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nGMS and Locality Based Service Redesign

nGMS and Locality Based Service Redesign. Using nGMS to effect change and gain local ownership - A North Devon Approach. Multiple Practices – Bright shiny isolated services. Systems Mismatch.

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nGMS and Locality Based Service Redesign

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  1. nGMS and Locality Based Service Redesign Using nGMS to effect change and gain local ownership - A North Devon Approach

  2. Multiple Practices – Bright shiny isolated services

  3. Systems Mismatch • A single practice can never deliver all of the services, to all of those in need, to the required standard of care. i.e there will always be a mismatch of resources available to need under the current system (of both staff and the local population).

  4. Centralist Approach – Uniform Grey

  5. Systems Mismatch • A Centralist Approach can never deliver all of the services, to all of those in need, to the required standard of care. i.e Large centralist organisations lack the face to face sensitivities required by primary care and denigh ownership of problems to those who understand them best.

  6. Tackling the paradigm … nGMS as a tool to develop and commission Primary Care

  7. Background - Weaknesses • Overspending/Overtrading • PCT perceived as GP Hostile • Poor communication • PCT seen as separate to Primary Care • Capacity • Poor understanding of “what we are about” • Still in mourning - “When we were fundholders….”

  8. Background - Strengths • Quality of General Practice • Practice Management • Previous history of joint working • Still willing to listen • Ripe for change • New Management Team • The only way is up...

  9. Commissioning to Empower The Referral Monitoring, Audit and Service Redesign LES

  10. RMA&SR LES • Purpose • Engagement • Empowerment • Ownership • Using ALL PCT skills and capabilities • Resource Management • Service Development • Cost Containment • And...

  11. RMA&SR LES • AND…. • Rewarding innovation and change.

  12. 2 Parts • Part 1 • Referral Data Collection and Audit • Part 2 • Locality Service Redesign

  13. Part 1Referral Data Collection and Audit • Purpose • Knowing what we do • Bringing Practices together • Benchmarking • Identifying best practice • Spotting difference

  14. Part 1Referral Data Collection and Audit • Process • Practices collect referral data • As localities practices review data • Identify areas for development • Nominate Locality Representation to Locality Management Groups

  15. Part 2Service Redesign • Purpose • Brings all locality health and social care providers to a single table • Develops locally owned solutions • Empowers providers to solve issues • Rewards achievement

  16. Part 2Service Redesign • Process • Locality Management Groups • Indicative budgets • PCT Business support manager • Reward • 2.5% of Savings to practices • 2.5% of Savings to Locality Development Fund

  17. Clustered Practices – Bright Shiny Shared Services A Locality - The Virtual Health Park

  18. The Training Practice Clustered Practices – Bright Shiny Shared Services The Virtual Health Park

  19. The Dermatology Centre Clustered Practices – Bright Shiny Shared Services The Virtual Health Park

  20. Nurse Development Practice Clustered Practices – Bright Shiny Shared Services The Virtual Health Park

  21. SpecialistChronic Disease Management Clustered Practices – Bright Shiny Shared Services The Virtual Health Park

  22. Virtual Health Parks within the PCT

  23. Shared Pathways Acute Care Virtual Health Parks within the PCT

  24. Progress to date • 100% Sign up to Part 1 • Practices holding back on Part 2 • Concern re: Membership of LMGs • BUT... • 3.8% reduction in secondary care referral rate • Emergency admissions. • LES generation

  25. LES Generation • Diabetes • Community Nursing • Rheumatology • Paediatrics • Palliative Care • CHD/Heart failure • Diagnostics - Direct Access Care Packaging • ???

  26. Problems • Capacity • “Fair budgets” • Speed of idea generation - too fast!!! • Maintaining focus and enthusiasm • PCT “letting go”

  27. Solutions? • Jointly decide what’s important • No such thing as fair… just has to be the best you can do. • Get out of the office… (Go surfing?) • Sometimes there is no solution? • People

  28. Next Steps • Indicative Budgets - Real Budgets • Locality/Practice Based Commissioning • Other IC contracts • LES generation • Long term illness • ???

  29. Questions Your opportunity to ask questions and my opportunity to say “B******d if I know! What do the rest of you think?”

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