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DacCom PbC Ltd Where are we now?

Mark Jones discusses the proposed achievement payment for DacCom, the funding available, targets to meet, and steps to be taken for project management and service delivery improvement.

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DacCom PbC Ltd Where are we now?

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  1. DacCom PbC LtdWhere are we now? Mark Jones 27 March 2007

  2. Payments for 2006/7The DES • The PCT proposes an achievement payment to reward us for work done. • As agreed, we need to set aside 25% of this for DacCom, to pay outstanding invoices. • We will use any surplus to fund new projects pending agreement of funding for 2007/8. Mark Jones

  3. The year ahead:New game / New rules • West Herts PCT is more dynamic and powerful than its predecessors. • They clearly want to work in partnership with us to achieve key objectives. • But they are prepared to make other arrangements if necessary. • So the incentive for us is to take control: • Over the services provided to our patients • Over our own futures in the local health economy Mark Jones

  4. The key to the game is fundingThe proposed LES: • Funding to the practices for taking responsibility and being involved • £1 per patient • Funding to the practices for data validation • £0.50 per patient • Funding to the locality organisation (DacCom) for improvement projects • Linked to achievement of targets defined in a Framework document • Minimal funding at Level 1 • About £90k at Level 2 • About £180k at Level 3 Mark Jones

  5. What do we have to do for the money? • More than just a sign-up: • Individual GPs to dedicate time to PbC • Data validation and monthly reports • Support for the locality (DacCom) Examples of targets at Level 3: • DacCom has formal agreements with 90%+ practices • Latest QOF scores 900+ for 90% of practices • 90%+ of practices meeting EoE prescribing indicators • 80% of practices meeting PCT prescribing indicators • Systems in place to routinely scrutinise referral levels by individual practice with agreed action plans • Evidence of demand being managed by 75%+ of practices Mark Jones

  6. So what does this mean? • There is a lot of money available • Could be over £300k in Dacorum • But we have to work for it • The Framework is ‘coercive’ – it is very easy for a minority of practices to destabilise the locality • On the other hand it does give us the resources we need to make a real impact on patient care Mark Jones

  7. Next steps:Practice agreement • A simple statement along the lines of an enhanced service specification. • Key points to include: • Sign up to the business plan • Provide a monthly status report (format defined) • Provide admin time up to a specified limit for data analysis • Strive to meet prescribing objectives agreed with DacCom • Implement process changes in the practice as required to deliver service redesign projects • Qualify for the LES payment • Review after 6 months to ensure the agreement remains effective Mark Jones

  8. Next steps:Defining deliverables • We must be absolutely clear about what we will deliver in 2007/8. This is what we will be paid for. • We have to do this for each of the following: • Prescribing • Out patient activity • In patient activity • Community nursing services • Diagnostic services • Unscheduled care – Out of Hours • Unscheduled care – A&E / Urgent Care Centre • Counselling • Other community and mental health services • Tertiary care • We need to ensure Clinical Leads are in place to deliver this analysis Mark Jones

  9. Next steps:Defining deliverables • It is just as important to define what we do not expect to deliver. • Avoid “mission creep” • Avoid diversion of effort • Ensure we remain able to deliver what we have promised • We have designed a simple process for formal initiation of projects • If it has gone through the process, we are doing it • If it has not gone through the process, we are not doing it • This decision point releases funding for the project • Using this process, anybody can propose a new project Mark Jones

  10. Next steps:Progressing projects • Counselling • We have a clinical lead • We have a management lead • We need to feed this project into the process and secure funding • Physiotherapy • Identify clinical and management leads • Urgent care remains a very high priority • Work with other West Herts PbC groups and identify what we need to do Mark Jones

  11. Next steps:Introducing project management • Track projects through 4 key milestones: • Milestone 1 – Agree Business Case • Milestone 2 – Plan Agreed • Milestone 3 – Ready to Go Live • Milestone 4 – Did it work? • Programme Management Group: • Mark Jones, Mary McMinn, Suzanne Novak, Chris Waldron • Funding and resources • Who does what by when • Working intimately with the DacCom Exec: • Clinical leadership and direction • Decision making Mark Jones

  12. Key Issues: • The Deficit • We cannot separate service redesign from financial accountability • Referral Management • We must address the strategic demand for a CATS • How will we deliver this in Dacorum? • Provider Organisation • How do we proceed with this? • Urgent Care • Integration with West Herts or Herts • What model of service? • Resourcing this locally • Prescribing • Finding a more effective model for budgetary control Mark Jones

  13. Finally: • At last, we have a vision of PbC that can deliver substantial results • We have access to significant funding, and real support from the PCT • We have sensible plans in place for funding, resourcing and progressing projects • We are beginning to have an impact – we have delivered sensible spending decisions for counselling and physiotherapy • Retaining our engagement and cohesion as a group of practices is still the key to success Mark Jones

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