1. Norfolk Council on Ageing – 26th January 2011. Liberating the NHS & GP Commissioning Groups Mark Taylor, Director of Locality Development & Integration

2. What are the changes trying to achieve? Put patients at the heart of everything the NHS does Achieve outcomes that are among the best in the world Empower clinicians to deliver results based on the needs of patients “No decision about me, without me”

3. Process to Date White Paper “Liberating the NHS” & 4 supplementary papers published in July Consultation period to 11 th October 2010 First reading of the Health & Social Care Bill – 19 th January Phased implementation from April 2011 onwards (subject to Parliamentary Process)

4. For Commissioning: GP Commissioning Consortia will be established taking on the functions of PCTs and PBC groups A new NHS Commissioning Board will be established to allocate resources to GP Commissioning Groups and hold them to account. Once GP Commissioning Consortia and the NHS Commissioning Board have been established – PCTs and SHAs will be abolished A much stronger role for local authorities in health Statutory Health and Well Being Board responsible for a Health & Wealth Strategy hosted by Local Authorities Public Health function switches to local authorities What are the main changes?

5. For Health Providers: All NHS Trusts will become Foundation Trusts by 2014 and be given more freedom Any remaining NHS Trusts will be merged with FTs otherwise Monitor will be developed into an economic regulator and the Care Quality Commission will act as a quality inspectorate across health and social care

6. Healthwatch replaces LINKS Choice will be extended including choice of GP The market based approach continues using national tariffs to re imburse hospitals and financial penalties for quality lapses. A commission on funding long term social care PCTs need to reduce their management costs by 46% by 2013/14 ahead of being abolished. Abolition of QUANGOS such as NICE Other changes

7. PCT’s x 158 NHS Trusts Foundation Trusts Independen t/ Third Sector GP’s, Dentists, etc. Current Structure Dept of Health SHA’s x 14

8. Future Structure Dept of Health NHS Commissioning Board x 1 GP Commissioning Groups x ? Foundation Trusts Independent/ Third Sector GPs, Dentists, etc Local Authoritie s Health & Well Being

9. What isn’t changing… Focus on delivering an integrated experience for the patient/citizen Move towards localism Focus on Personalisation in health as well as social care Desire to make more use of Third sector – but as substitute not additional to the state. Use of a quasi market to drive choice and efficiency A desire to reform funding of long term social care into an affordable model There is no money!

10. A Change of Culture….? Current Future Top down……………………………Bottom Up Managerially led…………………….Clinically Led Focus on Process Targets…………Focus on Outcomes Upward Accountability………………Outward Accountability to communities Public Sector Culture………………. Entrepreneurial Culture Slow Pace of Change………………..Rapid Pace of Change Prescribed Structures………………..Locally Determined Structures

11. Health Bill January 2011 Delegation to GP Commissioning Consortia starts 2011/12 SHA’s abolished 2012 Consortia take on commissioning responsibilities from 2012/13 Funding allocations direct to consortia from 2013/14 PCTs abolished from 2013 Timetable for PCTs

12. Where are we in Norfolk? GPs deciding on number and shape of consortia Possibly likely to be 4/5 Gt Yarmouth and Waveney, and North Norfolk established as a Pathfinders West Norfolk also likely to follow NCC establishing Health & Well Being Board PCT restructuring ready for change and integrating commissioning with social care

13. The opportunities….. Engage clinicians better to drive commissioning Reflect local need Engage communities Integrate health, care & prevention Reduce costs?

14. The risks….. Lack of GP support Rapid implementation Loss of PCT expertise The money

15. Questions?