The Changing Face of UK Primary CareMark Limber
Carol Limber
(CMA Group Consulting)
NHS Background & Funding…
4th largest employer in the world (after Chinese Army, Indian Railway and WalMart)
Serves a population of 66 million people 1948 - budget of £437million* roughly £9 billion at today’s value
2008/9 over 10 times that amount -more than £100 billion Average rise in spending over the full 60-year period of about 4% 60% of the NHS budget is used to pay staff. 20% drugs and other
supplies, remaining 20% buildings, equipment, training costs, medical equipment, catering and cleaning
NHS funding comes directly from taxation. 2008/9 budget roughly equates to a contribution of £1,980 for every man,
woman and child in the UK.
* Exchange rate currently around £1 = $2 NZD
Health and Social Care Bill 2010-11
3 Central Themes• Patients in control of their
care - More influence / more choice
• Move to measuring Outcomes not Process
• Develop clinical leadership
The Bill proposes to create an independent NHS Board, promote patient choice, and to reduce NHS administration costs.
Old and New Structures…
Out with the old…..
DH
10 Strategic Health Authorities
131 PCTs
GP Practices
Department of Health
Strategic health
authorities
Primary Care Trusts
Acute Hospitals
Mental Health Trusts
GP Dentists Primary Care Clinics
Ambulance Trusts
Old and New Structures…
& In with the new.
DH for Public Health
NHS Commissioning Board
4 Clustered SHAs
PCTs currently clustering
Community Consortia (150-300)
Department for Public Health
NHS Commissioning
Board
Community Consortia
Any Qualified Provider
What would the Consortia do?
150-300 consortia (still not decided) Responsible for commissioning effectively for their
population Demonstrating VFM Responsibility for the money Understand risk stratification / changing population Understand profitability / internal and external SLR Demonstrate local leadership Big – Localness / Small – Connectiveness Lead / Follow / Get out of the Way
Possible Structures…
Federation
Consortia
Consortia
Consortia
Practice
Practice
PracticeGP GP
Patient Care Decisions
Performance and Budget Monitoring
Contract Management
Risk
Hardware & Infrastructure
Views from the GP World…
Most GPs probably not in favour Lack of skills Motivation Knowledge Desire
However – enough in favour to drive the changes
What about the rest of Primary Care?
The Challenges….
Political position is weakTop down rather than bottom up approachWatered down versionResistance from the noisy fewConsortia will become mini Primary Care
Trusts
Improving Health Outcomes
Improving Healthcare Outcomes…
The NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets.
Quality standards will inform the commissioning of all NHS care and payment systems.
Providers will be paid according to their performance. Payment should reflect outcomes, not just activity, and provide an incentive for better quality.
NHS Outcomes Framework…
Preventing people from dying prematurely
Enhancing quality of life for people with long-term conditions
Helping people to recover from episodes of ill health or following injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and protecting them from avoidable harm
Effectiveness
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Patient experience
Safety
The framework will be organised around 5 national outcome goals / domains covering the breadth of NHS activity
How EFFECTIVE the care provided by the NHS isWhat the patient EXPERIENCE is likeHow SAFE the care provided is
These will help the public and Secretary of State for Health to track:
So, how will the NHS Commissioning Board drive improvements in the NHS Outcomes Framework?
NHS OUTCOMES FRAMEWORKDomain 1
Preventing people from
dying prematurely
Domain 2Enhancing the quality of life for
people with LTCs
Domain 3Recovery
from episodes of ill health /
injury
Domain 4Ensuring a
positive patient
experience
Domain 5Safe
environment free from avoidable
harm
NICE Quality Standards (Building a library of approx 150 over 5 years)
Commissioning Outcomes Framework
Commissioning Guidance
Provider payment mechanisms
Commissioning / ContractingNHS Commissioning Board – certain specialist services and primary care
GP Consortia – all other services
Duty of quality
Du
ty o
f qu
ality
Du
ty o
f qu
alit
y
tariffstandard contract
CQUIN QOF
NHS OUTCOMES FRAMEWORKDomain 1
Preventing people from
dying prematurely
Domain 2Enhancing the quality of life for
people with LTCs
Domain 3Recovery
from episodes of ill health /
injury
Domain 4Ensuring a
positive patient
experience
Domain 5Safe
environment free from avoidable
harm
NICE Quality Standards (Building a library of approx 150 over 5 years)
Commissioning Outcomes Framework
Commissioning Guidance
Provider payment mechanisms
Commissioning / ContractingNHS Commissioning Board – certain specialist services and primary care
GP Consortia – all other services
Duty of quality
Du
ty o
f qu
ality
Du
ty o
f qu
alit
y
tariffstandard contract
CQUIN QOF
The National Programme for IT
National Programme for IT…
Background
Live 2003
£6bn budget
Connecting and standardising health IT systems
Reduce costs
Joining secondary and primary care
UK split into 5 clusters (circa 10-12m population)
Contracts awarded to 3 LSPs
Some successes and some failures
NPfIT (Successes & Failures)
SuccessesPrinciples were sound
Localised standard systems
PACS
Choose and Book
Those with no systems improved
‘Free’
Raised the profile of IT
FailuresContract negotiation
Too rigid
Took many organisation backwards
Took away choice
Focussed on products and not functions
Excluded best in class suppliers
Over promised
Information Revolution…
Information Strategy published
alongside the Health BillSeeks to put patients at the centre of the
systemInvolve patients in ownership of their
informationMake information more freely
available
Putting patients and public first…
• Patients will have access to the information they want, to make choices about their care. They will have increased control over their own care records.
• Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment.
• The Government will enable patients to rate hospitals and clinical departments according to the quality of care they receive.
Information and Technologies to Improve Communication
Care Closer to Home…
• Use of tele-health and remote devices• E-consultation• Ambulatory management of long-term
conditions• Service Redesign / changing roles e.g. (GPs /
Nurses with Special Interests)• Delivering services differently – telephone
consultations / 1-1 for high risk patients• Keeping patients out of hospital
Summary…
Thank you for listening