1. PCT Progress & Intentions Audley-Jones Practices TTL 3 December 2008

2. Overview Draft Commissioning Intentions 2009/10 Progress on PBC –PCT Processes –Commissioning Cases Q&A

3. Draft Commissioning Intentions Draft, for consultation Set out what we plan to do in 2009/10 for: 1.Planned Urgent and Acute Care 2.Primary Care 3.Community Services 4.Public Health, Screening and Prevention 5.Long Term Conditions 6.Mental Health 7.Children and Young People 8.End of Life 9.Maternity and Newborn 10.Learning Disabilities

4. Planned & Urgent Care Managing Demand: Contractual controls Guidance on thresholds for surgery Additional GP referral Triage Gateway Direct access to community based diagnostic services Developing Community Based Services Reconsidering options for GP/PwSI services Community Based Outpatient Services Reducing Emergency Activity/Admissions COPD Asthma CHD Urgent Care Centre Step up/down beds Reviewing Pathways to improve care: Stroke Heart Failure

5. Outpatients Closer To Home Ophthalmology, Cardiology, ENT, Paediatrics, Diabetic medicine, Orthopaedics, Rheumatology, Dermatology, Ante natal, Coronary Heart Disease, Thoracic Medicine, Heart Failure, Gynaecology, Medicine for the Elderly

6. Primary & Community Care One new GP Practice Commission equivalent of 6.5WTE dentists to improve access Continuing drive to improve premises Additional focus in areas of highest deprivation Increasing use of Pharmacy services to deliver care Re-commissioning GP OOH Services Extend PBC – Integrated Care Organisation Pilots

7. Public Health Immunisation Breast Screening Sexual Health & Teenage Pregnancy Smoking Healthy Weight Circulatory Disease & Cancer Health inequalities

8. Long Term Conditions Better information for patients/carers Carers’ Support Services Review & Re-commission pathways: –COPD –CHD –Diabetes –Parkinsons Disease –MS –Heart Failure

9. Mental Health Promoting well being, tackling stigma Improved Access to Psychological Therapies Re-commission some services – early detection & intervention Implement new dementia strategy Support for carers

10. End of Life Pilot new service framework to deliver: –Specialist palliative care –Case management & coordination –Integrated domiciliary care Enabling more patients to die at home if this is their wish.

11. Children & Young People Establish long-term organisational arrangements with 2 local authorities Increased focus on prevention & early intervention Major change programme for CAMHS to be phased in over next 5 years Review patterns of hospital admissions Improving user experience, particularly for children with disabilities

12. Maternity & Newborn Improve services for vulnerable & ‘at risk’ women – focussed in areas of highest deprivation Improved access to perinatal mental health service Continuation of Family Nurse Partnership pilot Increasing cycles of IVF from 1 to 3

13. Learning Disabilities Implement recommendations from ‘Health for All’ report Transfer social care commissioning and funding responsibility to Local Authorities Close NHS Campus and re-provide services in the community.

14. Progress on PBC PCT Processes much improved Approval of Commissioning Cases now faster and more thorough Timescales –Submission to approval decision – 2 to 6 wks –Procurement, following approval – 2 to 9 months depending on type. PBC commissioned services now starting!

15. Want to Know More? Full Commissioning Intentions document can be found on the PCT website: http://www.see-pct.nhs.uk/documents/meetings/public_27_11_2008/commissioning%20intentions.pdf

16. Commissioning Cases Approved, started November 2008: ENT – pilot for community service Ultrasound – pilot for community service MSK – self-funding pilot with consultant physio Being Procured: Ophthalmology – AWP tender in progress to start service in New Year. Endoscopy – AWP tender in progress, service to start in New Year

17. Commissioning Cases Approved: Cardiology – 24hr ECGs, 24hr BP in community Anticoagulation – PCT wide initiative, spec. being developed for service to begin from around May 2009. Not Approved: Diabetes – postponed pending outcome of existing pilot Endoscopy in the community – case subsumed in PCT- wide initiative Anticoagulation – case subsumed in PCT-wide initiative

18. Questions?

20. Target AP R MAYJUNEJULYAUGSEPTAnnual Target Tren d Out of Hours: Activity – Annual contract = 40,000 + tolerance of 5% (Total=42,000) 261 6 31202615234427352343Total= 42,000 Initial telephone call answered within 60 seconds (95%+) 95%95.19 % 95.81 % 95.63 % 92.84 % 96.04 % 95%+  Calls abandoned before answering (<5%) 5%1.62 % 1.33 % 1.54 % 0%1.65 % <5%  Definitive clinical assessment for urgent <20 minutes (95%+) 98.9 5% 99.39 % 100% 95%+  Definitive clinical assessment for urgent <60 minutes (95%+) 99.2 0% 99.43 % 99.41 % 98.66 % 99.90 % 95%+  Commence face to face consultation for urgent <2 hours (95%+) 100 % 95%+  Commence face to face consultation for emergency cases <1 hour (95%+) 100 % 66.67 % 100% 95%+  Commence face to face consultation for less urgent <6 hours (95%+) 100 % 95%+  Out of Hours Performance Measures