Improving NHS Productivity Dr Donal M Hynes Vice-Chair NHS Alliance PEC Chair NHS Somerset

No reduction in resources NHS Resource Gap

SelfCommunityPrimaryHospitalTertiary

SelfCommunityPrimaryHospitalTertiary

GP ownership Express the size of the problem in recognizable terms

Bridgwater Quipp Urgent care Elective LTCs Meds Primary Mental LD Non-clin 3,443,000 7,634,000 2,395, ,000 2,096, ,000 3,892,000

Bridgwater Quipp Total£20,209, GP one less referral to OPD per week £250,000

Bridgwater Qipp Total£20,209,000 Need to reduce emergency admissions by 130 per week every week 90

Fundamental cultural change 1.Population -active participant 2.Clinicians -proactive in health

Size matters 1.Rearrange services 2.Change core concepts

Form follows function

Size matters Delegating up is easier than delegating down Risk Management options Monopoly Commissioners

Golden rules for consortia 1.Come within budget 2.Hit Quality Targets 3.No noise in the system

Population engagement Provide governance –Open and transparent –Vested interests –Voluntary Organisations and commissioning

Population engagement Democratic Legitimacy –Tough decisions –Choice traded for Voice –Community responsibility ethos

Clinicians Primary Care Clinicians – Generalists –Patient in context of community –Responsibility for health maintenance –Local peer pressure/support

Clinicians Specialists –Non hospital-based –Not at the end-stage crisis point only –Not remote from patients environment

COSS Clinicians Community Orientated Specialist Services Develop community services Become more closely engaged with Primary Care clinicians Follow patient into community More of the same

CBSS Clinicians Community Based Specialist Services Manage patient as part of community In-reach beds Integrated with other clinicians Radical Change

CBSS Clinicians Emergency admissions Clinician to Clinician

Making it happen Conversations with local authorities Start looking at spend on a weekly basis within practice Clinician to clinician discussions

Why bother?

In any circumstances where there are concerns that an individual practice is causing ineffective or wasteful use of NHS resources, the consortium of which it is a part would be expected to work with that practice to address the relevant issues. If problems persisted and there were concerns that a practice was not meeting its contractual duties, the NHS Commissioning Board would need to address this as part of its responsibility for managing primary care contracts.