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LINCOLNSHIRE. Good Idea Good Data Budget right in first place Configuration / Clinicians working together (unscheduled care example)- framework Succession planning Risk – size of budget – what bit of the budget Control of Contracts Workload / Time Understanding what we commission

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Lincolnshire

LINCOLNSHIRE

Good Idea

Good Data

Budget right in first place

Configuration / Clinicians working together

(unscheduled care example)- framework

Succession planning

Risk – size of budget – what bit of the budget

Control of Contracts

Workload / Time

Understanding what we commission

Legislation- passion / will

Locally Sensitive

Governance Framework

Lean & Agile System

Real Budgets in the East Midlands event 8Jun10


Lincolnshire cont

LINCOLNSHIRE (cont)

Solve how the budget works

  • GMS / PMS

  • Succession Planning

    Will / Desire

    Buy in from all GP’s

    Framework / levers

    Budgets right

    Scale up

Glass is half full in NHSL !!!

Team engagement

CBSM

Dashboard

Up for it

Started bits of it already ( 2 devolved Budgets)

We feel we are ahead of the game

Radical

Break from tradition sky is the limit THINK BIG!

Real Budgets in the East Midlands event 8Jun10


Nottinghamshire county

NOTTINGHAMSHIRE COUNTY

What do we need?

Legal entity & form, set up costs

Managing internally – rules of engagement & sanctions for underperformance

Rules for performance management

Data & intelligence – is this good enough to sign the cheque?

Clarity over direction of travel

? No longer clear commissioning / provision split

Incentives for providers

? Tariffs for whole pathways of care

Less income = less capacity to do anything but the “day job” so incentives to engage essential

Infrastructure

Real Budgets in the East Midlands event 8Jun10


Nottinghamshire conty cont

NOTTINGHAMSHIRE CONTY (cont)

? Liability for overspend

? 1 year “break even” no longer 3 years

Shared incentives with providers including secondary care shared targets

Threshold for tendering

Need to move from small scale risk-averse to large scale impact = higher risk, permissive culture

Huge reduction in management capacity

What % of the total PCT budget – including (PCT) management?

How big to influence provider behaviour vs how small to keep everyone engaged & local perspective?

Real Budgets in the East Midlands event 8Jun10


Nottingham city basselaw

NOTTINGHAM CITY & BASSELAW

Real Budgets in the East Midlands event 8Jun10


Derbyshire county

DERBYSHIRE COUNTY

Answer from task 1:

Tiered approach

levels of risk sharing

choice for clinical consortia

Increasing autonomy & Increasing responsibility

2 dimensions size “federation”

size “super-federal”

responsibility & autonomy

Decision devolved to lowest possible level & nearest to problem & delegate upwards issues that need to be shared subsidiarity

Networks of shared interest i.e. all consortia coming together to negotiate with acute provider

Consortia contract for commissioning expertise on an ‘agency basis’, ‘chambers’, ‘virgin’ or ‘BUPA’

Would need a governance framework to act as a safety net in case of market failure of commissioner or providers

Would also want to retain some of benefits of larger organisations & joint working

Real Budgets in the East Midlands event 8Jun10


Derbyshire county cont

DERBYSHIRE COUNTY (cont)

Key Issues - ‘Hard’ budget #1

What happens when you overspend?

Need to completely disentangle & fully understand budget (how possible?)

how do we disentangle block contracts?

Link GMS/PMS prescribing & commissioning as whole – risk assess, due diligence & go

Issues of time, capacity & skill to do this

How do we manage conflict of interest in whole budget’?

Revolution may be unrealistic & undoable – Evolution may be option – currently GPs manage services & risk

How do we make the difficult decision to close the local hospital?

What are the transaction & management costs of operating this system?

Real Budgets in the East Midlands event 8Jun10


Derbyshire county cont1

DERBYSHIRE COUNTY (cont)

Key Issues - ‘Hard’ budget #2

Solution – give clusters the budget & they will disentangle

Benefits in joint working & a federated approach – spread best practice

Increased management costs offset by reduced duplications

Not a vehicle for equity but a vehicle for innovation – will this be politically acceptable? & to the public?

Real Budgets in the East Midlands event 8Jun10


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