Commissioning for People with Long Term Conditions

1
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
2
Welcome Introductions Dr Ian Banks Professor
European Mens Health, Leeds Metropolitan
University
3
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
4
Texting Instructions

• Use your keypad to write and send text messages
  (like writing a text message on a mobile phone)
• The c key will backspace/delete letters
• The 0 key is used for a space character
• When you have finished, press the large button to
  submit

5
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
6
Commissioning for Peoplewith Long Term Conditions

• Mark Britnell
• Director General of Commissioning System
  Management

7
Key points

• Focus on long term population health
• Care closer to home
• PCTs are leaders of the local health service
• PCTs will be investors in health
• World class commissioning will add years to life
  and life to years

8
Personalised services Patients at the heart of
services Clinicians driving improvement Renewed
LTC focus
9
(No Transcript)
10
Stronger voice for individuals
communities Patients as Partners Increased
support for self care Service users and carers
have more say person-centred care
planning Integrated health and social care
services
11
Putting people at the centre of
commissioning Understanding the needs of the
population Sharing and using information more
effectively Assuring high quality providers for
all services Developing incentives for
commissioning for health and well-being
The Commissioning Framework for Health and
Well-being
12
World Class Commissioning

• Vision purpose to excite
• Build consensus on characteristics
• Starting from a great place for whole population
  health improvements
• Commonwealth Fund
• Essence of the NHS
• Strength of primary care
• All population covered

13
World Class Commissioning
Adding years to life and life to years
14
(No Transcript)
15
PCT Commissioning competencies
Work collaboratively with local people partners
Continuous engagement with patients carers
Leads strong continuous clinical engagement
Sets 5 year strategic health outcomes
Shapes and reforms the market
Outstanding knowledge management
16
Information is vital to . .

• Predict intervene sooner
• Manage care by joining services together
• Helping people to self care
• Assess the long term health needs of the
  population . . .and then make intelligent,
  informed priorities

17
What does this mean for Long Term Conditions

• Putting People at the Centre
• Greater self care
• Access to good information and advice about local
  services and health
• Individual budgets
• Understanding Needs of Population and Individuals
• Population
• Joint Strategic Needs Assessment
• Individual
• Predictive Case Finding
• Person-centred assessment and care planning

18
What does this mean for Long Term Conditions

• Assuring high quality providers for all services
• Commissioning focused on outcomes
• Wider range of providers from all sectors
• More innovative provision, tailored to needs of
  individuals
• Integrated working across health and social care
• Developing incentives for commissioning
• Local Area Agreements brining together local
  partners
• PBC used to design care packages that suit
  individual needs
• PBC spending on non-health interventions
• Direct payments/Individual budgets

19
LTC we have more to do

• Initial focus has been on emergency bed target
  and case management still important
• Rationale for need to improve LTC care still
  exists
• World Class Commissioning LTC requires whole
  system transformation
• Focus on better care for all people with LTCs

20
We can transform lives

• Commissioning key to achieving better LTC care
• Better experience and outcomes for people with
  LTC
• Today about learning from others spread some of
  the how to
• Gains to be had are huge adding years to life
  and life to years

21
Thank you
22
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
23
Clinical engagement

• Dr Alf Collins
• Consultant in Pain Management Consultant to PTW
  Programme
• Somerset

24
My clinical work pain management
Managing life with pain
Managing pain
25
Our service we are not perfect!

• A musculoskeletal interface service that sees
  6,000 new clients per annum
• All people initially seen by a physiotherapist
• Close collaboration with an orthopaedic
  department of 10 consultants

26
The underpinning philosophy

• To ensure that the people we see
• are empowered to live as fruitful and independent
  a life as they would wish
• share decision making re the treatment or
  support they receive, informed by tailored,
  helpful information

I went to the doctor with a problem. I came
back with a disease
27
Goal-driven recovery growing confidence

• Reasonable goals
• Self-adjustment (response shift)

Self-management skills acquisition
Acceptance Readiness to change
Best evidence disease/ symptom management
28
The psychology of living with a LTC
Ongoing health-related suffering despite optimal
medical management
29
The psychology of living with a long term
condition
thoughts
feelings
Social roles
beliefs
Actions/behaviours
30
The psychology of living with a long term
condition
impairment
thoughts
Symptoms,
context, meaning
feelings
Afferent input
Social roles
beliefs
Actions/behaviours
31

Fear and avoidance behaviour
Culture, development
symptom
Anxiety, fear
Worse symptoms at lower thresholds
Illness beliefs
Doctors
Experience, conditioning
Disuse, Disability, Depression
Activity avoidance
32
Cellular pathology
Organ pathology (impairment)
Symptoms
Disability
33
Impairment and disability
disability
impairment
34
Impairment and disability
disability
Disabling conversations
Enabling conversations
impairment
35
All this can be very difficult for some
clinicians

• Challenges supremacy of disease theory
• Compartmentalises biomedicine into just one
  aspect of an individualised care plan

36
(No Transcript)
37
The therapeutic imperative a matter of
expectation
Of course Ill order another test
Please help me
38
Being a frontline clinician
Needs of DH/SHA/Trust
Needs of individual patients
Needs of service
Need to maintain professional standards
Need to nurture self and family
39
How can we help you to align these needs, so
they dont compete and so your life is easier?
40
Co-create services

• Support clinicians in working with patients
  as partners in service redesign

Clinical evidence and expertise
Patient experience and expertise
Co-Created services
What skills or training do you feel you need to
be able to work in this way?
41
Co-produce outcomes

• Support clinicians in working in partnership with
  patients to share decisions about desired
  outcomes from all clinical encounters

A meeting of 2 experts
Shared decision making
Co-Produced outcomes
42
What are the wins for clinicians?

• Co-created services
• Needs of individuals and populations are aligned
• Freshness and vitality of working strategically
  with patients as partners
• Shared decision making/co-produced outcomes
• Shared responsibility, shared risk, shared work!
• Difficult patients (difficult consultations)
  become rare indeed
• Less stress all round

43
A challenge

• The professional agenda
• Evidence based care/treatment
• Professional guidelines
• Systems and pathways

• The agenda of a person with a LTC
• Individualised care
• Values and beliefs taken into account
• Mental model for condition may not match the
  medical model

PCP
Communication skills healthcare partner and
navigator
44
What is the key to engaging clinicians?

Engaging patients total collaboration. The
Wanless fully engaged vision
45
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
46
QA Session
47
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
48
(No Transcript)
49
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
50
Welcome Back Feedback Dr Ian Banks Professor
European Mens Health, Leeds Metropolitan
University
51
Workshop Themes Messages

• Involvement rather than consultation
• Personal care plans should be seen as the
  smallest unit of commissioning, this will enable
  practices to support commissioners, particularly
  in relation to hidden patients
• Let patients own and take responsibility for
  their own care management
• All agreed clinical champions, management
  leaders and expert patients are required to
  deliver effective service redesign
• Break down barriers with secondary care
• Why are PCTs spending money on other risk models
  rather than PARR, which is free?

52
Commissioning for People with Long Term
Conditions Wednesday 19th September 2007 The
Brewery, London
53
After the event

• If you would like to receive a copy of the LTC
  Compendium please ensure you complete the form in
  your event bag. Please leave with PCC upon exit
• Detailed workshop feedback will be emailed to all
  attending delegates
• Text questions received today and tomorrow will
  be answered and circulated
• Delegate contact list including email addresses
  will be emailed to all delegates please advise
  conference organisers or email events_at_pcc.nhs.uk
  by cop Thursday if you do not wish for your
  details to be shared
• We welcome feedback and an online questionnaire
  will be emailed to all delegates, please complete
  this as we really value your feedback
• All presentations and voting results will be
  available for download in the next few days from
  www.primarycarecontracting.nhs.uk/events website

54
Thank-you to LTC Team, Department of Health for
organising the events Primary Care Contracting,
i4 Events, IML and The Brewery for supporting the
events Thank-you for attending
55

• For more information, please go to
• www.dh.gov.uk/longtermconditions
• www.primarycarecontracting.nhs.uk/events