1. The Perfect Storm – are we eQIPP’d to survive it? Peter Rowe, National QIPP Lead – Medicines Use and Procurement Rowe Creative Limited ©

2. 2 The Perfect Storm  Austerity  White Paper  Management Cost Savings Department of Health

3. “These changes are so big you can see them from space” David Nicholson. 3Department of Health

4. Managing the Transition 4Department of Health

5. 5 1.PCTs still trying to address management cost reduction on their own? 2.QIPP delivery falters 3.Legitimacy post WP – ‘abolition’ has an immediate effect 4.Leadership changes – ‘domino effect’ 5.Referrals on the increase 6.Secondary care activity levels on increase 1.‘Take your time’ message to GPs from DH 2.Competition for leadership/mandate creates delays in getting going 3.Negotiations between DH and GP professional bodies 4.Pilots? Department of Health

6. 6 1.‘Holding PCT’ sub-regional structure 2.Stronger LA role in managing transition and secondary care negotiations 3.Industrial strength QIPP and management cost reduction 4.Through holding PCT structure, shared responsibility for business continuity during transition 5.Clear role and mandate for PCT in transition 1.Even ‘bottom-up’ emergence of GPCC can be coordinated 2.PCT ‘Facilitator’ role helps encourage new GP leadership to come forward and to build network of GPCCs 3.Targeted GP development programme tailored to what they are telling us they need 4.Coordinated commissioning support offers best chance to compete with private sector Department of Health

7. Provider Transition o All NHS Trusts to be Foundation Trusts (FTs) by 2014 o Special Health Authority to be established to hold non FTs to account until then o All sectors to prepare for any ‘willing provider’ o Tariff can be undercut

8. 8 NHS ‘Post’ White Paper Commissioning  Independent Commissioning Board  Commissioning Consortia  Health & Wellbeing Boards  Patients (Personalisation) Provision  Any Willing Provider  Monitor  Care Quality Commission Department of Health

9. 9 Who will have the commissioning cash?  Independent Commissioning Board – 20-30%  Commissioning Consortia – 62-75%  Health & Wellbeing Boards – 5-8%  Patients - ????? Department of Health

10. Commissioning Consortia  Primary Care and Commissioning from same place  Most patients with long-term conditions will have care provided and most hospital care commissioned from the same place  Medicines are one of the key enablers for system reform

11. 11 QIPP  Minimal growth for the next 3 – 5 years  Increasing Demand - Demographic - Technological - Consumer Driven/Political?  Gap £15 - £20 Billion over 3 – 5 years Department of Health

12. 12 Options??  Waiting Times  Reduced Quality  Stop Prevention  Salami Slice  R & D  Education and Training Department of Health

13. 13 NO! Not acceptable and will not deliver! Department of Health

14. 14 QIPP(S)  Quality  Innovation  Productivity  Prevention  ….Safety Department of Health

15. 15 QIPP at Every Level  Organisation (1)  Local System (2)  Sub Regional – eg Greater Manchester (3)  Regional(4)  National (5) Department of Health

16. 16 The Real Action is at Level 1 That’s where our people are and where the medicines are prescribed and used Department of Health

17. Heads, Beds and Meds!!  Heads – Staff  Beds – Infrastructure  Meds - Medicines 17Department of Health

18. 18 Medicines and Procurement  Quality and Value  Repositioning Medicines  Supply Chain Department of Health

19. 19 Quality and Value  National Prescribing Centre (NPC) Good Prescribing Guide  ‘Top Tips’ for Providers  Better Care, Better Value (BCBV) Indicator Department of Health

20. 20 Repositioning Medicines  Support Better Outcomes  Support Service Re-design  Support Greater Productivity  Support/Require Workforce Re- design Department of Health

21. 21 Supply Chain  Self Care  Community Pharmacy Contract  Hospital Procurement  Cancer Drug fund  Home Care  Value Based Pricing  Working with Pharmaceutical Industry Department of Health

22. 22 Medicines and Workforce  `Blockbusters’  Application of best practice  Improving access to medicines through new ways of working Support:  Better outcomes/quality  Pathway Re-design  Workforce Re-design  Greater productivity Department of Health

23. 23 QIPP(S)  Quality  Innovation  Productivity  Prevention  ….Safety Department of Health

24. Thank you! Any questions ? 24Department of Health