Delivering OOHs services

Delivering OOHs servicesDelivering OOHs services

David CarsonDavid Carson

National Clinical Lead National Clinical Lead Access & Choice Primary Access & Choice Primary CareCare

www.out-of-hours.infoWhat's happeningWhat's happening

• A&E and Ambulance worried A&E and Ambulance worried about being dumped onabout being dumped on

• COOPs worries about the COOPs worries about the futurefuture

• Where are staff coming fromWhere are staff coming from• PCTs face new world of PCTs face new world of

commissioningcommissioning• Have providers the skills to Have providers the skills to

work co-operativelywork co-operatively

www.out-of-hours.infoPrejudice and Prejudice and perceived wisdomperceived wisdom

• Is NHS better than GPsIs NHS better than GPs• Are GPs better than the Are GPs better than the

NHSNHS• Are COOPs better than Are COOPs better than

Private sectorPrivate sector• Is the private sector better Is the private sector better

than the COOPthan the COOP• COOPs compete as wellCOOPs compete as well

www.out-of-hours.infoWhat it isWhat it is

• Major opportunityMajor opportunity• Achieve real joined up servicesAchieve real joined up services• Providers have opportunity to Providers have opportunity to

innovateinnovate• PCTs and trusts meet PCTs and trusts meet

imperativesimperatives• Patients get even more effective Patients get even more effective

access to integrated health careaccess to integrated health care

www.out-of-hours.infoBackground Policy Background Policy FrameworkFramework

• OOH ReviewOOH Review• RECREC• NHSD ReviewNHSD Review• Choice and PluralityChoice and Plurality

www.out-of-hours.infoOOH ReviewOOH Review

• Integrated OOH servicesIntegrated OOH services• Network of providersNetwork of providers• Clinical LeadershipClinical Leadership• StandardsStandards• Joined up planning and Joined up planning and

commissioningcommissioning

www.out-of-hours.infoReforming Emergency Reforming Emergency CareCare

• Same principles as OOHSame principles as OOH• Current focus on A&ECurrent focus on A&E• Solutions may reside outside Solutions may reside outside

A&EA&E• Chronic disease management Chronic disease management

- real opportunities in - real opportunities in contractcontract

• Integrated response to Minor Integrated response to Minor Illness and InjuryIllness and Injury

www.out-of-hours.infonGMSnGMS

• DOH fully committed to DOH fully committed to delivery of contractdelivery of contract

• OOH will provide OOH will provide mechanism to meet in-mechanism to meet in-hours nGMS Challengehours nGMS Challenge

• Opportunity to build PC Opportunity to build PC capacity and volumecapacity and volume

www.out-of-hours.infoPluralityPlurality

• NHSNHS• Mutual / Voluntary SectorMutual / Voluntary Sector• Private SectorPrivate Sector• All have a roleAll have a role• PCT provision is perhaps PCT provision is perhaps

last choicelast choice

www.out-of-hours.infoGP opt out and re-GP opt out and re-provision.provision.

• Relevant yes but perhaps not in Relevant yes but perhaps not in terms of re-provisionterms of re-provision

• 2 Different things2 Different things• Opt out is Practice decisionOpt out is Practice decision• Look beyond this questionLook beyond this question• Staffed by GPs and others Staffed by GPs and others

attracted to work in services attracted to work in services and providersand providers

• Are we looking back too muchAre we looking back too much

www.out-of-hours.info

The deliveryThe delivery


OOH Challenge OOH Challenge

• Information to support Information to support development.development.

• ProvidersProviders• PCTsPCTs• STHAsSTHAs• Other IssuesOther Issues


DataData


Capacity informationCapacity information

• Urgent need to collect and collate existing Urgent need to collect and collate existing informationinformation

• Use as basis of planning integrated serviceUse as basis of planning integrated service• All data should be shared with all providers All data should be shared with all providers

(including acute and ambulance service)(including acute and ambulance service)• Should be mapped by:Should be mapped by:

– Case mixCase mix– GeographyGeography– TimeTime– CompetenciesCompetencies


ProvidersProviders

www.out-of-hours.infoWho are the providersWho are the providers

• COOPSCOOPS• PRIMECAREPRIMECARE• AMBULANCEAMBULANCE• A&EA&E• COMMUNITY COMMUNITY

NURSINGNURSING• SOCIAL SOCIAL

CARECARE

• MENTAL MENTAL HEALTHHEALTH

• WICsWICs• DENTISTRYDENTISTRY• PHARMACYPHARMACY• Any anyone Any anyone

else working else working OOHOOH

www.out-of-hours.infoProvidersProviders• More opportunity for joint More opportunity for joint

developmentdevelopment• Providers stop competing on all Providers stop competing on all

aspectsaspects• Co-operate and build on your Co-operate and build on your

strengths (None are good at all)strengths (None are good at all)• Limited view of opportunities by someLimited view of opportunities by some• At scale Vs localAt scale Vs local• More attention to planning processMore attention to planning process• Provider development process is Provider development process is

needed in every areaneeded in every area

www.out-of-hours.infoCOOPs COOPs • Brilliant jobBrilliant job• Can be monopolyCan be monopoly• Legitimate for PCTs to ask difficult Legitimate for PCTs to ask difficult

questionsquestions• Not legitimate to exclude anybodyNot legitimate to exclude anybody• Shift of ownership from those who Shift of ownership from those who

are responsible as members to are responsible as members to those who work as membersthose who work as members

• Significant opportunity to increase Significant opportunity to increase local public involvementlocal public involvement

www.out-of-hours.infoMutual TransferMutual Transfer• COOP to COOPCOOP to COOP• Basis of COOP membership Basis of COOP membership

changes from those with changes from those with responsibility to those working responsibility to those working within COOP.within COOP.

• Will require support as per Will require support as per guidance from PCTsguidance from PCTs

• Working on governance modelsWorking on governance models– Provider developmentProvider development– Further papers comingFurther papers coming

www.out-of-hours.infoCommercial ProvidersCommercial Providers

• StrengthsStrengths• Resilience due to sizeResilience due to size• Clinical governance Clinical governance

structuresstructures• Logistics and management Logistics and management

capacitycapacity• Often complementary Often complementary

services to local COOPsservices to local COOPs

www.out-of-hours.infoAmbulance serviceAmbulance service

• Also StrengthsAlso Strengths• Part of networkPart of network• IPASIPAS• Do not have all the Do not have all the

answersanswers• Have some of themHave some of them• Must be at the tableMust be at the table

www.out-of-hours.infoProvidersProviders• Stop competing on every aspectStop competing on every aspect• Yes the NHS as wellYes the NHS as well• Co-operate and build a decent Co-operate and build a decent

integrated service building on integrated service building on your strengthsyour strengths

• Have confidence in what you do Have confidence in what you do wellwell

• Accept that others have much Accept that others have much to offer.to offer.


PCTsPCTs

www.out-of-hours.infoPCTs PCTs • Support providersSupport providers• Establish ProvidersEstablish Providers• New territoryNew territory• Support changeSupport change• Have you contestability and Have you contestability and

sustainability?sustainability?• A network gives more options than A network gives more options than

a single preferred providera single preferred provider• Yet to see an area in which a single Yet to see an area in which a single

provider has all the answersprovider has all the answers

www.out-of-hours.infoPCTsPCTs• Potential for one PCT solution to Potential for one PCT solution to

destabilise othersdestabilise others• Agree on what development activity could Agree on what development activity could

be sharedbe shared• Inter PCT process requires attentionInter PCT process requires attention

– Sign up at Board levelSign up at Board level

• Evidence based approach to optionsEvidence based approach to options• Risk of narrow anecdotes and individuals Risk of narrow anecdotes and individuals

views restricting thinkingviews restricting thinking• Single PCT options will be very rareSingle PCT options will be very rare

www.out-of-hours.infoDevelopment ProcessDevelopment Process

• PCT agree areas of joint working PCT agree areas of joint working across areaacross area– WorkforceWorkforce– DataData– Provider developmentProvider development

• PCTs agree areas local workingPCTs agree areas local working• Senior support to joint projectSenior support to joint project• PCTs agree to provider support processPCTs agree to provider support process

– PCTs will require to consider PCTs will require to consider supporting the establishment of supporting the establishment of providersproviders

www.out-of-hours.infoPCTsPCTs• 5 Years Guaranteed year on year 5 Years Guaranteed year on year

funding increasefunding increase• Some have made plansSome have made plans• Some plans are goodSome plans are good• Some will need revisitingSome will need revisiting• Have you really addressed the Have you really addressed the

issue or chosen the easiest option?issue or chosen the easiest option?• May have to revisit some LDP May have to revisit some LDP

priorities and even trust recovery priorities and even trust recovery plansplans

www.out-of-hours.infoSTHAsSTHAs

• Key roleKey role• Mentioned in contractMentioned in contract• Overview of PCT process nowOverview of PCT process now• Review of plans and hot spotsReview of plans and hot spots• Legitimate role in ensuring Legitimate role in ensuring

plurality and adequate plurality and adequate provisionprovision

• Benchmark and support PCT Benchmark and support PCT networksnetworks


IssuesIssues

www.out-of-hours.infoWorkforceWorkforce

• Significant number of WF initiatives in Significant number of WF initiatives in Agency and in WDCsAgency and in WDCs

• Important for STHAs and PCTs to ensure Important for STHAs and PCTs to ensure OOH and PC issues are on WDC agenda OOH and PC issues are on WDC agenda nownow

• We will be issuing a summarised version We will be issuing a summarised version on where latest WF information and on where latest WF information and evidence can be accessedevidence can be accessed

• No magic bullet but skill mix and flexible No magic bullet but skill mix and flexible roles are keyroles are key

• Liberating the talents is a good example of Liberating the talents is a good example of moving to more flexible working patterns.moving to more flexible working patterns.

www.out-of-hours.infoNHSD ReviewNHSD Review

• Technical LinksTechnical Links• Capacity in 2004/5 and Capacity in 2004/5 and

2005/62005/6• Ensure that developed Ensure that developed

arrangements are consistent arrangements are consistent with NHSD direction.with NHSD direction.

• NHSD commissioning NHSD commissioning framework likely during PCT framework likely during PCT planning processplanning process

www.out-of-hours.infoWhat I hear What I hear procurementprocurement

• PCT not talking to usPCT not talking to us• Provider bullying meProvider bullying me• Director of Finance wants Director of Finance wants

me to tender first (for me to tender first (for what?)what?)

• Preferred providers (what Preferred providers (what is this? And what are the is this? And what are the implications)implications)

www.out-of-hours.infoProcurementProcurement

• Open process Open process • Legitimate to include providers Legitimate to include providers

in processin process• ““Cannot Talk” to providers is not Cannot Talk” to providers is not

true!true!• Providers should identify Providers should identify

strengths / weakness / benefits of strengths / weakness / benefits of joint workingjoint working

• Agreement needed on process Agreement needed on process jointly across each networkjointly across each network

www.out-of-hours.infoCompetitionCompetition

• Is not only about tenderingIs not only about tendering• Its about contestability and Its about contestability and

strengthsstrengths• Then working co-operativelyThen working co-operatively• We do not have excess We do not have excess

capacitycapacity• We need to build capacityWe need to build capacity

www.out-of-hours.infoWhat now in every areaWhat now in every area• Functional inter PCT forum with Functional inter PCT forum with

clear terms of reference, objectives clear terms of reference, objectives and timetable - The WHATand timetable - The WHAT– Requires support and secretariatRequires support and secretariat

• Functional provider forum to Functional provider forum to support identification of roles and support identification of roles and opportunities for all providers - opportunities for all providers - The HOWThe HOW– Requires terms of reference , Requires terms of reference ,

objectives, support, timetable and objectives, support, timetable and secretariatsecretariat

www.out-of-hours.infoOpportunityOpportunity

• Best opportunity in a Best opportunity in a generation to build on the generation to build on the best of current practicebest of current practice

• Will require focussed work Will require focussed work and investment.and investment.

• Drop the baggageDrop the baggage• Lets get on and do itLets get on and do it• And Deliver - Please!And Deliver - Please!

Documents

Delivering OOHs services