CCG Perspective on Integrated System Redesign

Tim O’Donovan September 17th 2013

The existing MSK system• MSK System Redesign: the redesign of services that diagnose and

treat bone, muscle, and tissue conditions and disorders, and associated pain (ICD-10 Chapter XIII, M00-99)– Includes elective orthopaedics, rheumatology, physiotherapy,

podiatry and chronic pain– Excludes trauma and non-elective activity

• MSK patient population approx. 45,000• Over 25 different provider contracts• Total budget circa £25 million

The challenge: the patients’ view• Referred to the wrong service/clinician

– Frustrated by no direct referral from part to the system to another: “ping ponged back to GP”

– Continual onward referral to different elements of care until diagnosis is received

• Poor co-ordination of information and administration across the system

• No integration with social care at assessment• Long waits for and within outpatient clinics• Difficult to get in contact with team post-op

BCCG MSK Strategic Vision

• The White Paper: Liberating the NHS, provides an opportunity to move towards integrated systems of care

• BCCG response to the opportunity and challenges highlighted– Encourage integration of services through a system contract with

aligned incentives, improving the co-ordination of patient care through a PRIME CONTRACT

– Commissioning for outcomes, better value and less waste, with patients getting the right care in the right place, first time

– Empower clinical leadership to challenge and champion, and to develop new ways of providing care across the pathway

Specification• Single budget, prime contract for 5 years• Four main types of care:

– Patient support and empowerment– Support, education and advice for primary care– Community-based MSK service– Use of hospital facilities only when those facilities

are needed• Incentivised game-changing outcome measures

Prime Contractor

National Context• Prime Contracting• Alliance Contracting• Integration• Incentives• Payment/Capitation/PBR• Outcome Focus• System Approach

Members Involvement• Approach your local CCG/s, overview and scrutiny,

opportunities, good ideas e.g. joint injections• Opportunity to get involved through workshops, clinical

networks – Output is influencing specifications, KPIs, outcome measures

• Check supply to health – advertising market engagement workshops, procurements

• Are you linked in locally? Discussion with local colleagues on provision, federation, consortia, stand alone practice