London cancer workshop 9 th March 2011

Agenda TimeSession 2.00pmWelcome and objectives 2.10pmThe model of care 2.25pmProvider network development 2.45pmQuestion and answer session 3.00pmCoffee 3.15pmWorkshop session Incentives, strategy and practicalities 4.00pmFeedback and discussion 4.20pmClosing remarks and next steps 4.30pmEnd of session

Objectives To inform providers of the implementation programme To engage providers in the development of the provider network model and specification To outline to providers the timeframe for specification development and provider network bids To prompt providers to begin provider network discussions and bid development

The model of care Chris Harrison

Developing the proposals 45 clinicians working over 12 months Three work areas: early diagnosis; common cancers and general care; rarer cancers and specialist care Case for change: December 2009 Model of care: August 2010 Extensive 3-month engagement on proposals – over 85 per cent of survey respondents supportive

The case for change Later diagnosis has been a major factor in causing poorer relative survival rates There are areas of excellence in London but inequalities in access and outcomes exist Treatment and care should be standardised Specialist surgery should be centralised: common treatments should be localised where possible Comprehensive pathways should be commissioned; organisational boundaries should not be a barrier

The model of care Improve early diagnosis by addressing public awareness, GP access to diagnostics, screening uptake rates and health inequalities Extended local provision of common cancer services, such as chemotherapy, non-complex surgery and acute oncology Further consolidation of surgical services for rarer cancers into specialist centres A small number of networks of providers delivering standardised pathways

Provider networks Model of care recommends the split of commissioning and provider networks Provider networks to deliver comprehensive pathways in response to fragmentation of services Concept right but language of networks clouds issue Integrated cancer systems containing all NHS organisations delivering cancer services from diagnosis to end of acute care

Implementation workstreams WorkstreamPhase one Dec10–Mar 11 Phasetwo Apr 11–Mar 12 Phase three Apr12–Mar Publichealth and primary care 2. Best practice 3. Radiotherapy commissioning 4. Integrated system designation 5. Integrated system development

Integrated system development Rachel Tyndall

Integrated system designation Providers will be asked to respond collaboratively to a integrated system specification There will be more than one and fewer than five Which system they are in will be the provider’s choice Only providers in a system will provide cancer services Legal status required for contracting

Services Integrated systems will be required to demonstrate how they will contribute to the delivery of the model of care: – Early diagnosis – General care – Common cancer – Rarer cancers and specialist care

Specification In addition to services, the integrated system specification will cover 6 areas: – Scope – Governance – Information – Incentives – Culture – Research and education

Standards Commissioners will set measures and thresholds to assure quality and drive excellence

Incentives Money – Commissioning incentives – Within integrated system – E.g. stroke tariff Workforce – Cross boundary working – Clinical leadership Reputation – Of system versus of organisation – Performance info across pathway

The givens We will change the way we commission to commissioning by pathways Only those part of an integrated system will provide cancer services Will contain as a minimum all secondary and tertiary care providers Some pathways will cross systems Will demonstrate commitment to implementing model of care for common and rarer cancer services Clinically led with an overarching governance board will manage system as single entity

Timeline Event/taskBy London Delivery Group31 st January 2011 Announcement of specification development process8 th February 2011 Individual meetings with providersFeb/Mar 2011 Specification development eventsEarly March 2011 Publication of specificationsApril 2011 Support for bid developmentApr/May/Jun 2011 Individual or group meetings with providersApr/May/Jun 2011 Deadline for bid submission30 th June 2011

Workshop Incentives, strategy and practicalities Rachel Tyndall

The givens We will change the way we commission to commissioning by pathways Only those part of an integrated system will provide cancer services Will contain as a minimum all secondary and tertiary care providers Some pathways will cross systems Will demonstrate commitment to implementing model of care for common and rarer cancer services Clinically led with an overarching governance board will manage system as single entity

Group session - incentives Tables 1 and 4 How should tariffs for the whole pathway be set? How should prices for the interventions within the pathway be set? Should commissioners be involved in setting these prices? What are the future capital funding arrangements to ensure that the required investment takes place?

Group session - strategy Table 2 How would financial accountability work across the integrated system? How would being part of an integrated system with pathway pricing affect an organisation’s financial strategy? Will the impact on business models be significant enough to prompt Monitor’s involvement, particularly for FT applications?

Group session - practicalities Table 3 What are the information requirements to make the system work? What form of contracting will be required for intra-system activity and flows? What influence will MFF have on the distribution of work within the system? How can it be ensured that the creation of integrated systems does not add costs to service delivery?

Feedback session

Next steps Further workshops with your colleagues Ongoing work in March on commissioning an integrated system Outline specification published in April Ongoing development of the model beyond April Bidding stage from April to June Tailored support available during bid development For further information on the case for change and model of care visit