Business Opportunities arising from the White Paper

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'Business Opportunities arising from the White
Paper' PSMG, 30th January 2007 Paul
Midgley Director The Healthcare
Partnership Office -0870 2413506 enquiries_at_healthc
arepartnership.com
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Overview

• Introduction to Our Health, Our Care, Our Say
• Overview of the four key themes
• Theme one case study
• Theme two case study
• Theme three case study
• Theme four case study
• Issues knowledge, skills, structural alignment,
  data
• Summary opportunities for partnership working

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The single most important document since the NHS
Plan of 2000
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Our health, our care, our say a new direction
for community services
www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf

• Public consultation Summer /Autumn 2005
• Published January 30th 2006, passed by Parliament
  Summer 2006
• England only
• 240 pages
• 10 year reform programme legally binding

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Our health, our care, our say making it
happenHealth and social care working together in
partnership
October 2006 Progress report from 80 pilot sites
www.dh.gov.uk/assetRoot/04/14/00/65/04140065.pdf
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Choice and patient involvement
Prevention early intervention
Improved Access, Tackling inequalities
Meeting needs of Patients with long term
conditions
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Smoking cessation
Reducing incapacity-related unemployment
Tackling obesity
Increasing resources and planning for prevention
and early intervention
Choice and patient involvement
More homecare using technology
Prevention early intervention
Increasing self care and appropriate conditions
management
Improved Access, Tackling inequalities
Meeting needs of Patients with long term
conditions
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Increased information on, and more input into
support package for service users and carers
Local service users input/feedback on services to
be actioned where problems identified
Increased user satisfaction with their care
package
Prevention early intervention
Choice and patient involvement
Improved Access, Tackling inequalities
Meeting needs of Patients with long term
conditions
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Case Study Individual budgets

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Prevention early intervention
Choice and patient involvement
Increasing range of urgent care services
Joint working between health and social care
communities and authorities to reduce inequalities
Improved Access, Tackling inequalities
Meeting needs of Patients with long term
conditions
Promoting emotional and physical wellbeing
services to prevent mental and physical health
problems
Easier registration with GPs, and improved access
and convenience
More community-based services
Improved support for patients _at_ home to prevent
admissions including use of technology
Improving community support for patients
discharged from hospital
Shifting services from acute hospitals to
community settings
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Specialties targeted for Hospital to community
shift

• Dermatology
• Urology
• Orthopaedics
• General Surgery
• Gynaecology
• ENT

To be addressed in ALL PCTs Local Delivery
Plans.and Foundation Trusts Acute Trusts
business plans White Paper implementation will
be monitored by the SHA Monitor
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PBC Early wins top tips
PBC early wins and top tips - DoH, February
2006

• Pathways for GPs to consider for redesign
• COPD
• Heart Failure
• Long term conditions
• Mental Health
• Ophthalmology
• Podiatry

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Most chosen clinical specialties in PBC plans
for redesign

• These cover the obvious quick wins as follows
• Specialties Number of PCTS of Total  
• Dermatology 86 53.4
• Admissions Management Unplanned/ Urgent
  Care 73 45.3
• Diabetes 56 34.8
• COPD 46 28.6
• Orthopaedics and Trauma 44 27.3
• ENT 43 26.7
• Gynaecology/Obstetrics 37 23.0
• Cardiovascular Disease 34 21.1
• Musculo- skeletal 33 20.5
• Ophthalmology 30 18.6
• Prescribing 30 18.6
• Diagnostics 29 18.0
• Referral Management 28 17.4
• Urology 24 14.9
• Surgery Minor 23 14.3
• Long-term Conditions 20 12.4
• Mental Health 19 11.8

www.nhis.info - specialist enquiry
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Key features of service redesign

• Health needs assessment identifies priority
  clinical area for redesign (e.g. Local Delivery
  Plan priorities, public health)
• Existing clinical pathway mapped out and costed
• All stakeholders meet to brainstorm options
  (facilitation!)
• Various points of the pathway may be changed
  including use of PWSIs consultants or
  specialist nurses running community based
  service, plus voluntary sector involvement
  looking for quick wins and cost savings first
• Detailed Business Case(s) submitted to PCT
  outlining clinical and financial benefits of
  redesign of specific aspects by potential service
  providers
• Contracts set up for any new providers to be
  accredited may be accessible via Choose and
  Book referral system
• 7. Newly re-designed services will operate via
  protocols or guidelines including drug use
  (formularies)

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e.g. United Health (Europe) in Derbyshire

e.g. Principia in S Notts combining PBC
community nursing services
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Prevention early intervention
Choice and patient involvement
Increased support for self care, an increase in
Expert Patients and Expert Carers programme
availability
Improved Access, Tackling inequalities
Meeting needs of Patients with long term
conditions
Users and carers get choice of services as close
to home as possible
Prevention of avoidable hospital admissions
Local partnerships between health and social care
to deliver better services
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Services closer to home

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Empowering enabling individuals with long term
conditions to take control of their health
Regular Secondary care admissions
High of professional care
High-risk cases
Risk management in primary care e.g. Community
Matrons
Professional care
Equally shared care
More complex cases
Mainly managed in primary care including GPSI
Self care
7080 of the people with long-term conditions
High of self care
Diagnosed by primary care, health maintained by
annual disease reviews Patients enrolled into
Expert Patient schemes
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we could expect people who have gained
self-management skills to make around 40 fewer
visits to their GPs and 17 fewer visits to
outpatient clinics. We can also expect 50
reductions in length of stay in hospital, and
days off work because of sickness

http//www.expertpatients.nhs.uk/public/default.as
px?loadpublications
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Dr Ian Greaves, Gnosall Medical Centre, SW Staffs



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What does all this mean to pharma?
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Selling in a post-White Paper NHS world

• Market Intelligence/Data/Joint business planning
• Whole primary and secondary care team need to
  know whats on the PCTs/each PBC clusters
  service re-design agenda and produce an
  integrated plan for working priority clusters
• Networking/Influencing
• With key individuals in high potential clusters
  or high current users
• Between secondary care and primary care KOLs
• Provide redesign e.g.s from elsewhere
• Network your KOLs with innovator KOLs from areas
  that have already successfully redesigned a
  similar service
• Facilitation/Partnership
• Meetings organising, facilitating, funding
  practice/cluster/super-cluster/PCT/SHA/national
  level
• With board/steering group stakeholders
• With full service redesign group
  (multidisciplinary)
• With full cluster group ie all practices
  represented
• Evidence for guideline/formulary inclusion inc.
  health outcomes data
• Medical Information evidence pack for your
  product
• Local/national KOL endorsement in person plus
  copies of existing protocols
• Flexible Pull Through/Data/local marketing
  capability
• once product on guidelines, pull through by
  publicising guidelines in calls at meetings, etc
• Production of locally approved materials

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Who are pharmas customers in a PBC driven market?
Other hospital- Based advocates
Area Px committee members
Consultant KOL Product Advocates
PBC Cluster Board Lead GP
GPSI in area of Interest to your product
GP PBC Cluster Board member
GP PBC lead for practice
Director of Adult Social Services?
GP lead in disease area
PCT PBC Commissioning manager
GP Senior Partner
PCT pharmacist Medicines Management team
PCT educational lead Protected learning time
Director of Public Health (NHS/LA)?
GP Partner
Community Nurse Specialists inc matrons
Salaried GP
Expert Patient Tutors?
Other PBC Cluster board members
Practice Manager

• Prescribing
• Practice Nurse
• variety of grades
• specialisations

Valued added Service providers Improve access
e.g. training
Practice Nurse - non prescribing
Community Pharmacists (extended
service Provider?)
Potential Rxer
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Partnering opportunities

• 90 of practices are part of a PBC group the
  new PCGs
• 95 of practices have a PBC business plan you
  need a copy
• Saving money is a key driver in 2006-7 beware!
• Providing more services outside hospitals is a
  key driver
• Service redesign is complex, requires excellent
  networking
• and communication skills (including local
  marketing)
• PHARMA has the skills and resources the NHS
  needs
• Patient education is key a Pharma strength
• Good intelligence is paramount you need data
  sources and skilled manpower to seek out
  opportunities for early engagement
• More formularies will result from PBC evidence
  based, peer reviewed prescribing will become
  widespread in primary care, requiring an account
  management approach