Delivering Out-of-Hours Services David Carson. My Presentation Policy Framework Who will deliver OOH services? The role of PCTs and SHAs Some cross-cutting.

Delivering Out-of-Hours Services

David Carson

My Presentation

• Policy Framework

• Who will deliver OOH services?

• The role of PCTs and SHAs

• Some cross-cutting issues

Background Policy Framework

• OOH Review

• REC

• NHSD Review

• nGMS

• Choice and Plurality

Policy I : OOH Review

• Standards

• Clinical Leadership

• Integrated OOH services

• Network of providers

• Joined up planning and commissioning

Policy II: Reforming Emergency Care

• Same principles as OOH• Current focus on A&E headline figure• Integrated response to Minor Illness

and Injury• Solutions may reside outside A&E

within network provision• Chronic disease management - real

opportunities in contract

Policy III: NHS Direct Review

• Technical Links• Capacity in 2004/5 and 2005/6• Clear set of criteria being developed for

joint operational arrangements• Ensure that developed arrangements

are consistent with NHSD direction and key role in emergency care.

• NHSD commissioning framework out for consultation

• Must be in the development process - integration of clinical processes

Policy IV : nGMS

• Opt out is not partial

• Specific notice periods

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

• Opportunity to build PC capacity and volume

Policy V: Plurality

• NHS

• Mutual / Voluntary Sector

• Private Sector

• All have a role

• PCT provision is perhaps backstop choice

Who will deliver OOH Services?

• GP Opt-Out and re-provision

• Capacity Information

• Providers

• Mutuality

• Commercial Providers

• The Ambulance Service

• NHS Direct

Delivery I: GP opt-out & re-provision.

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

• 2 Different things• Opt out is Practice decision• Look beyond this question• Services staffed by GPs and others

attracted to work in services and providers

Delivery II : Capacity Information• Urgent need to collect and collate existing

information• Should be mapped by:

– Case mix– Geography– Time– Competencies

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

(including acute and ambulance service)

Delivery III : Providers

• Limited view of opportunities by some• Providers stop competing on all

aspects – cooperate and build on your strengths (none are good at everything)

• More opportunity for joint development• More attention to planning process• At scale versus local• Provider development process is

needed in every area

Delivery IV : Mutuality• COOP to COOP• Basis of COOP membership changes from

those with responsibility to those working within COOP and beyond.

• Will require support as per guidance from PCTs• Working on governance models

– Provider development– Further papers coming

• Mutual Transfer - January• Model Constitution - March

Delivery V: Commercial Providers

• Strengths

• Resilience due to size

• Clinical governance structures

• Logistics and management capacity

• Often complementary services to local COOPs

Delivery VI: Ambulance Service

• Also Strengths

• Part of network

• Have increasing role

• Must be at the table

• Time to develop effective PC Capacity

Delivery VII: NHS Direct

• Technical Links• Capacity in 2004/5 and 2005/6• Clear set of criteria being developed for

joint operational arrangements• Ensure that developed arrangements

are consistent with NHSD direction and key role in emergency care.

• NHSD commissioning framework out for consultation

• Must be in the development process - integration of clinical processes

PCTs

• Networks• Inter-PCT Co-operation • Self-provision

PCTs I : Networks

• Have you achieved contestability and sustainability?

• A network gives more options than a single preferred provider

• Yet to see an area in which a single provider has all the answers

• Support providers (or establish new providers)

• Support change• Give OOH the priority it requires

PCTs II: Inter-PCT Co-operation

• Potential for one PCT solution to destabilise others

• Agree on what development activity could be shared

• Inter PCT process requires proper attention (probably at Board level)

• Single PCT options will be very rare

PCT III: Self-Provision• OOH Volumes within individual PCTs are low -

few economies to be gained• Enough service volume to have senior

professional and operational leadership?• Track record?• Delivers contract but what next?• Aspects of provision at scale do not exclude local

initiatives• Question the perception that PCT provision is the

only way to control costs

Role of SHAs• Key role• Overview of PCT process• Review of plans and hot spots• Key role in ensuring plurality and adequate provision• Overview of capacity and market

– No of providers– Capacity of providers– Assure overall provision is adequate

• Benchmark and support PCT action

Other Issues

• Workforce

• Clinical Leadership

• Procurement and tendering

• Accreditation and the Quality Standards

Other Issues I : Workforce

• Significant number of WF initiatives in Agency and in WDCs

• Important for SHAs and PCTs to ensure OOH and PC issues are on WDC agenda now

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

Other Issues II : Clinical Leadership

• Effective clinical leadership underpins effective team working

• Clinical leaders key role in developing brokering network / inter provider operational arrangements

• Employed skill mix workforce (even GPs may be employed in new OOH organisations)

• The organisational structure requires capacity and competency to attract, develop and support senior clinical leaders

Other Issues III: Procurement &

Tendering

• Procurement is not the same as tendering • It is legitimate to include providers in process• Providers should identify strengths / weakness

& the benefits of joint working• Then working co-operatively• We do not have excess capacity• We need to build capacity

Other Issues IV: Accreditation & Standards

• Under review

• Process of accreditation potentially within contracting

• Standards will apply to all providers (including practices who do not opt out)

• Revised Standards in April

A Unique Opportunity

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

• Will require focussed work and investment.

• More complex but worth the effort

OOH Challenges• Providers• Networks• Joint operations• Clinical leadership• Making most of opportunities• Short medium and long term arrangements• Immediate priority not the enemy of the next stage• Workforce