COPD - what is it? C = Chronic O = Obstruction of the airways P = Pulmonary D = Disease Emphysema, Chronic bronchitis, smokers lung, ‘Asthma’ BREATHLESSNESS.

COPD - what is it?

C = Chronic

O = Obstruction of the airways

P = Pulmonary

D = Disease

Emphysema, Chronic bronchitis, smokers lung, ‘Asthma’

BREATHLESSNESS

cough

Why does COPD matter….to clinicians, commissioners and

patients? Common and increasing in prevalence

1 in 8 acute medical admissions Significant cause of death

1 in 20 deaths 1 in 7 patients admitted with COPD die within 3 months

Significant cause of morbidity 1 in 3 patients with COPD readmitted within 3 months One million bed-days

Preventable and treatable Caused by smoking Patients live with COPD for many years Disabling and frightening breathlessness

Thinking strategically, implementing locally

A joint British Thoracic Society (BTS)

and General Practice Airways Group

(GPIAG) initiative providing the clinical

leadership required to drive high

quality patient-centred care across the

traditional boundaries of secondary and

primary care to integrate and improve

the services for people with respiratory

disease

Who’s who

Anthony Davison, Clinical Director, Southend (BTS Co Chair)

Stephen Holmes, GP, Taunton (GPIAG Co Chair)

Steph Austin, Project Manager, End of Life and Deprivation of Liberties Derby City PCT

Dermot Ryan, GP, Loughbourgh

Stephen Gaduzo, GPwSI, Stockport

Kevin Gruffydd-Jones, GP, Bath

Louise Restrick, consultant respiratory physician, London

Jane Scullion, consultant respiratory nurse, Leicester

Steve Connellan, retired consultant respiratory physician, and coding expert!

Sharon Haggerty, Head of Adult Services, County Durham

Steve Catling, lay representative

Supported by:

Siân Williams (Project Manager ex NHS Manager)

BTS & GPIAG Chairs and CEs

BTS 2600 doctors, doctors in training, nurses, stop smoking professionals, specialist nurses, respiratory physios, technical and physiological measurement

GPIAG: 2400 primary care professionals with respiratory interest

INTEGRATION across professions, across primary and secondary care

Practice basedCommissioning

Money followingpatients

(payment by results)

The context from which we evolved

All Trustsable to apply for

FT status

More choicefor patients

Stronger PCTswith fair funding Regulation for

safety and quality

Independent Sector addingcapacity and

innovation

Better CareBetter patient

experienceBetter value-for-

money

Better information

New providers

e.g. social enterprise

How it felt

F R A G M E N T A T I O N

isolation over reliance on data

Job cuts

People asked to work outside competence

Anxiety

Why IMPRESS is relevant

Primary and community care strategy Leading local change Support PCTs and clinicians to make local decisions on

integrated primary and community care services

World Class Commissioning Lead meaningful engagement with clinicians

Manage knowledge and assess needs

Prioritise for improved outcomes

Influence and shape the market

Support and manage providers

How we can add value

Make it simpler to commission the right thing

Where clear evidence of best practice Eg Pulmonary Rehab, hospital at home

Where uncertain evidence but certain need Eg end of life care COPD

Communicate in language meaningful to clinicians and commissioners

BTS / GPIAG leadership

Make tensions energising not draining

What we are achieving

Role model for integration Primary and secondary care Doctors, nurses, managers Lay representation

Improved understanding Processes Policy Standards

Produced “things” for commissioners and clinicians

Role model: network which “does”

Clinical strategy for COPD will require networks Communication face-to-face

Increased respect Sharing beliefs

Sharing resources, knowledge, opinion eg primary care innovation

Learning: gain from different attitudes eg to risk Positive relationship with pharma industry Include providers and commissioners, clinicians and

managers: start here Project manager: have one Work out positions on 3rd sector, patients, social care Challenges about primary care competence and

secondary care responsiveness: find ways to demonstrate competence

For you to use: Website: www.impressresp.com Jargon Buster Skill mix and competence framework Vision letter to Darzi team Submission to PbR team on unbundling tariff +

guide to coding Criteria for Hospital Referral, Admission,

Discharge and follow up Conference: Royal College of Physicians (6

March 08) Service specification paper: how to guide and

sample COPD spec Delivering care closer to home: outpatient shift

paper Guide to respiratory coding

For you to use (2) Educational package ready by February 2009 Effective Care - Effective

Communication: Living and Dying with COPD

Advised on Clinical Strategy and communications strategy End of life care quality markers - detailed response to consultation Stories

Somerset PCT tender Kings Fund scenario planning Wigan, Hammersmith community consultants Needs assessment, Salford

Commissioning to meet the needs of patients with

COPD

What next?

Education and training across the system: explore roles Develop clinical leaders and networks Launch and implement ‘Living and Dying with COPD’

communication skills education programme Shared evidence bases (service development and clinical) How to procure improvement and integration PROMs Audit patient journey experience Evaluation criteria for evaluating impact of new services Sleep services Asthma Extending our reach and evaluating our impact Use Clinical Strategy to raise profile of respiratory care Managing Long Term conditions meeting 7 April 28 April, London first IMPRESS conference,

Respiratory specifications

Networks Needs assessment: JSNA,

East Region PHO model Vision Clinical leadership What do you want - the matrix,

human capital, research How much do you want to

spend - programme budgeting Who’s accountable for what? Training and education Governance Procurement rules Contracting currency

Care Closer to Home Integration Substitution

Location Skills Technology Model from medical model to

supported self care/co-creation/co-production model

Organisational (eg by private or voluntary sector)

Segmentation Simplification “Decisions about location

and level of specialism should be kept separate”

“ right care at the right time, reliably, by the professional(s) most competent to provide their care. “Patients…more flexible access: timing and mode of consultation

with a HCP of their choice…[that] suits them at that point in their lives

Dos and don'ts of procurement

Commissioners (1)

Support or establish a clinical network for needs assessment, service specification and care pathways

Beware IP exploitation when develop specifications Involve local patients actively and continuously What’s sustainable and cost-effective: competitive

procurement or a continuous improvement What’s readiness of the local NHS to enter a fair

competition: how will you help? What’s impact on integration and on NHS sustainability if

the contract is won by a non-NHS provider Who will be your expert primary and secondary care

advisors to adjudicate bidders?

Dos and don'ts of procurement

Commissioners (2)

Is responsibility for keeping the service up-to-date with best practice built into the specification?

Consider NHS human and intellectual capital: should spec include provision of audit, research, education and training of primary and community care professionals?

Consider inclusion of incentives to reward best practice Have benchmark data for evaluation and some manageable but

important evaluation criteria e.g. continuity of care for patients, equity of access across practices and localities, hospital utilisation, unscheduled care.

Clarify for clinicians who the commissioners are - names, contacts Consider unintended consequences e.g. residual costs of providing

an acute medicine service and therefore the total costs of the system if investment is removed from a local trust.

25 June 2008

Dos and don'ts of procurement

NHS clinicians

Get involved in any local clinical network across primary and secondary care Actively work together to consider improvements Use IMPRESS resources e.g. BTS referral criteria to assist in these conversations Plan for how you and your colleagues will listen to patients and engage them in not just self-

management but also in service design, information provision and service evaluation Campaign for investment in respiratory care: demonstrate how it can meet commissioners’

aims: reduction in avoidable hospital admissions care closer to patients’ homes prevention (“upstream” eg system-wide leadership for smoking cessation)

Maintain relationships with colleagues but be sure you know what their role is now, and who the decision-makers:

who is a PCT commissioner? who is in the PCT provider organisation? who is a practice-based commissioner? who is a GP with an interest in providing services?

25 June 2008

Dos and don'ts of procurement

Bidders: it needs one knowledgeable person full-time for several weeks + expert help

Familiarise yourselves with process: scoring system, timelines and adjudication Get help early from people who have the appropriate skills in

budgeting and scenario planning data analysis social marketing presentations

Make connections with key stakeholders directly Having read the specification, is it appropriate to bid – does it fit organisation’s

strategy? Do you have the resources to bid? What are the risks of not bidding, or not winning? Do you have the resources to deliver the service? If you bid, respond to the specification as it is written in the final documents; seek

clarification using the formal processes Start thinking “out of the box”, without being restricted by knowing how things are

done now or the implications for the use of NHS assets. Think about not just the written submission but any other adjudication processes

such as an interview. Who should attend? For what reason? Imagine what your competitors might do