Planned Care Briefing
22nd September 2011
Before we start …
•Refreshments •Notepaper
•Toilets
•Blue cards
•Fire escape •Questions
• Introductions
Why do things differently?
Dr Umesh Roy
Leicester City Clinical Commissioning
Group
The high cost of care
• While the NHS budget has been protected, it is facing its
most difficult financial challenges ever
• This is because our year-on-year budget increases will
not keep up with the rate at which our costs are rising
• There are 4 main reasons for those rises in costs:
• The population is changing, with people living longer
• People have more complex health needs than before
• The cost of many medicines are increasing
• New medical developments cost more money
The high cost of care
• The NHS in England needs to save £20billion over the
next four years to:
• Continue to improve frontline patient care
• Protect essential services
• Local NHS bodies are working together to see how we
can do things differently, helping us to get the very best
value for the money spent on healthcare.
• There are also other reasons for doing things differently
such as reducing the number of patient visits to different
locations as part of a single pathway.
The high cost of care
• We face some difficult choices about what we do
differently to ensure we can support those with
healthcare needs
• Doctors, including hospital consultants and managers,
have come together to identify projects that will help us
meet these challenges
• The ways we provide treatment for patients with certain
known conditions is one of those areas
Planned Care
What is planned care?
• Care and treatment for people with known medical
conditions which is planned in advance. For example,
being booked in for an operation, and the outpatient
visits which may follow. It is also known as Elective care.
• Some services are also delivered in other settings such
as community hospitals, primary care and a range of
independent providers (eg: opticians, chemists)
Planned Care
Today we are going to talk about two workstreams:
• Workstream 1
Community Planned (Elective) Care Services
• Workstream 2
Extending Patient Choice of Provider
Workstream 1
Community Planned (Elective)
Care Services
Dr David Briggs – East Leicestershire & Rutland
Clinical Commissioning Group
Vikki Taylor - Director of Commissioning Development,
Leicester, Leicestershire and Rutland Cluster
Planned Care Services
Overview
• Outpatient, Day case and Radiography services
currently take place in Community Hospitals across
Leicestershire County and Rutland.
• These services are hosted by Derbyshire Community
Health Services NHS Trust as part of ‘Transforming
Community Services’ until 31 March 2012.
Planned Care Services
Review
• An extensive review is currently taking place to identify
which services will be delivered from Community
Hospitals in the future.
• Once this review is complete an open procurement
process will take place to identify who will provide this
service in the future.
• The successful provider(s) will start delivering the
services from 1st April 2013.
Planned Care Services
Progress to date…
• Clinicians and managers have engaged with the local
population to hear their views on the services that they
think should be delivered from Community Hospitals
• Clinical representatives of the West Leicestershire and
the East Leicestershire and Rutland Clinical
Commissioning Groups (CCG’s) have considered these
views when thinking about which services should be
delivered from Community Hospitals.
• Discussions with both CCG’s indicated a number of key
principles that the review of planned care services
should be based upon.
Key principles of review
• Ensuring that the services available in the community
are suitable and cost effective
• Where appropriate to offer outpatient appointments
closer to people’s homes
• Redesigning pathways from beginning to end ensuring
that patient care is ‘joined up’ from primary care based
interventions to specialist care in hospital.
• The CCGs need to agree a priority list of pathways to
review, where patients will benefit from having access to
more services in a community hospital setting
Planned Care Services
Progress (cont)…
• As a result of the work to date the following pathways
have been prioritised by the Clinical Commissioning
Groups:
•
•
•
•
•
Ophthalmology
Diabetic Medicine
Respiratory
Dermatology
Gastroenterology
Planned Care Services
Next steps
• Work will start on the development of the specification of
these care pathways once GP representatives are
assigned to each priority area.
• A full market analysis of potential providers for the
services identified will be carried out to inform the
procurement process.
• Full project plans have been developed to ensure all
services will be in place by April 2013.
Please make a note of any
questions for our session towards
the end
Workstream 2
Extending patient choice of
provider
Dr David Briggs – East Leicestershire Clinical
Commissioning Group
Jane French - Deputy Director, Leicester
Leicestershire and Rutland Cluster
Why extend choice?
• Allows for a higher and better level of service to be bought
by encouraging innovation
• Keeps waiting times down so that patients are seen
sooner
• Moves services to a lower cost setting
• Provides more choice on the times of the service,
including evenings and weekends where appropriate
• New service providers will work with current providers to
ensure that services are protected and ‘joined up’
Where should we
extend choice?
The extension of patient choice has been shown to work well
in other areas of the country. There are a number of existing
providers that have shown they can provide an excellent and
cost effective service.
Some services are especially suitable for patient choice:
• The service should not be part of a complicated condition /
pathway where continuity is essential
• There should be no expensive equipment required that
would increase overall cost
• The service should not affect other services in a detrimental
way
Where have we already
extended choice?
Across Leicester. Leicestershire & Rutland choice has
already been extended in a number of services and patients
are benefitting from shorter waiting times and services that
are easier to access:
•
•
•
•
Carpel tunnel syndrome
Vasectomies
Minor dental procedures
Specialist orthodontics
Extending patient
choice of provider
• The Government is committed to increasing patient choice and
personalisation in NHS-funded services. Since 2010 the
government has specifically committed to extending choice of ‘Any
Qualified Provider’ for appropriate services.
• This means that when patients are referred (usually by their GP)
for a particular service, they should be able to choose from a list of
qualified providers who meet NHS service quality requirements,
prices and normal contractual obligations.
• This is expected to improve clinical outcomes and patients’
experience of local services as providers will improve their
services to respond to local patient need
What is Any Qualified
Provider (AQP) ?
• AQP is the term given to a contracting process which
means multiple potential organisations, including NHS
organisations, voluntary organisations and independent
providers can bid to provide healthcare services.
• The aim of this is to extend patients’ choice of
healthcare providers and enable patients and their
carers to select the best possible service for their need.
• This means that when patients are referred to a specific
service they will have the choice of a range of qualified
providers who meet specific NHS requirements rather
than be limited to one or two providers.
Key principles of AQP
• Providers qualify and register to provide services via an
assurance process that confirms providers’ fitness to
offer NHS funded services.
• Commissioners set local pathways and referral protocols
which providers must accept.
• Referring clinicians offer patients a choice of qualified
providers for the service being referred to.
• Competition is based on quality, not price. Providers are
paid a fixed price determined by a national or local tariff.
Progress so far…
Nationally, the Department of Health has already consulted
with a range of stakeholders including patient groups,
voluntary organisations and service providers to identify a
national ‘menu’ of services suitable for AQP.
These services are:
•
•
•
•
•
•
•
•
Musculo-skeletal services for back and neck pain
Adult hearing services in the community
Continence services (adults and children)
Diagnostic tests closer to home such as some types of
imaging, cardiac and respiratory investigations to
support primary assessment of presenting symptoms
Wheelchair services (children)
Podiatry services
Venous leg ulcer and wound healing
Primary Care Psychological Therapies (adults)
What happens now…
• NHS Leicester, Leicestershire & Rutland is required to
select three or more services from the list in which to
implement the AQP process.
• There is also the option to choose additional local
services if necessary.
• While a range of services will be subject to patient
choice of any qualified provider, this will not be
appropriate for all services. For example, we would not
expect to offer patient choice of any qualified provider for
A&E and critical care.
Questions to the panel
Panel members
• Dr Umesh Roy - Leicester City Clinical Commissioning
Group
• Dr David Briggs - Chair, East Leicestershire & Rutland
Clinical Commissioning Group
• Dr Chris Trzcinski - Chair, West Leicestershire Clinical
Commissioning Group
• Vikki Taylor - Director of Commissioning Development,
Leicester, Leicestershire & Rutland
• Jane French - Deputy Director Contracting,
Procurement and Performance Leicester, Leicestershire
& Rutland
What we would like to
know from you
The Leicester, Leicestershire & Rutland Clinical
Commissioning Groups need your views to help them
identify and prioritise community and mental health
services in which to implement patient choice of Any
Qualified Provider
How will the views of
local people be used?
• Your views will be used to help the CCGs determine which
services should be opened to the wider healthcare provider
market to create greater choice for patients
• All views will be anonymously collated and amalgamated
into a single report
• They will be carefully considered alongside the views of
local clinicians, and a range of other, existing patient
feedback sources such as survey results and patient
evaluation exercises
• A list of priority services will then be agreed in October
2012, and the new contracting processes will be taken
forward from 2013
Summary
• Surveys and feedback
•Evaluation forms
•Next steps
Contacts
Get involved team:
Getinvolved@leicestercity.nhs.uk
0116 295 7571
Customer services:
customerservices@leicestersity.nhs.uk
0116 295 7011