1. 'Business Opportunities arising from the White Paper' PSMG, 30 th January 2007 Paul Midgley Director The Healthcare Partnership Office -0870 2413506 enquiries@healthcarepartnership.com

2. Overview Introduction to Our Health, Our Care, Our Say Overview of the four key themes –Theme one – case study –Theme two – case study –Theme three – case study –Theme four – case study Issues – knowledge, skills, structural alignment, data Summary – opportunities for partnership working

3. The single most important document since the NHS Plan of 2000……

4. Our health, our care, our say: a new direction for community services Public consultation Summer /Autumn 2005 Published January 30 th 2006, passed by Parliament Summer 2006 England only 240 pages 10 year reform programme – legally binding www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf

5. Our health, our care, our say: making it happen Health and social care working together in partnership www.dh.gov.uk/assetRoot/04/14/00/65/04140065.pdf October 2006 Progress report from 80 pilot sites

6. Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions

7. Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions Smoking cessation Tackling obesity Reducing incapacity- related unemployment Increasing resources and planning for prevention and early intervention More homecare using technology Increasing self care and appropriate conditions management

10. Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions Increased information on, and more input into support package for service users and carers Local service users input/feedback on services to be actioned where problems identified Increased user satisfaction with their care package

11. Case Study – Individual budgets

12. Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions More community- based services Increasing range of urgent care services Joint working between health and social care communities and authorities to reduce inequalities Easier registration with GPs, and improved access and convenience Promoting emotional and physical wellbeing services to prevent mental and physical health problems Improving community support for patients discharged from hospital Improved support for patients @ home to prevent admissions including use of technology Shifting services from acute hospitals to community settings

13. Specialties targeted for Hospital to community shift Dermatology Urology Orthopaedics General Surgery Gynaecology ENT To be addressed in ALL PCTs Local Delivery Plans…….and Foundation Trusts & Acute Trusts business plans – White Paper implementation will be monitored by the SHA & Monitor

16. PBC Early wins & top tips Pathways for GPs to consider for redesign: –COPD –Heart Failure –Long term conditions –Mental Health –Ophthalmology –Podiatry PBC – early wins and top tips - DoH, February 2006

17. Most chosen clinical specialties in PBC plans* for redesign These cover the obvious quick wins as follows : SpecialtiesNumber of PCTS% of Total 1.Dermatology8653.4 2.Admissions Management Unplanned/ Urgent Care7345.3 3.Diabetes5634.8 4.COPD4628.6 5.Orthopaedics and Trauma4427.3 6.ENT4326.7 7.Gynaecology/Obstetrics3723.0 8.Cardiovascular Disease3421.1 9.Musculo- skeletal3320.5 10.Ophthalmology30 18.6 11.Prescribing30 18.6 12.Diagnostics29 18.0 13.Referral Management2817.4 14.Urology24 14.9 15.Surgery – Minor23 14.3 16.Long-term Conditions20 12.4 17.Mental Health19 11.8 18.Rheumatology1911.8 * www.nhis.info - specialist enquiry

18. Key features of service redesign 1.Health needs assessment identifies priority clinical area for redesign (e.g. Local Delivery Plan priorities, public health) 2.Existing clinical pathway mapped out and costed 3.All stakeholders meet to brainstorm options (facilitation!) 4.Various points of the pathway may be changed – including use of PWSIs & consultants or specialist nurses running community based service, plus voluntary sector involvement – looking for quick wins and cost savings first 5.Detailed Business Case(s) submitted to PCT outlining clinical and financial benefits of redesign of specific aspects by potential service providers 6.Contracts set up for any new providers to be accredited – may be accessible via Choose and Book referral system 7. Newly re-designed services will operate via protocols or guidelines including drug use (formularies)

20. e.g. United Health (Europe) in Derbyshire e.g. Principia in S Notts – combining PBC & community nursing services

24. Prevention & early intervention Choice and patient involvement Improved Access, Tackling inequalities Meeting needs of Patients with long term conditions Users and carers get choice of services as close to home as possible Local partnerships between health and social care to deliver better services Prevention of avoidable hospital admissions Increased support for self care, an increase in Expert Patients and Expert Carers programme availability

25. Services closer to home

26. Empowering & enabling individuals with long term conditions to take control of their health High % of self care Equally shared care High % of professional care High-risk cases More complex cases 70–80% of the people with long-term conditions Self care Professional care Risk management in primary care e.g. Community Matrons Regular Secondary care admissions Mainly managed in primary care including GPSI Diagnosed by primary care, health maintained by annual disease reviews Patients enrolled into Expert Patient schemes

31. http://www.expertpatients.nhs.uk/public/default.aspx?load=publications we could expect people who have gained self-management skills to make around 40% fewer visits to their GPs and 17% fewer visits to outpatient clinics. We can also expect 50% reductions in length of stay in hospital, and days off work because of sickness

35. Dr Ian Greaves, Gnosall Medical Centre, SW Staffs

36. What does all this mean to pharma?

37. Selling in a post-White Paper NHS world –Market Intelligence/Data/Joint business planning Whole primary and secondary care team need to know whats on the PCTs/each PBC clusters service re-design agenda and produce an integrated plan for working priority clusters –Networking/Influencing With key individuals in high potential clusters or high current users Between secondary care and primary care KOLs Provide redesign e.g.s from elsewhere Network your KOLs with innovator KOLs from areas that have already successfully redesigned a similar service –Facilitation/Partnership Meetings – organising, facilitating, funding – practice/cluster/super-cluster/PCT/SHA/national level –With board/steering group stakeholders –With full service redesign group (multidisciplinary) –With full cluster group ie all practices represented –Evidence for guideline/formulary inclusion inc. health outcomes data Medical Information evidence pack for your product Local/national KOL endorsement in person plus copies of existing protocols –Flexible Pull Through/Data/local marketing capability once product on guidelines, pull through by publicising guidelines in calls at meetings, etc Production of locally approved materials

38. Prescribing * Practice Nurse -variety of grades & specialisations Practice Manager Salaried GP* GP Partner* GP Senior * Partner GP lead* in disease area GP PBC lead* for practice GP PBC* Cluster Board member PBC Cluster* Board Lead GP Community Nurse* Specialists inc matrons Community* Pharmacists – (extended service Provider?) PCT *pharmacist Medicines Management team PCT PBC Commissioning manager Practice Nurse - non prescribing Area Px committee members Consultant* KOL Product Advocates GPSI* in area of Interest to your product Other hospital- Based advocates* PCT educational lead Protected learning time Valued added Service providers – Improve access e.g. training Who are pharmas customers in a PBC driven market? Other PBC Cluster board members * Potential Rxer Expert Patient Tutors? Director of Adult Social Services? Director of Public Health (NHS/LA)?

39. Partnering opportunities 90% of practices are part of a PBC group – the new PCGs 95% of practices have a PBC business plan – you need a copy Saving money is a key driver in 2006-7 – beware! Providing more services outside hospitals is a key driver Service redesign is complex, requires excellent networking and communication skills (including local marketing) PHARMA has the skills and resources the NHS needs Patient education is key – a Pharma strength Good intelligence is paramount– you need data sources and skilled manpower to seek out opportunities for early engagement More formularies will result from PBC – evidence based, peer reviewed prescribing will become widespread in primary care, requiring an account management approach