PCT Manager Event

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PCT Manager Event

• ISTCs and the NHS

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Building stronger partnerships

• Delivering the vision
• Quality innovation
• Capacity choice
• Building on experience
• ISTCs
• Gsup
• Choose and book
• The future a long term partnership

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The opportunities

• Innovation
• Additionality
• Logistical strengths
• Investment in new facilities
• Transfer of risk
• Information on quality
• Opportunities for training

Overall Prices down Waiting times down
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Practice based commissioning

• Control
• Responsiveness
• Focus
• Incentivisation
• For a good partnership, need to understand each
  others perspective
• PCT / Practice / ISP

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Not PFI

• But a partnership
• It is not in the either partys interest to rip
  off the other
• Work together or dont work at all

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• Challenges for Success
• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• Need alignment for best result
• Need to hold both sides to account

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Minimise Surprises for private sector

• Local Government is not the DoH
• DoH is not the NHS
• The PCTs are not the SHAs
• Trusts PCTs have conflicting agendas
• Consultants have complex agendas
• Private practice
• Professional standards (clinical care and
  training)

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Surprises for Private sector

• Variations in Geography
• Analytic competence
• Clinical involvement
• Time sensitive shifts in priorities
• Plans (new build) fail
• WL suddenly found

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• What the IS brings
• Opportunities for the NHS

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Information

• Real time information on activity
• Outcomes data
• Monthly performance review
• Monthly incidents reviews
• Process information for partner trusts
• Data on experience for each clinician
• Price data for consumables for partner trusts

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Opportunities for the NHS

• Frameworks
• Outcomes the NHS TC programme
• PROMs
• IT IS
• Learn from IS experience especially on activity
  and costing

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• Why is it the way it is?
• How should it be?

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Additionality

• Understand history, politics and consequences
• What has often happened
• Local NHS asks for Additionality flexibility
• Local Doctors want Additionality
• If IS helps locals, who want involvement, it can
  be a breach of contract
• IS will always want to accommodate local NHS
• Need clarity to protect IS and NHS

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• Safety
• Accuracy
• VFM

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Safety

• ASA issues
• Shared judgement to avoid claims of cherry
  picking
• Experience allows better outcomes
• Evidence only refuted in England

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Case mix how to do better

• Wave 1 Experience
• First cut (juniors with no understanding)
• Second cut (seniors with political insight)
• Third cut Into contract (first effective, rushed
  input)
• Delivery revision (first clinical input)
• Logistics driven revision (first viability test)
• Impact on scheduling
• Who picks up the cost?

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• First principles
• Failure in systems

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First principles

• Case load of NHS offers opportunity for
  separation of electives for better results
• Surgeons have been asking for this for years
• Should allow redeployment of DGHs for things only
  they can do
• Then, fixed volumes, specified cases and agreed
  times allow aggressive pricing leading to good
  value for money for public purse
• NHS TCs should also be able to do this (21)
• If TCs fail
• TCs pay
• If commissioners fail
• They pay

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Failure to track patient flows

• We have to commit pay, to get the work done in
  advance this allows low price to NHS
• The doctors have to be scheduled and leave other
  work
• If NHS work does not arrive on time we still
  carry the cash flow risk as our suppliers are
  small businesses
• Because NHS insisted on Additionality we have to
  pay so we have to charge. Flexibility on
  additionality would make this easier for both
  sides
• Logistical failure is also putting NHS TCs at
  risk

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests

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Financial rigour

• Monthly tracking of performance in real time
• All leases treated as committed expenditure
• Our suppliers have to be paid
• Financial analysts follow every months figures
• We have to cost every procedure and consumable
  (working with NHS Docs?)

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• Patients waiting v Public health
• Elective care v community care
• Outcomes v results
• Who owns the hospitals
• Who employs the staff
• etc

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Where do the patients wait?
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True waits How to do it

• SHAs (clean high level old)
• PCTs (should own data)
• Trusts (hold data)
• Logistics (data control divided)
• Why and how the ISPs want to help
• Avoids payment delay (financial rigour)
• Ops/strategy skills
• Consultants interims
• Protect relationship

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Challenges for Success

• Commitment and purpose
• Information
• Additionality
• Case mix
• Logistics of referral
• Accounting perspectives
• Ideology
• Vested interests
• Related to ideology
• Includes private practice
• Marginals and Fund Holding

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Common Myths

• Risk from transfer to NHS
• Risk from failed delivery
• Risk in financial investment (HCC)
• Risk from delays in build
• Risk from capacity delay
  

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Not PFI

• But a partnership
• It is not in the either partys interest to rip
  off the other
• Work together or dont work at all