning Priorities & feedback problems
with Providers.
Sandwell and West Birmingham Clinical Commissioning Group
Clinical Commissioning Group
 CCG Authorisation
 Patient & Public Consultation on major service changes
 Large-scale patient & public engagement events
 Commission, Contract & Performance
 Primary care strategy inc. Medicines Management
 Manage: SWBH, Dudley Group*, BCHC, BCH*, BWH*,
BSMHT, ROH**may be led by one CCG on behalf of others
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 QIPP Plan / Strategy & Performance monitoring
 Commissioning Business Plan
 Organisational Development
 Health & Wellbeing Board
 Emergency Planning (inc. Winter Planning)
 Interface with PCT Clusters / NHS Commissioning Board
 Secure information required for intelligent
commissioning.
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Our Role
By April 2012 - shadow form as a CCG in readiness for 2013.
We want to:
• Be clear on the health needs of our population and how we
are going to improve their health
• Get the balance right between local and strategic decisions
• Show real clinical leadership and development across the
health economy
• Do this new role in the most effective way we can
• Create a clinical commissioning group that leads by example
• Be effective in communications within our organisations and
the people we serve
• Be ready to lead and manage the NHS as a system by April
2013.
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New NHS
Parliament
Key:
Accountability
Funding
Department of
Health
NHS Commissioning
Board
Monitor
CQC
Licensing
Partnership
SWBCCG
Contracts
Birmingham HealthWatch
2° and 3°
Providers
Sandwell HealthWatch
Patients & Public
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Estimating the Size of the Challenge - Commissioners
A Conceptual Model
G/PMS etc
2.7%
Prescribing
5.1%
Ophthalmology
2.4%
Dental
5.0%
Community services
4.0%
Ambulance
6.0%
A&E
3.2%
Outpatients
5.3%
In-patent emergency
2.4%
In-patent elective
2.4%
Non- PbR outpatients
5.3%
Non- PbR in-patients
2.4%
Transfer to Social Care
Specialised Services
2.0%
Price Pressure
Mental Health
PCT Management Costs
1.9%
0.0%
Other
2.0%
The scale of the financial challenge has been estimated by applying demand pressure forecasts
by service line and price pressure forecasts to current levels of spend. Cost pressures associated
with the planned transfer of funds from NHS allocations to social care are also included.
By 20014/15, there will be a recurrent cost pressure of £2.4bn (£1.3bn demand pressure, £1.0bn
price pressure and £100m social care transfer). 44% of this will be offset through increases in
commissioner allocations, leaving a residual recurrent cost pressure of £1.35bn in 2014/15.
Cost Pressures minus Allocation
3.0
Financial Gap
2.5
£bn
2.0
1.5
Forecast Demand Pressure
(CAGR – 2011/12 to 2013/14)
Demand Pressure
Additional Allocation
1.0
0.5
0.0
2010-11
2011-12
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2012-13
2013-14
2014-15
Forecast Price Pressure
2011/12
2.1%
2012/13
2.1%
2013/14
2.6%
2014/15
2.7%
Quality Innovation Productivity and Prevention
Providers
Workforce
Commissioners
Management
Costs
Demand
Management
Infrastructure
Prioritisation
Service
Development
Service Need
Reduction
Contracting and
Price Efficiency
Service
Development
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Beds Days by Admission Method and Age Group
Birmingham Providers 2009/10
Emergency
Elective
Maternity Other
100%
90%
80%
75+
70%
60%
50%
55-74
40%
30%
20%
18-54
10%
<18
0%
0%
20%
40%
60%
80%
100%
Areas we can target
Doing exactly what we should be doing
Better primary care
delivering more services
Secondary care
delivering
specialist services
Improved patient experience
And releasing savings
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Doing the right things right
Improving quality
Different place
Increase efficiency
Stop doing things
Decrease dependency
Different provision
Keeping local and clinical engagement at the centre of how we deliver –
a grass roots approach
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Our ambition as a CCG
•
•
•
•
•
Improve patient experience and quality of care
Improve health for our population
Working towards delegation/authorisation in 2012-13
Continue to build on good work done so far (RCRH)
Remain committed to the build of the new hospital and
working in partnership
• Through continuous improvement, create rewarding
experience for clinicians wherever they are
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Getting the best out of services - diabetes
Patients
- regular follow up
- easy physical
access
- close to home
SWBH
-Managed care
- Professional
opinion
- Costs covered
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CCG
- Patients
managed safely
- Upstream
interventions
- Value for money
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Over to you
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