1. DERBYSHIRE COUNTY PCT A Business Strategy for the Provision of a County Wide Cardiac Rehabilitation Service

2. Who we are Janet Whitehead – Public Health Specialist. Derbyshire County PCT. Ciara Scarff - LTC Commissioning Manager. Derbyshire County PCT. Dr Clare Hawley - GPwSI in Cardiology, Chesterfield, Derbyshire.

3. Setting the scene and understanding the issues Developing a business strategy from a Commissioner point of view Influencing the business strategy from a clinical perspective Aims of our presentation

4. Introduction to Derbyshire County PCT Derbyshire County is one if the largest PCTs in the County – it has a population of 712,000 and covers 1,025 square miles There is a Spearhead area within the County which reflects the health inequalities within Derbyshire. The County is diverse. There are rural areas, urban areas, ex-mining areas and affluent areas which often conceal pockets of deprivation.

5. Our Providers Cheshire There are a small number of community providers represented by the blue stars There are two acute Trusts within Derbyshire delivering phase 3 There are a large number of providers of phase three outside of the County 11 external providers leads to great difficulty when it comes to commissioning an agreed, equitable service

6. Models of service provision across the County PCT North Phase 2 - Community staff provided support Heart Manual offered as part of choice for phase 3 Phase 3 – 4 programmes CRHFT x 1 - Community Hospitals x 2 - Leisure Centre x 1 South Phase 2 – Community Cardiac Liaison Nurses Angina Plan Phase 3 – 6 programmes - DRI x 3 - Derby City x 2 - Community Hospital x 1

7. Who is offered a Phase 3 Programme? North of the County 859 patients 572 (67%) admitted CRHFT of these: 55 (10%) died 260 (46%) not recruited to a programme 186 (33%) recruited to CRHFT programme 71 (13%) chose Heart Manual South of the County 1256 patients of these: 283 (23%) not recruited to a programme 699 (56%) recruited to a programme 202 (16%) followed up with Angina Plan

8. Key points Services not properly commissioned and developed in a piecemeal fashion Variation in service delivery resulting in inequalities across the County Lack of capacity of existing providers particularly in the north of the County Variation in investment across the County Low profile prior to merging of 6 PCTs Difficulty in contracting for an equitable service across the County Poor data and poor data quality

9. Stuck in a rut!

10. The process

11. Moving forward! Let us through! We’re NHS Managers! Commissioners cannot work alone. Involve the right people from the start: Clinicians including a lead clinician Patient representatives Finance and data analyst support Public health Leisure services

12. Understand the current picture Starting point is to define your baseline. What capacity do you need and who are you currently providing for? Can be complicated if you have multiple providers Get analyst support Use NICE Commissioning Tool to help with demand Face the fact you may not be able to get all the data you would ideally like to have!

13. Get a handle on your finances Understand what you are paying for…..not as easy as it sounds! Payment for cardiac rehab often have developed incrementally and can be hard to identify in large contracts with acute trusts Get finance on board and start the process early You may find out you are overpaying but you may also end up with a bill like we did when investigation by the Trust identified the PCT hadn't been paying!

14. Build your case! Make use of tools and evidence available Learn from other areas Make the changes attractive to the PCT!

15. Opportunity to ensure quality and reduce gaps in service Allow for innovation Define strong health outcomes Get buy-in Define your specification

16. To summarise… Get the right people together Understand what is currently happening Identify improvements Build your case or work within existing resources Produce a service specification that identifies key performance measures

17. The clinical perspective

18. Team Engagement

19. ‘Necessity, who is the mother of invention’ Plato - Greek author & philosopher Athens (427 BC - 347 BC)

20. You have got to be in it to win it

21. Playing the game – the strategy

22. Ask the audience?

23. Phone a friend Ggfbfggggggggggg

24. Competencies - feedback

25. The strongest link wins the prize

26. Any questions? Contact details: Derbyshire County PCT Long Term Conditions Commissioning Team Tel: 0115 9316161