business opportunities arising from the white paper' psmg, 30 th january 2007 paul midgley...
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'Business Opportunities arising from the White Paper'
PSMG, 30th January 2007
Paul MidgleyDirector
The Healthcare Partnership
Office -0870 [email protected]
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Overview• Introduction to ‘Our Health, Our Care, Our Say’
• Overview of the four key themes
– Theme one – case study
– Theme two – case study
– Theme three – case study
– Theme four – case study
• Issues – knowledge, skills, structural alignment, data
• Summary – opportunities for partnership working
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The single most important document since the
NHS Plan of 2000……
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Our health, our care, our say: a new direction for community services
• Public consultation Summer /Autumn 2005
• Published January 30th 2006, passed by Parliament Summer 2006
• England only
• 240 pages
• 10 year reform programme – legally binding
www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf
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Our health, our care, our say: making it happen
Health and social care working together in partnership
www.dh.gov.uk/assetRoot/04/14/00/65/04140065.pdf
October 2006
Progress report from 80 pilot
sites
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Prevention & earlyintervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with
long term conditions
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Prevention & earlyintervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with
long term conditions
Smoking cessationTackling obesity Reducing incapacity-
related unemployment
Increasing resources and planning for prevention and
early intervention
More homecare using technology
Increasing self care and
appropriate conditions
management
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Prevention & earlyintervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with
long term conditions
Increased information on, and more input into support package for service users and carers
Local service users input/feedback on services
to be actioned where problems identified
Increased user satisfaction
with their care package
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Case Study – Individual budgets
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Prevention & earlyintervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with
long term conditions
More community-based services
Increasing range of urgent care services
Joint working between health and social care
communities and authorities
to reduce inequalities
Easier registration
with GPs, and improved
access and convenience
Promoting emotional and physical wellbeing
services to prevent mental and physical
health problems
Improving community support for patients discharged from hospital
Improved support for patients @ home to prevent admissions including use of technology
Shifting services from acute hospitals to community settings
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Specialties targeted for Hospital to community shift
• Dermatology
• Urology
• Orthopaedics
• General Surgery
• Gynaecology
• ENT
To be addressed in ALL PCTs’ Local Delivery Plans…….and Foundation Trusts’ & Acute Trusts’ business plans – White Paper implementation will be
monitored by the SHA & Monitor
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PBC Early wins & top tips
• Pathways for GPs to consider for redesign:– COPD– Heart Failure– Long term conditions– Mental Health – Ophthalmology– Podiatry
PBC – early wins and top tips - DoH, February 2006
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Most chosen clinical specialties in PBC plans* for redesign
These cover the obvious “quick wins” as follows:
Specialties Number of PCTS % of Total
1. Dermatology 86 53.4
2. Admissions Management Unplanned/ Urgent Care 73 45.3
3. Diabetes 56 34.8
4. COPD 46 28.6
5. Orthopaedics and Trauma 44 27.3
6. ENT 43 26.7
7. Gynaecology/Obstetrics 37 23.0
8. Cardiovascular Disease 34 21.1
9. Musculo- skeletal 33 20.5
10. Ophthalmology 30 18.6
11. Prescribing 30 18.6
12. Diagnostics 29 18.0
13. Referral Management 28 17.4
14. Urology 24 14.9
15. Surgery – Minor 23 14.3
16. Long-term Conditions 20 12.4
17. Mental Health 19 11.8
18. Rheumatology 19 11.8
* www.nhis.info - specialist enquiry
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Key features of service redesign 1. Health needs assessment identifies priority clinical area for redesign (e.g. ‘Local
Delivery Plan’ priorities, public health)
2. Existing clinical pathway mapped out and costed
3. All stakeholders meet to brainstorm options (facilitation!)
4. Various points of the pathway may be changed – including use of PWSIs & consultants or specialist nurses running community based service, plus voluntary sector involvement – looking for quick wins and cost savings first
5. Detailed Business Case(s) submitted to PCT outlining clinical and financial benefits of redesign of specific aspects by potential service providers
6. ‘Contracts’ set up for any new providers to be ‘accredited’ – may be accessible via Choose and Book’ referral system
7. Newly re-designed services will operate via protocols or guidelines including drug use (formularies)
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e.g. United Health (Europe) in Derbyshire
e.g. Principia in S Notts – combining PBC & community nursing services
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Prevention & earlyintervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with
long term conditionsUsers and carers get choice of services as
close to home as possible
Local partnerships between health and social
care to deliver better services
Prevention of avoidable hospital
admissions
Increased support for self care, an increase in ‘Expert Patients’ and ‘Expert Carers’ programme
availability
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Services closer to home
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Empowering & enabling individuals with long term conditions to take control of their health
High % ofself care
Equally sharedcare
High % of professional
careHigh-risk cases
More complex cases
70–80% of thepeople withlong-termconditions
Self care
Professional care
Risk management in primary care e.g.
Community Matrons
Regular Secondary care
admissions
Mainly managed in primary care including GPSI
Diagnosed by primary care, health maintained by annual disease reviews
Patients enrolled into ‘Expert Patient’ schemes
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http://www.expertpatients.nhs.uk/public/default.aspx?load=publications
‘we could expect people who have gained self-management skills to make around 40% fewer visits to their GPs and 17% fewer visits to outpatient clinics. We can also expect 50% reductions in length of stay in hospital, and days off work because of sickness’
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Dr Ian Greaves, Gnosall Medical Centre,
SW Staffs
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What does all this mean to pharma?
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Selling in a post-White Paper NHS world– Market Intelligence/Data/Joint business planning
• Whole primary and secondary care team need to know what’s on the PCT’s/each PBC cluster’s service re-design agenda and produce an
integrated plan for working priority clusters
– Networking/Influencing
• With key individuals in high potential clusters or high current users
• Between secondary care and primary care KOLs
• Provide redesign e.g.s from elsewhere
• Network your KOLs with innovator KOLs from areas that have already successfully redesigned a similar service
– Facilitation/Partnership
• Meetings – organising, facilitating, funding – practice/cluster/super-cluster/PCT/SHA/national level
– With board/steering group stakeholders
– With full service redesign group (multidisciplinary)
– With full cluster group ie all practices represented
– Evidence for guideline/formulary inclusion inc. health outcomes data
• Medical Information evidence pack for your product
• Local/national KOL endorsement in person plus copies of existing protocols
– Flexible Pull Through/Data/local marketing capability
• once product on guidelines, pull through by publicising guidelines in calls at meetings, etc
• Production of locally approved materials
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Prescribing *Practice Nurse
-variety of grades& specialisations
Practice Manager
Salaried GP*
GP Partner*
GP Senior *Partner
GP lead* in disease area
GP PBC lead* forpractice
GP PBC* Cluster Board
member
PBC Cluster* Board Lead GP
Community Nurse*Specialists inc
matrons
Community* Pharmacists –
(extended serviceProvider?)
PCT *pharmacistMedicines
Managementteam
PCT PBCCommissioning
manager
Practice Nurse- non prescribing
Area Px committeemembers
Consultant*KOL Product Advocates
GPSI* in area of Interest to your
product
Other hospital-Based advocates*
PCT educational leadProtected learning
time
Valued addedService providers –
Improve access e.g. training
Who are pharma’s customers in a PBC driven market?
Other PBCCluster board
members
* Potential Rxer
Expert PatientTutors?
Director of AdultSocial
Services?
Director ofPublic Health(NHS/LA)?
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Partnering opportunities• 90% of practices are part of a PBC group – the new PCGs
• 95% of practices have a PBC business plan – you need a copy
• Saving money is a key driver in 2006-7 – beware!
• Providing more services outside hospitals is a key driver
• Service redesign is complex, requires excellent networking
and communication skills (including local marketing)
• PHARMA has the skills and resources the NHS needs
• Patient education is key – a Pharma strength
• Good intelligence is paramount– you need data sources and skilled manpower to seek out opportunities for early engagement
• More formularies will result from PBC – evidence based, peer reviewed prescribing will become widespread in primary care, requiring an account management approach