Right Care for Patients, Right Care for Populations Whole Patients, Whole Pathways, Whole Systems Dr Steven Laitner GP and National Clinical Lead for Shared Decision Making

2 Whole people One thing I have always found is that you have got to start with the customer experience and work backwards to the technology. Steve Jobs

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Department of Health

5 St Albans & Harpenden spent £730,000 on ENT admissions in 2010 (excluding non PbR activity). This was £5 per head – lower than the national average (£7 per head ) and similar areas (£6 per head). The locality spent £300,000 less than expected. Lattimore surgery is an outlier – it’s spend rate is higher than expected NHS Comparators – spend on ENT total admissions excluding non PBR activity (age and sex adjusted rate) Lattimore Lodge

Department of Health 6 St Albans & Harpenden spent £260,000 on ENT outpatient attendances in 2010 (excluding non PbR activity). This was £2 per head – lower than the national average (£4) and similar areas (£3). The locality spent £350,000 less than expected NHS Comparators – spend on ENT outpatient attendances (first and follow up) excluding non PBR activity (age and sex adjusted rate) Elms Midway

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8 Traditional model – methods of controlling Demand and delivering savings

Primary care holistic assessment and care COMMUNITY MULTIDISCIPLINARY SPECIALIST SERVICE (Pathway Hub) Prime contractor Highly specialised, intensive, episodic hospital care Referral triage SUBCONTRACTING Hub functions: Referral triage Skilling up 1’ care Specialist Assessment Specialist integrated care Shared Decision Making Personal Health Planning Supported Self Care Patient & carer support Voluntary sector provision PATHWAY MANAGEMENT Referral

10 Thank you Management is doing things right; leadership is doing the right things Peter F Drucker