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The White Papers. Changing the NHS. Equity and Excellence: Liberating the NHS. Published in July 2010 Equity and Excellence: Liberating the NHS is a White Paper setting out a vision, strategy and proposals for the NHS It describes a system where:

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The white papers

The White Papers

Changing the NHS

Equity and excellence liberating the nhs
Equity and Excellence: Liberating the NHS

  • Published in July 2010

  • Equity and Excellence: Liberating the NHS is a White Paper setting out a vision, strategy and proposals for the NHS

  • It describes a system where:

    • Patients are at the heart of everything the NHS does

    • Healthcare outcomes in England are among the best in the world

    • Clinicians are empowered to deliver results

Background to the white paper
Background to the White Paper

Many consultation documents published:

  • Commissioning for patients

  • Transparency in outcomes – a framework for the NHS

  • Local democratic legitimacy in health

  • Regulating healthcare providers

  • An Information Revolution

  • Greater choice and control

  • Developing the healthcare workforce

    And a review of arm’s-length bodies

Its a lot of change
Its a lot of change!

“These changes are so big, you can see them from space.”

Sir David Nicholson

Chief Executive, NHS

Wide ranging proposals
Wide ranging proposals...

  • Reduction in management costs (-45%)

    • SHAs abolished 2012

    • PCTs abolished 2013

  • Reduced and more strategic role for DH

    • Improved public health

    • Tackling health inequalities

    • Reforming adult social care

  • Public health White Paper (December 2010)

    • Public Health Service

    • Public health to shift to Local Government with DsPH

    • Ring fenced public health budget

Patient focus nhs information revolution
Patient focus(NHS information revolution)

  • There should be ‘no decision about me without me’

  • To achieve this:

    • patients should have access to more information about healthcare, in a range of formats

    • patients should be able to rate and record their experience and patient experience data should be given more prominence (PROMs)

    • patients should have greater control of their records and be able to share them with organisations such as patient support groups

    • patient choice should be extended to include greater choice of provider, choice of consultant-led team, which GP they register with, and choice around diagnostic tests

    • choice should also be extended in areas such as maternity, mental health, long-term conditions and end of life care (AWP)

Patient and public involvement
Patient and public involvement

  • LINks  local HealthWatch

  • Independent consumer champion - national HealthWatch (within CQC)

  • HealthWatch will represent the views of patients and carers

  • HealthWatch will be able to suggest which poor performing services should be investigated

  • Proposed functions of local HealthWatch include:

    • Helping to shape the planning and delivery of health and social care services

    • Supporting individuals making complaints

    • Helping people access and make choices about care (‘Citizens Advice Bureau for health’)

Delivering outcomes
Delivering outcomes

  • Secretary of State will hold the NHS to account for improving healthcare outcomes through a new NHS Outcomes Framework

    • NHS Outcomes Framework - five national outcome goals or domains:

    • Preventing people from dying prematurely

    • Enhancing the quality of life for people with long-term conditions

    • Helping people to recover from episodes of ill health or following injury

    • Ensuring people have a positive experience of care

    • Treating and caring for people in a safe environment and protecting them from avoidable harm

Delivering outcomes1
Delivering outcomes

  • Outcome goals or domains

  • Outcome indicators

  • NICE Quality Standards to support commissioners to understand how better care can be delivered

Empowering clinicians
Empowering clinicians

  • GP consortia - responsible for commissioning local services

  • An autonomous NHS Commissioning Board - responsible for commissioning other services such as primary medical services, dentistry and community pharmacy.

  • A new role for local government - to support local strategies for NHS commissioning and integration of NHS, social care, and public health services

  • All NHS Trusts will become foundation trusts (FT), or be part of an FT with staff having a greater say in how their organisations are run

Gp consortia
GP consortia

  • Every GP practice will belong to a consortium

  • Consortia will commission majority of NHS services for their patients

  • NHS Commissioning Board will allocate budgets to consortia

  • Consortia will hold contracts with providers, e.g. FTs

    Original timetable:

  • Shadow consortia form in 2011/12

  • Take on commissioning responsibility 2012/13

  • Full financial responsibility from April 2013

  • Pathfinder consortia now taking first steps

Nhs commissioning board
NHS Commissioning Board

  • a ‘lean and expert organisation’

  • free from day-to-day political interference

  • Shadow Board set up in April 2011 (in Leeds)

  • Regional offices?

    Five main functions:

  • Providing national leadership on commissioning for quality improvement - including designing model contracts

  • Promoting and extending public and patient involvement and choice

  • Ensuring the development of GP commissioning consortia

  • Commissioning certain services that cannot solely be commissioned by consortia, including community pharmacy

  • Allocating and accounting for NHS resources

  • Enhanced role for local government
    Enhanced role for Local Government

    • statutory Health and Wellbeing Board

      • shadow form in 2012 / fully functioning in 2013

      • but early adopters being formed in 2011

    • leading joint strategic needs assessments (JSNA) to ensure coherent and co-ordinated commissioning strategies

    • supporting local voice, and the exercise of patient choice

    • promoting joined up commissioning of local NHS services, social care and health improvement

    • leading on local health improvement and prevention activity

    Regulating healthcare providers
    Regulating healthcare providers

    • The White Paper proposes that services are provided by autonomous providers who are regulated by:

      • Monitor; and

      • the Care Quality Commission (CQC)

    • Monitor will become an economic regulator for health and adult social care, regulating prices, promoting competition, and supporting service continuity

    • The CQC’s role will be strengthened and given a clearer focus on essential levels of safety and quality of providers

    Developing the healthcare workforce
    Developing the healthcare workforce

    ‘It is time to give employers greater autonomy and accountability for planning and developing the workforce, alongside greater professional ownership of the quality of education and training.’

    • Replacement of SHA workforce planning role by Healthcare Provider Skills Networks

    • Health Education England

      • Allocating and accounting for NHS education and training resources

      • Will subsume Medical Education England

    • Funding changes

      • Multi-Professional Education and Training (MPET) budget - to fund education and training for the next generation of clinical staff only

      • Provider levy in the future?

    Progress with the reforms
    Progress with the reforms

    • December 2010 - publication of:

      • Response to Liberating the NHS consultation

      • Response to Outcomes Framework consultation

      • Outcomes Framework 2011/12

      • Operating Framework 2011/12

    • January 2011 – publication of the Health and Social Care Bill

    The public health white paper nov 2010

    The Public Health White Paper (Nov 2010)

    Healthy Lives, Healthy People: Our strategy for public health in England

    Healthy lives healthy people
    Healthy Lives, Healthy People

    • Ring fenced funding for public health sits with local government

    • Public Health Outcomes Framework

    • ‘Health premium’ – incentivise local government and communities to improve health and reduce inequalities

    • Public Health England (budget ~£4bn)

    • Numerous consultation documents to follow

    Roles of public health england
    Roles of Public Health England

    • Health protection

    • Emergency preparedness

    • Recovery from drug dependency

    • Sexual health

    • Immunisation programmes

    • Alcohol prevention

    • Obesity

    • Smoking cessation

    • Nutrition

    • Health checks

    • Screening

    • Child health promotion including those led by health visiting and school nursing

    • Some elements of the GP contract (including the Quality and Outcomes Framework (QOF)) such as those relating to immunisation, contraception, and dental public health

    Consultations transparency in outcomes
    Consultations - Transparency in Outcomes

    • To improve and protect the nation’s health and to improve the health of the poorest, fastest.

    • Indicators sit below the 5 domains

    Consultations funding and commissioning routes for public health
    Consultations - Funding and commissioning routes for public health

    • Describes who will be commissioning what, from whom

    • Public Health England will fund public health activity through three routes:

      • Allocating funding to local authorities;

      • Commissioning services via the NHSCB; and

      • Commissioning or providing services itself

    • LA and GP consortia share duty to produce JSNA

      • LA has responsibility to develop PNA

    The white papers

    Department of Health (DH) health

    Public Health budget

    NHS budget

    Public Health England

    (within DH)

    Funding for commissioning specific public health services

    NHS commissioning architecture

    (NHS Commissioning Board and GP commissioning consortia)

    Ring-fenced public health grant

    Providers (incl GPs)

    Health & Wellbeing Boards

    Local authorities

    Consultations funding and commissioning routes for public health1
    Consultations - Funding and commissioning routes for public health

    • What will local authorities commission?

      • Sexual health services

      • School immunisation programmes

      • Accidental injury prevention (falls etc.)

      • Physical activity & obesity programmes

      • Drug and alcohol misuse

      • Tobacco control

      • NHS Health Check Programme

      • Behavioural/ lifestyle campaigns/ services to prevent cancer, long term conditions, campaigns to prompt early diagnosis

    Next steps

    Next steps health

    For LPCs and

    pharmacy contractors

    What should pharmacists contractors do
    What should pharmacists / contractors do? health

    • Keep up to date with national and local developments related to the White Papers

    • Recognise the impact of the White Papers on your pharmacy when revising business plans

    • Work with your LPC to ensure you are ready to capitalise on opportunities presented by the changes

    • Strengthen your relationships with local GPs and local councillors and feedback relevant information to your LPC

    What should lpcs do
    What should LPCs do? health

    • Keep up to date with national and local developments related to the White Papers

    • Work with your contractors to ensure they are ready to capitalise on opportunities presented by the changes

    What should lpcs do1
    What should LPCs do? health

    • Strengthen your relationships with local GPs and the LMC (and other LRCs)

    • Develop relationships with emerging consortia

    • Strengthen relationships with LG/councillors

    • Develop relationships with emerging Health and Wellbeing Boards

    Summary timeline for reform
    Summary - Timeline for reform health

    April 2011

    April 2012

    April 2013

    1st full yr of new system

    Learning & planning for roll-out

    Full preparatory year

    Regional outposts?

    Winding down towards closure in April 2012


    NHS CB

    In shadow form

    Fully operational

    Clustering (by June) and providing support to pathfinder consortia

    Supporting consortia & ongoing roles Moving towards closure in Apr 2013


    GP consortia

    Pathfinder consortia starting to engage with commissioning

    All consortia fully established with shadow allocations

    Full commissioning

    H&W Boards

    Early implementer Boards start to form

    Boards in place with shadow budgets

    Fully operational

    Public Health England

    Assumes full responsibility for public health and takes on functions of HPA & NTA

    Fully operational

    In shadow form

    More information and briefings available at

    More information and briefings available at: health


    Nhs community pharmacy contract

    NHS Community Pharmacy Contract health

    Likely changes in 2011

    Likely changes to the contract in 2011
    Likely changes to the contract in 2011 health

    • Targeted MURs

      • National target groups

      • Data collection

    • New Medicines Service

    • Updates to the Clinical Governance requirements