View
750
Download
1
Category
Preview:
Citation preview
www.england.nhs.uk 15/04/2023
The future is local
Webinar No1
30th January 2015
www.england.nhs.uk
GeneralPractitioner
Specialist
Patient
Public funding and public provision
Public fundingIncreasing marketisation
www.england.nhs.uk
• Funded through general taxation• Free at the point of need• Mixed economy of providers• Principles
• Choice• Quality• Safety• Transparency of outcomes• Value
www.england.nhs.uk
Constant change!
• 2012 Health & Social Care Bill• 2013 NHSEngland• 2014 Five Year Forward View• 2015 NHSE, NHSIQ, SCN, Senates etc• 2015 General Election
15/04/2023
www.england.nhs.uk
Respiratory diseases
• COPD • Lung Cancer• Pneumonia• Asthma• Bronchiectasis • ILD (Pulmonary fibrosis)• TB• Respiratory failure and obstructive sleep apnoea
www.england.nhs.uk
Why is COPD important?
• A common long term disabling condition• One of the top five causes of premature mortality• Frequent cause of hospital admissions• Most cases remain undiagnosed in primary care• Large variations in care account for avoidable mortality• Rehabilitation and self-management work• Integrated, anticipatory care is cost effective
www.england.nhs.uk
Years of life lost
PYLL rate, England
www.england.nhs.uk
Strategic Clinical Networks
Focus on priority areas to improve outcomes and bring together users, providers and commissioners.
• Cancer
• Cardiovascular (inc Cardiac, Stroke, Diabetes )
• Maternity and children
• Mental health, dementia and neurological conditions
www.england.nhs.uk
COPD: Long term care
Primarily CCG responsibility
Delivered by Primary Care & Acute Trusts
Some specialised commissioning
(transplantation, LVRS, home ventilation)
www.england.nhs.uk
www.england.nhs.uk
How to influence the system?
• CCGs (no national priority)• Thematic priorities (early
diagnosis etc)• Programme Boards
(rehabilitation)• Quality and financial
levers/incentives (CQIN, QOF, BPT)
• NICE, HQIP, NHSIQ,PHE etc• Local Networks• Patient organisations• Professional Societies• Colleges
www.england.nhs.uk
Key Targets and organisational agendas
• Public and political awareness• Early diagnosis• Long Term Conditions• Acute care
• Integrated care• Population level commissioning• Year of care • Commissioning for value• Personal healthcare budgets
www.england.nhs.uk *
www.england.nhs.uk
Delayed or inaccurate diagnosis
• Estimated nearly 3.7 million sufferers
• Only 900,000 diagnosed
• 85% patients with COPD have had missed diagnostic opportunities up to 20
years prior to diagnosis
• Approximately 10-30% of COPD patients admitted to hospital have new
diagnosis
www.england.nhs.uk
How do you get spirometry in to practices?
QOF
Case finding?
www.england.nhs.uk
www.england.nhs.uk
Multiple LTCs
Asthma
Hypertension
IHD
Diabetes
COPD
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
None 1 2 3 plus
South Somerset Symphony project
www.england.nhs.uk
www.england.nhs.uk 15/04/2023
www.england.nhs.uk
Long term conditions “House of Care”
LTCs are those conditions that cannot, at present, be cured, but can be controlled by medication or lifestyle modifications.
www.england.nhs.uk
Definitions
• Self care………What patients do all the time
• Action plans……Written instructions and medication for self
management of exacerbations alone
• Self management training……Providing the necessary skills,
knowledge and confidence to self-manage whole condition
• Pulmonary rehabilitation……A structured opportunity to
provide self management training.
• Integrated Care ……The commissioning framework for delivery
www.england.nhs.uk 15/04/2023
• Integrated acute and community Trust
• Clinical Leadership across the spectrum
• Commissioning incentives (LES & CQUIN)
• Focus on education
• All components of care joined up
www.england.nhs.uk
5 year forward view
• Realistic financial analysis• Above inflation investment and 4% CIP• Focus on prevention and multi-morbidity• More individual responsibility for health care budgets• Removal of primary/secondary care barriers• Less direct commissioning• Mixed models• Local prioritisation
www.england.nhs.uk
New models of care
• Greater devolution• More co-commissioning• Maximising local planning• Encouragement to develop new models
of care• Revitalising small hospitals• Getting serious about prevention• Empowering patients (PHBs etc)• Focus on success not failure• Parity for mental health• Greater efficiency
15/04/2023
www.england.nhs.uk
Barriers to access
Primary care Acute Trusts
GP SpecialistCare
New commissioning models
Multispecialty Community Providers (MCPs)
Primary and Acute Care Systems (PACS)
www.england.nhs.uk 15/04/2023
www.england.nhs.uk
www.england.nhs.uk
Commissioning for value
15/04/2023
www.england.nhs.uk
Problem
High undiagnosed COPD populationAbove average COPD spendHigh admission ratePoor audit results
Process
Right Care methodologyDeep Dive packStakeholder engagementRedesign of care pathways
Result
30% reduction in admissionsExceeded QIPP target by £164k
www.england.nhs.uk
Population level commissioning
• “Year of Care”• Stratification for:
• Risk• Need• Service provision
• Capitated budgets• Pilot sites ongoing
www.england.nhs.uk
Local respiratory networks can be a catalyst for change
• Working with CCGs to develop local strategy• Improve early diagnosis• New commissioning models (system wide)• Acute CQUINs (COPD, Asthma, Pneumonia, Smoking
cessation) • Generic diagnostic/therapeutic approach to
breathlessness• Improving rehabilitation capacity
www.england.nhs.uk
Kent, Surrey, Sussex Respiratory Network
www.england.nhs.uk
The future is local
• The NHS will develop from the bottom up• Local prioritisation• Common standards but local implementation• Focus on early and accurate diagnosis and case finding• Use practice informatics• Risk stratification allows population level commissioning• True integrated care requires new commissioning
models• Specialists will need to work across the spectrum• These models require wide stakeholder (including
patients) involvement
Recommended