Practice Based Commissioning

1. Practice Based Commissioning

2. Large PBC Consortium - 75 Practices, 351 GPs, 652,000 population Majority of Northamptonshire covered 4 locality groups 9 elected GP Board members, plus 3 appointed Management team of 9 Community Interest Company Developing public “membership” Who We Are

3. April 07 Nene Commissioning formed Management team in place Jan 08 Mar 08 First business case approved by PCT Mar 09 • Pro Active Care • Best Practice Scheme • And 23 other schemes Apr 09 • Grew from 61 to 75 practices • Awarded national ICO pilot Timeline

4. Countywide reduction in the number of outpatients 66 practices participating in the scheme • Monthly locality peer review • Locality data shared • Monthly practice peer review meetings • Named GP data • Action plans from each meeting Development of community based services Best Practice Scheme

5. Countywide comparison of GP referrals for Urology Northampton practices are highlighted in red

6. Best Practice Scheme

7. Fall in referral rate since start of scheme Increased uptake of direct access diagnostics Redesign on Orthopaedic triage service Introduction of community glaucoma service County wide purchase and training in the use of dermatoscopes Best Practice Scheme

8. £3.08M Business Case over 3 years Largest investment in community nursing for 20 years - Recruitment of 31wte Community Nurses • Collaborative Programme approach • 12 Practices, 152,000 population • 17 Practices, 165,000 population Provider Services, Age Concern, ICT, PCT Commissioners, Northamptonshire LINk Forms the basis of the ICO Pilot application Pro Active Care (PAC)

9. 258 Patient in PAC in 5 months • Reduction in emergency admissions (2.57% reduction wave 1 vs 0.79% reduction non wave 1) • Planned 1363 per annum, actual 100 in 3 months for wave 1 • Reduction in excess bed days • Phase II April 09 • Average risk of re-admission at discharge is 2.8 (on a scale of 1-10 where 10 = certain to be re-admitted and 1 means certain not to be re-admitted). • Each patient has remained on Pro Active Care for 1 to 5 weeks, the average stay being 1 to 2 weeks Pro Active Care Measures

10. Partners in the Northamptonshire Integrated Care Partnership Northamptonshire Healthcare NHS Trust Nene Commissioning NHS Northamptonshire Autonomous Provider Organisation Northampton General NHS Trust Northamptonshire County Council Social Services Other voluntary sector partners Age Concern East Midlands Ambulance Service NHS Northamptonshire Nenedoc Kettering General Hospital NHS Foundation Trust United Health UK

11. Hospice at Home End of life care Intermediate Care Whole system ownership Rapid Response Service Responsive primary care to home GP and Community Matron in hospital Effective acute/primary care interface Care Home Scheme Quality healthcare to care homes Future Schemes Innovation and improvement

12. Organisational Integration in Practice Integrated Care Programme Board Programme Office Representation from each relevant organisation at project level Representation from each relevant organisation at project level Pro Active Care Care Homes Scheme GP in A&E Other workstreams

13. Clinicians make decisions Delivering product Whatever it takes How we work - values

14. Monthly Board meetings Monthly locality clinical meetings Topic/project specific clinical leads and management support • Community Interest Company • Developing public/patient “membership” Emphasis on communication How we work – in practice

15. £1.7m freed-up resources £4m invest to save fund Commissioning Executive Increased responsibility and accountability Nene Commissioning and NHS Northamptonshire

16. Integrated Care Organisation Lead role for a specific area Primary Care Strategy – PMS review; 8-8 centres; education Increased responsibility and accountability – shift to outcomes Information – activity to budget management and control Where next – key challenges

17. Questions