Key information on the NHS for LOC Committee members

April 2013 NHS Reorganisation

Overhaul of:– Commissioning

– Provision

– Regulation

Context:– Ageing population

– Increasing demand

– Efficiency savings of £20 billion by 2015

NHS Commissioning

• Clinical Commissioning Groups (CCGs) have

responsibility for commissioning the majority of local

health services including hospital eye services and

community (formerly enhanced) eye services provided

by optical practices

www.england.nhs.uk/about/regional-area-teams/

• NHS England is responsible for commissioning all

primary care, including General Ophthalmic Services

(GOS) www.england.nhs.uk/ccg-details/

Department of Health

NHS

England +

Area teams

Public Health

England

Local Public Health

Units/Health & Wellbeing

Boards

Clinical Commissioning

Groups

HospitalsCommunity

Services

Primary care services

Department of Health

Primary Care Trust

Primary care

services

Community Services

Hospital Care

Public Health

Strategic Health

Authority

NHS – Old Arrangements NHS – New Arrangements

Commissioning of Primary Care

NHS England

4 Regions

27 AreaTeams

Organisational restructure early 2015 will reduce number of Area Teams

Single Operating Model for Primary Care Commissioning

• Single System across England

• Shared values and behaviours

• Common policies and procedures

• Clear outcome measures, indicators and single accountability framework

• Risk based approach to contract management

General Ophthalmic Services

• Broad structure of mandatory and additional services is unchanged

• NHS Sight tests continue to be demand-led

• Area Teams:

– Receive and consider contract applications in line with national policies and procedures

– less hands on monitoring of quality & outcomes

• NHS England are responsible for maintaining national Performers List; individual applications are dealt with at Area Team level https://www.performer.england.nhs.uk/documents

Clinical Commissioning Groups

• CCGs are commissioning organisations formed from general practices (210 CCGs)

• All GP practices are part of a CCG

• Practices hold the CCG to account for decisions made on their behalf

• Chair and Accountable Officer have key responsibilities

Commissioning Local Services

• CCGs are responsible for commissioning and monitoring community eye health services

• The NHS Standard Contract is used for all services and has 3 components; General Conditions, Service Conditions, Particulars

• The Service Specification forms part of the Standard Contract Particulars

The QIPP Agenda

CCGs will commission services in line with QIPP:

• Quality: Improving the quality of services delivered to the patient

• Innovation: Implementing change to enhance performance

• Productivity: Achieving more and better output from the same or less resource

• Prevention: Supporting ‘wellbeing and illness avoidance’ plus avoidance of preventable healthcare utilisation

LOC Company Model

• An LOC Company allows contractors to form a network to bid for and/or provide local services

• Attractive to CCGs as they have limited capacity for managing and monitoring services

• Single provider application in AQP procurements easier than contractors having to submit individual bids

• OptoManager IT platform provides data collection, audit, billing and payment disbursement to practices

Health & Wellbeing Boards

• Public Health has transferred to local authorities and to Public Health England which together promote health protection and prevention

• Health and Wellbeing Boards

• have been established for each upper tier council area

• are designed to promote joint working and integrated services across health and social care

Relationships

Health & Wellbeing

Board

NHS

Local Authorities

Public Services

Voluntary Sector & Public

Health & Wellbeing Boards

Coordinate & oversee activity for health & wellbeing across all local organisations

Wide representation with local variation

Clinical Commissioning Groups

GPs and other clinicians oversee commissioning process

Focus on local implementation to meet local needs

Public Health & Outcomes

• Joint Strategic Needs Assessments (JSNA)

– primary process for identifying needs and building a robust evidence base on which to base local commissioning plans

• Eye Health Needs Assessment (EHNA)

– facilitates understanding of the ophthalmic needs of the population and the service requirements to meet those needs

• Joint Health and Wellbeing Strategy (JHWS)

– provides the overarching framework within which commissioning plans for the NHS, social care, public health and other services which the health and wellbeing board agrees are relevant, are developed

Public Health Indicator

• Government has made eye health a Public Health priority from April 2013

• Eye health indicator will measure the rate of sight loss through chronic glaucoma, age related macular degeneration and diabetic retinopathy

• The indicator will enable the sector to work with the Health and Wellbeing Boards and new NHS to improve eye health and counter issues of inequality

Local Professional Networks

• Local Professional Networks (LPNs) have been established at Area Team level for Dental, Pharmacy and Eye Health

• Provide clinical leadership and facilitate clinical engagement at a grass roots level

• Support and advise the NHS England Area Teams

• Advise CCGs and Health and Wellbeing Boards

• LPNs are expected to focus on improving outcomes

– delivering high quality care

– reducing inappropriate variation

– reducing health inequalities

Local Eye Health Network

• Local Eye Health Network (LEHN) has a Clinical Chair and should include representation from:

• CCGs

• LOCs

• Hospital Eye Services

• Public health

• Patient representatives

• Key voluntary organisations

• There should be a core group and task and finish groups

• The LEHN should have clear objectives and work plan

LEHN Single Operating Model

The Single Operating Model for LPNs sets out objectives for LEHNs:

• improve access for sight tests for hard to reach groups

• support Health and Wellbeing Boards (HWBs) to carry out effective Eye Heath Needs Assessments (EHNAs)

• better service integration around patients’ needs and improved outcomes

• improving and redesigning services in line with national eye health pathways

• www.england.nhs.uk/wp-content/uploads/2013/08/lpn-sof.pdf

Commissioning Support Units

• CCGs use CSUs to provide many back-office commissioning support functions and services such as business intelligence and procurement

• Some CCGs also use CSUs to provide functions such as HR and finance (including processing claims for community services)

• Originally 19 CSUs across England but now reduced by around 50%

Other ‘New’ Bodies

• HealthWatch - consumer champion for health and social care, gathering and promoting the views of local people

• Clinical Senates - will provide advice and leadership on major healthcare decisions e.g. hospital closures

• Strategic Clinical Networks – cover a major condition e.g. cancer, cardiovascular disease, mental health

• Local Education and Training Boards - training and development of healthcare and public health workforce

• Academic Health Science Networks – spread innovation

Improving eye health and reducing sight loss: a call to action

• Improving eye health and reducing sight loss: a call to action was launched by NHS England in June 2014 to seeks the views of eye health stakeholders on the role that primary care services can play in tackling the wider challenges facing the NHS, including how the increased demand for NHS eye health services can be met against a backdrop of significant financial constraint

• The responses are to be used by NHS England to develop a strategy for future primary care services

• NHS England’s report on the Calls to Action for dentistry, pharmacy and eye health is due in Spring 2015

NHS Five Year Forward View

• The NHS Five Year Forward View was published in October 2014 to set out a vision for the future of the NHS

• The Five Year Forward View articulates why change is needed, what that change might look like and how we can achieve it

• It describes future models of care, defining the actions required at local and national level to support delivery

• The Five Year Forward View Planning Guidance confirms that NHS England’s report on the Calls to Action will take into account how pharmacy, eye health and dentistry can support the new models of care

Further information is available at www.locsu.co.uk/eyecare-

commissioning/