1. The New NHS Opportunities for Optometrists Chris Town Acting Chief Executive Cambridgeshire PCT

2. The NHS is Changing –Why ? Rising deficits/overtrading £800m at end 2005/06 in spite of unprecedented rise in expenditure from £32 billion in 1997 to projected £90 billion in 2008/09 Government and independent observers believe that there has been little transformational change resulting from the new investment. PCT’s have not given commissioning sufficient priority The NHS has a lack of consistent data and the knowledge of how to use it There is duplication of effort by multiple PCTs in the technical process of contracting

3. There are increasing concerns about Primary Care performance - access, demand management, efficient use of NHS resources including prescribing Clinicians have become less engaged in the processes of decision making in recent years Some Acute Trusts have been “game playing” in regard to Payment by Results and are still seen to be in an overall position of strength ‘Minimal change’ is seen to be resulting from new contracts for both Contractors and Employed staff including Consultatnts Everyone seems to accept the need to focus on front end prevention to begin to engineer shift in public behaviours and expectation but little appears to be happening.

4. The future –A nation getting older –Incidence of obesity/Diabetes etc rising rapidly –15 million people with long term conditions –Major technological opportunities People want change: –Greater control of their own health –Support to remain independent –Real choice –More local care –Care that is better integrated around individual needs

5. The New NHS More diverse providers, with more freedom to innovate and improve services (supply-side reforms) More choice and a much stronger voice for patients (demand-side reforms) Money following the patients, rewarding the best and most efficient providers, giving others the incentive to improve (transactional reforms) A framework of system management, regulation and decision making which guarantees safety and quality, fairness, equity and value for money (system management reforms) (system management reforms) Better care Better patient experience Better value for money

6. Therefore NHS and Private Sector are encouraged to develop alternatives to traditional NHS services e. g diagnostics, surgery, Primary Care etc PCT’s become the custodian of the health budget and are responsible for ensuring health is improved not providing care Patients make informed choices re where to get care Reducing tariff and competition mean costs are managed and providers compete on basis of quality Practice Based Commissioners buy services “closer to home” to prevent hospital referral/admission PBC is key to demand management – ensuring patient and clinician concordance with care pathways!

7. Old Principle The NHS is divided into primary and secondary care and the objective is to shift work from the latter institutional to the former; health and social care are separate sectors Diagnostics services are based in hospital Consultants are specialists who work in hospital Consultants can only cover one site New Principle Patients require integrated services designed to meet their needs. Diagnostics are available where appropriate Consultants and other specialists work in the most appropriate settings Consultants work in networks

8. Old Principle GPs make home visits Patients are referred to consultants Doctors prescribe Strict demarcation between staff and health and social care Planning is based on professional roles New Principle A range of professionals can make home visits Patients can be referred to a range of specialist professionals A range of clinicians prescribe Integrated teams focused on the needs of patients Planning is based on competence

9. The Challenges For PCT’s - Relationships will be critical: with Independent Contractors, with local authority commissioners, with providers(public and private sector) and with the public Engagement of all stakeholders in the direction of travel will need to be broadly based and rooted in robust analysis. There will need to be a sustained, open and honest conversation about change and priorities. (Rationing ! ) Anyone wishing to contract with the NHS will have to feel and respond to challenge on quality and on patients’ experience.

10. The End Point ! Clinicians are engaged and accountable for their decisions. The NHS and Hospitals in particular, manage costs Unsuccessful providers go out of business Practice Based Commissioners manage patient demand Patients get the right care in the right place Overall health of the population is improved Public/Politicians think the NHS is delivering value for money !

11. Threats and Opportunities For Optometrists Most PCT’s won’t know much about what you have to offer Can you get access to the decision makers to sell your proposals – would you know who to approach ? Can you produce a realistic business proposal/plan.

12. Specific Opportunities What can you offer PCT/PBC as alternatives to hospital referral and follow up appointments? Can you prevent admissions ? Payments for hospital procedures are fixed so can you offer better costs for certain diagnostic/treatment procedures? Can you offer better access to patients e.g appointment times, locations.

13. Thought For The Day It's always darkest before dawn. So if you're going to steal the neighbour's newspaper, that's the time to do it.