Delivering OOHs services

1. Delivering OOHs services David Carson National Clinical Lead Access & Choice Primary Care

2. What's happening • A&E and Ambulance worried about being dumped on • COOPs worries about the future • Where are staff coming from • PCTs face new world of commissioning • Have providers the skills to work co-operatively

3. Prejudice and perceived wisdom Is NHS better than GPs Are GPs better than the NHS Are COOPs better than Private sector Is the private sector better than the COOP COOPs compete as well

4. What it is • Major opportunity • Achieve real joined up services • Providers have opportunity to innovate • PCTs and trusts meet imperatives • Patients get even more effective access to integrated health care

5. Background Policy Framework OOH Review REC NHSD Review Choice and Plurality

6. OOH Review Integrated OOH services Network of providers Clinical Leadership Standards Joined up planning and commissioning

7. Reforming Emergency Care Same principles as OOH Current focus on A&E Solutions may reside outside A&E Chronic disease management - real opportunities in contract Integrated response to Minor Illness and Injury

8. nGMS DOH fully committed to delivery of contract OOH will provide mechanism to meet in-hours nGMS Challenge Opportunity to build PC capacity and volume

9. Plurality NHS Mutual / Voluntary Sector Private Sector All have a role PCT provision is perhaps last choice

10. GP opt out and re-provision. Relevant yes but perhaps not in terms of re-provision 2 Different things Opt out is Practice decision Look beyond this question Staffed by GPs and others attracted to work in services and providers Are we looking back too much

11. The delivery

12. OOH Challenge Information to support development. Providers PCTs STHAs Other Issues

13. Data

14. Capacity information Urgent need to collect and collate existing information Use as basis of planning integrated service All data should be shared with all providers (including acute and ambulance service) Should be mapped by: Case mix Geography Time Competencies

15. Providers

16. COOPS PRIMECARE AMBULANCE A&E COMMUNITY NURSING SOCIAL CARE MENTAL HEALTH WICs DENTISTRY PHARMACY Any anyone else working OOH Who are the providers

17. Providers More opportunity for joint development Providers stop competing on all aspects Co-operate and build on your strengths (None are good at all) Limited view of opportunities by some At scale Vs local More attention to planning process Provider development process is needed in every area

18. COOPs Brilliant job Can be monopoly Legitimate for PCTs to ask difficult questions Not legitimate to exclude anybody Shift of ownership from those who are responsible as members to those who work as members Significant opportunity to increase local public involvement

19. Mutual Transfer COOP to COOP Basis of COOP membership changes from those with responsibility to those working within COOP. Will require support as per guidance from PCTs Working on governance models Provider development Further papers coming

20. Commercial Providers Strengths Resilience due to size Clinical governance structures Logistics and management capacity Often complementary services to local COOPs

21. Ambulance service Also Strengths Part of network IPAS Do not have all the answers Have some of them Must be at the table

22. Providers Stop competing on every aspect Yes the NHS as well Co-operate and build a decent integrated service building on your strengths Have confidence in what you do well Accept that others have much to offer.

23. PCTs

24. PCTs Support providers Establish Providers New territory Support change Have you contestability and sustainability? A network gives more options than a single preferred provider Yet to see an area in which a single provider has all the answers

25. PCTs Potential for one PCT solution to destabilise others Agree on what development activity could be shared Inter PCT process requires attention Sign up at Board level Evidence based approach to options Risk of narrow anecdotes and individuals views restricting thinking Single PCT options will be very rare

26. Development Process PCT agree areas of joint working across area Workforce Data Provider development PCTs agree areas local working Senior support to joint project PCTs agree to provider support process PCTs will require to consider supporting the establishment of providers

27. PCTs 5 Years Guaranteed year on year funding increase Some have made plans Some plans are good Some will need revisiting Have you really addressed the issue or chosen the easiest option? May have to revisit some LDP priorities and even trust recovery plans

28. STHAs Key role Mentioned in contract Overview of PCT process now Review of plans and hot spots Legitimate role in ensuring plurality and adequate provision Benchmark and support PCT networks

29. Issues

30. Workforce Significant number of WF initiatives in Agency and in WDCs Important for STHAs and PCTs to ensure OOH and PC issues are on WDC agenda now We will be issuing a summarised version on where latest WF information and evidence can be accessed No magic bullet but skill mix and flexible roles are key Liberating the talents is a good example of moving to more flexible working patterns.

31. NHSD Review Technical Links Capacity in 2004/5 and 2005/6 Ensure that developed arrangements are consistent with NHSD direction. NHSD commissioning framework likely during PCT planning process

32. What I hear procurement PCT not talking to us Provider bullying me Director of Finance wants me to tender first (for what?) Preferred providers (what is this? And what are the implications)

33. Procurement Open process Legitimate to include providers in process “Cannot Talk” to providers is not true! Providers should identify strengths / weakness / benefits of joint working Agreement needed on process jointly across each network

34. Competition Is not only about tendering Its about contestability and strengths Then working co-operatively We do not have excess capacity We need to build capacity

35. What now in every area Functional inter PCT forum with clear terms of reference, objectives and timetable - The WHAT Requires support and secretariat Functional provider forum to support identification of roles and opportunities for all providers - The HOW Requires terms of reference , objectives, support, timetable and secretariat

36. Opportunity Best opportunity in a generation to build on the best of current practice Will require focussed work and investment. Drop the baggage Lets get on and do it And Deliver - Please!