1. London cancer workshop 8 th March 2011

2. 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 Provider network scope, governance and incentives 4.00pmFeedback and discussion 4.20pmClosing remarks and next steps 4.30pmEnd of session

3. 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

4. The model of care Chris Harrison

5. 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

6. 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

7. 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 and non-complex surgery Further consolidation of surgical services for rarer cancers into specialist centres A small number of networks of providers delivering standardised pathways

8. 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 orgs delivering cancer care from diagnosis to end of acute

9. Implementation workstreams WorkstreamPhase one Dec10–Mar 11 Phasetwo Apr 11–Mar 12 Phase three Apr12–Mar 13 1. Publichealth and primary care 2. Best practice 3. Radiotherapy commissioning 4. Integrated system designation 5. Integrated system development

10. Integrated system development Rachel Tyndall

11. 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

12. 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

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

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

15. 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

16. Workshop Scope, governance and incentives Rachel Tyndall

17. 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

18. Group session How could orgs in the system hold each other to account? What are the interface performance measures? What can be done to incentivise providers to work differently? How could MDTs be made accountable to both patients and the system? How would the system hold MDTs to account? What impedes system-wide working at the moment?

19. 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 www.csl.nhs.uk/publicationswww.csl.nhs.uk/publications