'Business Opportunities arising from the White Paper'

PSMG, 30th January 2007

Paul MidgleyDirector

The Healthcare Partnership

Office -0870 2413506enquiries@healthcarepartnership.com

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

The single most important document since the

NHS Plan of 2000……

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

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

Prevention & earlyintervention

Choice and patient involvement

Improved Access, Tackling inequalities

Meeting needs of Patients with

long term conditions

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

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

Case Study – Individual budgets

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

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

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

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

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)

e.g. United Health (Europe) in Derbyshire

e.g. Principia in S Notts – combining PBC & community nursing services

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

Services closer to home

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

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’

Dr Ian Greaves, Gnosall Medical Centre,

SW Staffs

What does all this mean to pharma?

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

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)?

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