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DERBYSHIRE COUNTY PCT . A Business Strategy for the Provision of a County Wide Cardiac Rehabilitation Service. Who we are. Janet Whitehead – Public Health Specialist. Derbyshire County PCT. Ciara Scarff - LTC Commissioning Manager. Derbyshire County PCT.

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derbyshire county pct


A Business Strategy for the Provision of a County Wide Cardiac Rehabilitation Service

who we are
Who we are
  • Janet Whitehead – Public Health Specialist. Derbyshire County PCT.
  • Ciara Scarff - LTC Commissioning Manager. Derbyshire County PCT.
  • Dr Clare Hawley - GPwSI in Cardiology, Chesterfield, Derbyshire.
aims of our presentation
Aims of our presentation
  • Setting the scene and understanding the issues
  • Developing a business strategy from a Commissioner point of view
  • Influencing the business strategy from a clinical perspective
introduction to derbyshire county pct
Introduction to Derbyshire County PCT
  • Derbyshire County is one if the largest PCTs in the County – it has a population of 712,000 and covers 1,025 square miles
  • There is a Spearhead area within the County which reflects the health inequalities within Derbyshire.
  • The County is diverse. There are rural areas, urban areas, ex-mining areas and affluent areas which often conceal pockets of deprivation.
our providers
Our Providers
  • There are a small number of community providers represented by the blue stars
  • There are two acute Trusts within Derbyshire delivering phase 3
  • There are a large number of providers of phase three outside of the County
  • 11 external providers leads to great difficulty when it comes to commissioning an agreed, equitable service


models of service provision across the county pct

Phase 2 - Community staff provided support

Heart Manual offered as part of choice for phase 3

Phase 3 – 4 programmes


- Community Hospitals x 2

- Leisure Centre x 1


Phase 2 – Community Cardiac Liaison Nurses

Angina Plan

Phase 3 – 6 programmes

- DRI x 3

- Derby City x 2

- Community Hospital x 1

Models of service provision across the County PCT
who is offered a phase 3 programme
North of the County

859 patients

572 (67%) admitted CRHFT of these:

55 (10%) died

260 (46%) not recruited to a programme

186 (33%) recruited to CRHFT programme

71 (13%) chose Heart Manual

South of the County

1256 patients

of these:

283 (23%) not recruited to a programme

699 (56%) recruited to a programme

202 (16%) followed up with Angina Plan

Who is offered a Phase 3 Programme?
key points
Key points
  • Services not properly commissioned and developed in a piecemeal fashion
  • Variation in service delivery resulting in inequalities across the County
  • Lack of capacity of existing providers particularly in the north of the County
  • Variation in investment across the County
  • Low profile prior to merging of 6 PCTs
  • Difficulty in contracting for an equitable service across the County
  • Poor data and poor data quality
moving forward
Moving forward!
  • Commissioners cannot work alone. Involve the right people from the start:
  • Clinicians including a lead clinician
  • Patient representatives
  • Finance and data analyst support
  • Public health
  • Leisure services

Let us through! We’re NHS Managers!


Understand the current picture

  • Starting point is to define your baseline. What capacity do you need and who are you currently providing for?
  • Can be complicated if you have multiple providers
  • Get analyst support
  • Use NICE Commissioning Tool to help with demand
  • Face the fact you may not be able to get all the data you would ideally like to have!
get a handle on your finances
Get a handle on your finances
  • Understand what you are paying for…..not as easy as it sounds!
  • Payment for cardiac rehab often have developed incrementally and can be hard to identify in large contracts with acute trusts
  • Get finance on board and start the process early
  • You may find out you are overpaying but you may also end up with a bill like we did when investigation by the Trust identified the PCT hadn\'t been paying!
build your case
Build your case!
  • Make use of tools and evidence available
  • Learn from other areas
  • Make the changes attractive to the PCT!

Define your specification

  • Opportunity to ensure quality and reduce gaps in service
  • Allow for innovation
  • Define strong health outcomes
  • Get buy-in
to summarise
To summarise…
  • Get the right people together
  • Understand what is currently happening
  • Identify improvements
  • Build your case or work within existing resources
  • Produce a service specification that identifies key performance measures
necessity who is the mother of invention
‘Necessity, who is the mother of invention’

Plato - Greek author & philosopher Athens (427 BC - 347 BC)

phone a friend
Phone a friend


any questions
Any questions?

Contact details:

Derbyshire County PCT Long Term Conditions Commissioning Team

Tel: 0115 9316161