View of the future

1
View of the future

• Dr Sarah Chilvers
• Chief Executive,
• ChilversMcCrea Healthcare

2
Who are ChilversMcCrea Healthcare?

• Set up in 2001by Sarah Chilvers and Rory McCrea
• Commenced provision of General Practice in 2003
  as an NHS organisation albeit a limited company
• Now has contracts for and provides NHS GP
  services in 20 practices across the country from
  Leeds to Southampton

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Nottingham
Leeds
Harlow
Manchester
Chelmsford
Stoke on Trent
Milton Keynes
London
Brighton
Southampton
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ChilversMcCrea Healthcare

• Always looking to provide high quality and
  innovative solutions to difficult healthcare
  problems we filled the gap where it had become
  difficult to recruit GPs
• Use a skill mix model and work closely with
  several partner organisations and a range of
  healthcare professionals
• Exploring telemedicine opportunities and other
  community based options

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Current providers of COPD care

• The 6 of men over 65 years old who have COPD, to
  take an example, are cared for by
• Acute Trusts
• GPs
• Specialist nurses
• Locally Enhanced Services
• Pharmacists

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Whats going to change?

• At the moment most of those listed above are all
  NHS
• We are now seeing a much wider range of providers
• Third sector eg mutuals, social enterprise,
  charities
• Private sector eg DGHs run by PLCs
• Public sector will still remain

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The shape of services 1996
Health authority
Purchaser the what
Provider the how
GP
GP
GP
GP
Institutional sector
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The shape of services 2006?
Sets policy Commissions for populations Delive
rs it all providing some, sub-contracting the
rest
PCT
Purchaser
Provider
Provider
Provider
Provider
Provider
Institutional sector
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The shape of services 2007?
PCT
Purchaser
Provider
Provider
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Private providers

• Are existing in
• DGHs ie running medical wards, outpatients etc
• Primary Care
• ISTCs
• Service contracts with private providers
• Variety of funding arrangements
• Different sizes PLCs, Ltd Cos, Partnerships
• Different interests Profit, non profit,
  charitable
• Different strengths funding, know how, clinical

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What is driving the developments?

• Policy initiatives such as
• Payment by Results (PBR)
• Choose and Book
• Alternative Providers of Medical Services (APMS)
• Independent Sector Treatment Centres (ISTCs)
• Practice Based Commissioning (PBC)
• Connecting for Health
• The White Paper Your health, your care, your
  say

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Not all policy pulling in the same direction

• Payment by Results is drawing people into the
  hospitals
• Practice Based Commissioning is taking peoples
  treatments out of hospital
• Both driven by commercial interest of NHS
  organisations (and private)

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This is leading to Fragmentation

• The paradigm is changing
• What we used to know and understand regarding who
  was providing which services
• The system is becoming much more dynamic
• Organisations form and change collaborate and
  part
• A market is being created
• Each organisation will use different ways of
  doing things

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Potentially to innovation

• A whole spectrum of provision is being generated
• From High St provision to acute hospitals teaming
  up with PLCs
• Not necessarily original initiatives
• early discharge schemes were piloted in the late
  1980s
• The leverage and opportunity is available
• Through the funding and policy initiatives

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Example of the spectrum of provision
LTC Shops
Web / phone Solutions
Hospitals
Telemedicine
GPs
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NHS providers will need to think differently

• There will be a drive to address
• Prevention
• Treatment
• Emergency management
• In a different way
• GPs in particular will not be able to rely on
  the traditional business of general practice long
  term conditions management being in their arena

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Practice Based Commissioning will ensure that .
. .

• There will be a greater focus on delivering
  better outcomes around
• Emergency admission avoidance
• Early discharge
• Long term conditions management
• GPs will need to show much imagination and also
  take commercial risk to grasp the opportunities

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As an example for someone with COPD

• Telemedicine might provide a patient with
• Home oxymetry
• Home spirometry
• Link to a call centre via internet or phone
  connection
• Press button technology
• Telephone advice on how to change medication when
  readings suggest need
• Ultimate goal is hospital avoidance and patient
  satisfaction and wellbeing

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Whats in it for patients?

• Confusion possibly
• Better quality providers possibly
• Greater mobility, choice and flexibility quite
  possibly
• Greater range of access points yes
• Loss of the old family doctor and consultant who
  you always knew and loved maybe

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Is all this change towards a range of providers
and market place approach so bad?

• For COPD patients
• They may become more self caring
• Greater access to supportive information
• They could be better supported by a variety
  health professions
• At places and times more convenient to themselves
• The sensitivity of their medication changes could
  match more closely to their need

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The challenges

• Are to the policy makers to ensure that the
  tensions pull in the right directions
• The commissioners to put in high standards and
  quality measures
• The providers to work within the market place
  responsibly
• The health professionals to work closely together
  
• Managers to provide effective communication and
  coordination

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Dr Sarah Chilvers Chief Executive

• Tel [phone]
• 01279-451555
• www.chilversmccrea.co.uk
• sarah_at_chilversmccrea.co.uk