1. NEW Service Central Cheshire PCT Dr Bill Forsyth

2. A Bit of History…... Once upon a time in a galaxy far, far away…… Historical Accident of GP OOH Cover On Call as it used to be……… Change of Landscape Shared Rotas Co-operatives New GP contract

3. Consistent Themes Fear of Change What if you get busy? I dont want him looking after my patients Itll never work Our system cant be improved on Rapid normalisation/acceptance of new systems Demarcation disputes - esp A&E Lack of whole system approach

4. Current Position in Central Cheshire Population 250,000; 30 practices 5 different sets of arrangements across PCT 3 different Co-ops within PCT 3 practices on boundaries with other PCT Co-ops Concerns around Deputising Service used by 2 Co-ops

5. Blocks in Old System Insular, GP-dominated Cant be improved on Lack of strategy/development Poor IT use Reluctance to work with A&E, other agencies Lack of equity across PCT

6. Initial Survey Results Indicated 100% GP opt-out Indicated number of GPs willing to do some OOH work Some times less popular than others No surprises!

7. Options Status Quo - not viable Existing Co-ops flexing to cover whole PCT - unwillingness to do so; high costs for same service covering same areas Use of Deputising Service - quality concerns/cost PCT run service

8. PCT Approach One element of GMS Implementation Plan Linked to Emergency Care Network Collation of Data on activity Finance - available resources and costs Group to oversee - appropriate Membership Underpinning work-streams Outline proposals for comment/revision Process of continuing refinement of plans

9. Outline Plan NOT more of the same NOT just a GP service April 2004 start Single PCT run service Central Triage - robust, good quality 2 main PCCs - VIN and Leighton Hospitals Co-location/Integration with MIUs

10. Outline Plan Service tailored to match demand Service worked up in partnership with MCHT, MRAS, PT, SS Involving other disciplines - paramedics, SS, NPs, DNs, etc. - skillmix Evolving service - initially heavily GP-led Gradual growing of other staff Close monitoring of demand, problems, etc. with appropriate adjustment to service

11. Critical Planning Elements Rotas Recruitment - practices, GPs, salaried GPs, NPs, other staff Finance Not enough money in the system In generous baseline as usual No option but to fund gap

12. Other Key Elements Will and Commitment Communication, communication, communication Public Consultation Clinical expertise and input Recruitment Management and Organisational support Pharmacy Minor Illness and Rep Rx Schemes Shared working with neighbouring PCTs

13. Shared PCT Working Other Cheshire PCTs Adastra/Technical Links Programme Sharing best practice Cross-boundary issues

14. The Future? Evolving Service Management Board to oversee service delivery/quality, shape and develop service Appropriate membership critical PCT commitment Strategy/Innovation Integration with A&E/MIU Staff Training and Development

15. Opportunities in PCT Run Service Ability to cope with Financial Risks HR/Finance/Management Support Removal of vested interest/demarcation disputes Leverage to broker whole system change Shared working Easier to realise A&E/Minor Injuries, Ambulance Service benefits Other organisations

16. Mutual organisations Some of ideas seductive Should NHS be more like this? Disparaging of PCT ability to provide service Distrust/fear of PCTs Could be described as more of the same or attempt to preserve status quo Independence - good or bad thing?

17. From PCT Perspective Complicated/complex Introduces another organisation PCT remains responsible anyhow Alternative is simplicity and control Will this deliver integrated, whole-system working? Lack PCT resources - ?long-term viability Balancing risks and benefits

18. Way Forward? Understand wide variations in Co-op and PCT maturity/skills/attitudes Need to build relationships/trust Many similar strands to proposals Objectives should be the same Likely to be variety of solutions Does it matter as long as deliver?