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Our health, our care, our say The primary and social care White Paper Wellard's NHS training

Our health, our care, our say The primary and social care White Paper Wellard's NHS training wellards.co.uk 2006. Presentation overview. The New NHS in 2006/07 Primary v secondary care Introduction to the White Paper Chapter and verse Reactions to the White Paper

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Our health, our care, our say The primary and social care White Paper Wellard's NHS training

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  1. Our health, our care, our say The primary and social care White Paper Wellard's NHS training wellards.co.uk 2006

  2. Presentation overview • The New NHS in 2006/07 • Primary v secondary care • Introduction to the White Paper • Chapter and verse • Reactions to the White Paper • Other linkages to the White Paper • Implications for the industry

  3. The NHS in 2006/07 • Finance problems will dominate • GMS revisions • New Healthcare Commission standards • NICE/SMC/AWMSG will continue to pose problems • New community pharmacy contract beds down • More non-medical prescribers • Practice-based commissioning kicks off • PCT reconfiguration • Around 50 NHS foundation trusts by year end

  4. Wanless report 'The NHS should be a system where… primary care delivers an increasingly wide range of care, including diagnosis, monitoring, and help with recovery and where the majority of general and less specialised medical and surgical care has moved out of large hospitals.'

  5. Managed care

  6. Introduction to the White Paper

  7. Initial overview • Care closer to home with more choice • Services to be moved out of hospitals • Polyclinics are good • Joined up health and social care • Increasing GP provision in deprived areas • LTC, self-care and EPP • Health prevention, health promotion and MOTs • Note 'information prescriptions' • PBC as a major driver but no new money

  8. Coffee break

  9. Chapter and verse

  10. Executive summary • Four main goals are outlined: • Better prevention services with earlier intervention • More choice for patients and a louder 'voice' • Tackling health inequalities and improved access • More support for people with LTC

  11. Chapter one: our ambition for community-based care • Sets out the overall strategic direction • Includes care closer to home • Supporting independence and wellbeing • Giving people a say • Supporting people with high need • Realigning the health and social care system

  12. Chapter two: enabling health, independence and wellbeing • Looks at health, independence and wellbeing • Describes the health MOTs • PCT DPHs to have new role • 2008/09 QOF to include wellbeing outcomes • QOF overview on page 50 • Use of case studies

  13. Chapter three: better access to general practice • Best practice illustrated • Wants to tackle 'closed' lists • Extra primary care services to be put in place • Voluntary and private sector could be involved

  14. Chapter four: better access to community services • A lot on social care • Use of new community pharmacy contract • New 'urgent care' strategy • Sexual and mental health services mentioned

  15. Chapter five: support for people with longer-term needs • Remember LTC a key government strategy • EPP discussed in detail • Care plans to be introduced for LTC patients • Health literacy seems to be key

  16. High % of professional care Source: DH High-risk cases Equally shared care More complex cases High % of self care 70–80% of the people with long-term conditions Chapter five: support for people with longer-term needs

  17. Chapter six: care closer to home • A key chapter • New community hospitals • Use of GPSIs • Six 'specialist services' moved into primary care • PCTs will be 'forced' to do this • This will have significant impact on the acute sector • More integration of services is required

  18. Chapter six: care closer to home Diagnosis Treatment Initial appointment Follow-up GP/ other Simple tests Complex tests Non- surgical Step-down care Outpatient follow-up Outpatients Outpatients Day-case Inpatient Area Rationale Self-referral possible in some areas, for example infertility A&E remains in acute setting Good potential where equipment and specialist knowledge allows, but not huge volume Significant potential to devolve outpatient treatment, some already in train Large potential to devolve closer to home Subject to separate review Most takes place outside acute setting (for example pharmacy) Large potential to devolve, for example hernia I/P remains largely in acute, especially where general anaesthetic required Large potential to devolve to a communityhospital setting Key Potential to provide additional activity in community setting Large Some Limited

  19. Chapter six: care closer to home O/P appointments O/P appointments per 1,000 population Ratio of initial to follow-up appointments Q4 2004/05 Low decile Top decile Low decile Top decile Median Median Dermatology 525,773 2.89 3.70 4.82 1.53 1.82 2.41 ENT 559,046 3.76 4.46 5.60 1.26 1.44 1.74 Urology 366,707 1.77 2.25 2.66 1.82 2.36 2.69 Trauma and orthopaedics 1,334,696 7.76 9.44 11.27 1.61 1.88 2.32 General surgery 827,695 5.36 6.59 8.49 1.26 1.56 1.78 Obstetrics and gynaecology 581,079 4.00 4.86 6.74 1.06 1.27 1.74 TOTAL 4,194,996 NB: data is for one quarter only. 'Low decile' refers to the SHA with the third-lowest figure (out of 28). Source: HES Data, Q4 2005

  20. Chapter seven: ensuring our reforms put people in control • Patient choice • The role of PCT commissioning • PCT reconfiguration discussed • Plurality, including 'social enterprise' units • QOF and PBC

  21. Chapter eight: making sure change happens • More integration • High quality information • Accreditation • Role of the Healthcare Commission • Workforce issues

  22. Chapter nine: a timetable for action • A useful review of timelines • CCHDG • Case study • 30 'demonstrators' key

  23. Annexes • Annex A: YHYCYS review • Annex B: social care • Annex C: glossary of terms • Annex D: list of abbreviations and acronyms

  24. Reaction

  25. Comments… 'The publication of this major document finally heralds the approach of a genuine primary care-led NHS. The White Paper also marks the government's commitment to transferring more and more appropriate services from the hospital sector into the community supported by a proportional change in resource allocation. This will extend and expand patient care closer to home. Many of the proposals contained in the White Paper will be underpinned and driven by PBC, which itself is the lynchpin for the introduction of many of the government's latest policies.' Dr James Kingsland, NAPC chairman

  26. … comments… 'White Papers normally come in three flavours — bulldog, bulldog clip and bullshit. Bulldog White Papers, such as 2002's Delivering the NHS Plan are tough and wiry little things. With sharp teeth and quite a bark, they take a mouthful out of the shins of vested interest and promise radical change. By contrast bulldog clip White Papers have very little to say… their content is arrived at simply by placing a bulldog clip around various press releases, current initiatives are repeated and little new is promised. Where bulldogs confront, bulldog clips deflect. Bullshit command papers are richly illustrated, kaleidoscopic in their commitments and like a Chinese takeaway, satiates everyone straight after being consumed — while leaving a nagging feeling of hunger a few hours later.' Simon Stevens, former PM health adviser

  27. … comments 'Not to have mentioned community nurses at all in the White Paper when they are the cornerstone of what is going on in primary care doesn't make any sense at all. It is a real oversight by the Department.' Dr Beverly Malone, RCN general secretary 'Londoners should beware. This White Paper is just repacking a decades-old desire by health bureaucrats to scale down and close many of our great hospitals.' Dianne Abbott, Labour MP, Hackney North and Stoke Newington

  28. Executive summary Links

  29. Private primary care • Boots, Tesco, UHE and Virgin • Nuts and bolts of primary care provision (NHS Alliance) • Social enterprise again

  30. Increasing capacity in primary care • Role of WICs • New LIFT premises • 24/7

  31. The revised GMS contract • Letter from Dr Barbara Hakin • Funding frozen • Revised QOF • PBC in there • Note changes on dispensing doctors • NAPC not happy • SMF publication

  32. Practice-based commissioning • A one year DES in GMS • A 'must-do' • The WP 'oyster grit' • Note prescribing is in here too • Early wins and top tips • Major opportunities re business case prep

  33. National commissioning Regional commissioning PCT consortia commissioning PCT commissioning GP practice consortia commissioning GP PBC Patients Commissioning future?

  34. Links to LTC • Supporting people with long-term conditions • Community matrons • Dr Foster intelligence documents • DH document on self-care

  35. Implications for the industry

  36. Bringing it all together • Implementation and timescales • Back to the future: GSK's Optimal, etc • Enhanced roles of nurses and pharmacists • Dealing with 'social enterprise' units • Dealing with big 'corporates' • Major opportunity for 'support' initiatives

  37. Looking ahead • An uncertain future • King's Fund report

  38. What does this mean to us? • 2005 Innovex report • Impact on primary care teams • Impact on hospital teams? • New customers • New interface structures • Growing relevance of social services

  39. Final comments

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