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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!

Derbyshire county pct

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!

Derbyshire county 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