The Changing Face of UK Primary Care

Mark LimberCarol 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…..DH10 Strategic Health Authorities131 PCTsGP 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 HealthNHS Commissioning Board4 Clustered SHAs PCTs currently clusteringCommunity 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

Duty of quality

Dut

y of

qua

lity

tariff standard 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

Duty of quality

Dut

y of

qua

lity

tariff standard contract CQUIN QOF

The National Programme for IT

National Programme for IT…

BackgroundLive 2003£6bn budgetConnecting and standardising health IT systemsReduce costsJoining secondary and primary care

UK split into 5 clusters (circa 10-12m population)Contracts awarded to 3 LSPsSome successes and some failures

NPfIT (Successes & Failures)

SuccessesPrinciples were soundLocalised standard systemsPACSChoose and BookThose with no systems improved‘Free’Raised the profile of IT

FailuresContract negotiationToo rigidTook many organisation backwardsTook away choiceFocussed on products and not functionsExcluded best in class suppliersOver 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