Medlinc GP CommissioningConsortia

Dr Peter Stott MA FRCGPTadworth Medical CentreExecutive Lead GP Medlinc GPCC

Neighbouring groups in East SurreyMid Surrey Commissioning GroupDorkingElmbridge

Total population 320,000

New NHS Structure

Regional Health Authority (8)South Thames

Strategic Health Authority (10)South East Coast

PCTNHS Surrey

PBC Groups14 in Surrey

GP Commissioning Consortia(500 in the UK - Av pop 120,000)

14 in Surrey

Acute Hospital Trusts

ESHUT, KH, SASH

GPs

Dentists Opticians

Pharmacies

Community Nurses

School Nurses, Podiatry

Dieticians, Family Planning

Physiotherapy

Community Hospitals

(Central Surrey Health)

Mental HealthTrusts

Surrey Borders

Foundation TrustsRMH

Charities

Princess Alice

Relate

Social Services

NHS CommissioningBoard (Commissioning)

Monitor(Financial

accountability)

Care QualityCommission

(Quality Standards)

GP Consortia

Local Authorities(now includingPublic Health)

HospitalProviders

GP Practices

CommunityServices

AlternativeProviders

STATUTORYBODIES

PROVIDERS

COMMISSIONERS

The 2013 NHS Landscape: roles and responsibilities

Budget-sharing

NHS Surrey: Annual spending 2008-2009 (Total £1.4B)

Other, 2%Community

Services, 9%

Prescribing, 12%

Primary care, 13%

Mental Health, learning

disabilities and placements,

16%

Corporate, 2%

General & Acute Services, 46%

Source: NHS Surrey Annual Report 2009

2009-2010 (Total 1.6B)

Medlinc Budget 2011-2012 (£116M)

General and Acute, £63,161,000.00,

50%

Mental Health & Learning

Disabilities, £9,478,000.00, 8%

Community Services,

£16,366,000.00, 13%

Primary Care, £14,638,000.00,

12%

Prescribing, £12,829,000.00,

10%

Unfunded, £6,156,000.00, 5%

Corporate Services, £2,423,000.00, 2%

NB: £9M has beenremoved for QIPP

The QIPP Agenda

• Quality, Innovation, Prevention, Productivity• £38M overspent – historic deficit• Requirement for 8% savings year on year against

expected spend• Cost pressures: inflation; ageing; technology• Rising expectations

Evaluation by QIPP will the basis for introducing change

3 QIPP areas: Prescribing; long-term care; urgent care

Joint Commissioning Intentions• Spend set at a historic level• 2011-2012 contract to include strategies for change in 2012-2013

(SDIP)• Repatriation of long-term conditions into community (eg diabetes,

glaucoma, rheumatology, COPD)• Development of ‘virtual ward’• Community alternatives to acute hospital admission• Developing efficiencies by removing overlaps in care pathways• Introducing health outcome measures to aid patient choice• Working with others to develop EGH site into a health campus with

a mixed economy

 Key projects

Project  Milestone

Medlinks GPCC

A Sign up to LTC QIPP plan by June 2011. 

B Risk stratification implemented in practices and vulnerable patients at risk identified by GP practices. June 2011

C Define and agree enhanced Virtual Ward model for Medlinks July 2011

D Develop and implement revised COPD pathway - date

E Develop and implement AF pathway

F Develop and implement Diabetes pathway

G Enhanced Virtual ward in place by September 2011

H Mid Year review - October

I Integrate Telehealth into primary care pathways December 2011

J Implement Summary Care records - date

K Evidence of Care plans in place for 75% of  those on LTC registers in primary care by end of  2011/12

L Reduction in Surrey Heath GPCC Emergency admissions for COPD, HF, CHD and Diabetes by 0.5 per 1,000 population  end of 2011/12

M Reduction in Surrey Heath GPCC Emergency admissions for COPD, HF, CHD and Diabetes by a further 1.0 per 1,000 population by end of 2012/13

 

New responsibilities of GPCC• Commission NHS services• Determine healthcare needs• Determine service requirements to service needs• Enter into contracts with providers• Monitor and improve quality of healthcare• Provide an oversight of provider training and education• Manage budgets and establish priorities on meeting

healthcare needs• Meet all necessary reporting and audit responsibilities• Promote equalities of work with local authorities• Engage patients and the public

The Local Authority Perspective

Health and Well-beingBoard

HealthcareCommissioning

Social CareCommissioning

Providers

The Local Authority Perspective

Health and Well-beingBoard

HealthcareCommissioning

Social CareCommissioning

Providers

If we get it right, we cancombine global NHS values withlocal strategies“Think global – Act local”

NHS Surrey Governance Plan

• 4 levels – Aware/Active/Arbitrate/Accountable

• 3 realms Structure/Relationships/Performance

Service Development Improvement Plan (SDIP) – EGH and CSH

• Collaborative, transparent working to achieve overall governance of the transition– Referral numbers– Knowledge of waiting times and current activity by

practice– Financial control– Defined clinical pathways (QIPP)– Move some LTCs into community (diabetes,

rheumatology, ophthalmology, paediatrics)– Develop alternatives to A&E attendance– Reduce fragmentation between health and social care– Focus upon quality of care

Transformation Board

8 coordinated workstreams lead by an executive and a coordinating board

1. Continuing Care/ Long term conditions

2. Frail and elderly (King’s Fund Project)

3. Unplanned care

4. Women and Children

5. NEECH working group

6. Leatherhead Working group

7. Information (Community care)

8. Information (Acute care)