1. Practice Based Commissioning

2. Who We Are Large PBC Consortium - 75 Practices, 351 GPs, 652,000 population Majority of Northamptonshire covered4 locality groups 9 elected GP Board members, plus 3 appointedManagement team of 9Community Interest Company Developing public “membership”

3. Timeline Nene Commissioning formedManagement team in placeFirst business case approved by PCT April 07 Jan 08 Mar 08 Mar 09  Pro Active Care  Best Practice Scheme  And 23 other schemes Apr 09  Grew from 61 to 75 practices  Awarded national ICO pilot

4. Best Practice Scheme Countywide reduction in the number of outpatients 66 practices participating in the scheme Monthly locality peer review  Locality data shared Monthly practice peer review meetings  Named GP data  Action plans from each meeting Development of community based services

5. Countywide comparison of GP referrals for Urology Northampton practices are highlighted in red

6. Best Practice Scheme

7. Fall in referral rate since start of scheme Increased uptake of direct access diagnostics Redesign on Orthopaedic triage serviceIntroduction of community glaucoma service County wide purchase and training in the use of dermatoscopes

8. Pro Active Care (PAC) £3.08M Business Case over 3 years Largest investment in community nursing for 20 years - Recruitment of 31wte Community Nurses Collaborative Programme approach  12 Practices, 152,000 population  17 Practices, 165,000 population Provider Services, Age Concern, ICT, PCT Commissioners, Northamptonshire LINk Forms the basis of the ICO Pilot application

9. Pro Active Care Measures 258 Patient in PAC in 5 months Reduction in emergency admissions (2.57% reduction wave 1 vs 0.79% reduction non wave 1) Planned 1363 per annum, actual 100 in 3 months for wave 1 Reduction in excess bed days –Phase II April 09 Average risk of re-admission at discharge is 2.8 (on a scale of 1-10 where 10 = certain to be re-admitted and 1 means certain not to be re-admitted). Each patient has remained on Pro Active Care for 1 to 5 weeks, the average stay being 1 to 2 weeks

10. Partners in the Northamptonshire Integrated Care Partnership Northampton General NHS Trust Northamptonshire County Council Social Services Age Concern Nenedoc East Midlands Ambulance Service NHS Northamptonshire United Health UK NHS Northamptonshire Autonomous Provider Organisation Kettering General Hospital NHS Foundation Trust Nene Commissioning Other voluntary sector partners Northamptonshire Healthcare NHS Trust

11. Hospice at Home End of life care Rapid Response Service Responsive primary care to home Intermediate Care Whole system ownership Care Home Scheme Quality healthcare to care homes GP and Community Matron in hospital Effective acute/primary care interface Future Schemes Innovation and improvement

12. Organisational Integration in Practice Pro Active Care Care Homes Scheme GP in A&EOther workstreams Programme Office Integrated Care Programme Board Representation from each relevant organisation at project level

13. How we work - values Clinicians make decisions Delivering productWhatever it takes

14. How we work – in practice Monthly Board meetings Monthly locality clinical meetingsTopic/project specific clinical leads and management support Community Interest Company  Developing public/patient “membership” Emphasis on communication

15. Nene Commissioning and NHS Northamptonshire £1.7m freed-up resources £4m invest to save fund Commissioning ExecutiveIncreased responsibility and accountability

16. Where next – key challenges Integrated Care Organisation Lead role for a specific area Primary Care Strategy – PMS review; 8-8 centres; education Increased responsibility and accountability – shift to outcomes Information – activity to budget management and control

17. Questions