Update on NHSCB Key features of (proposed) NHSCB operating model for primary care

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1 Aim to cover Update on NHSCB Key features of (proposed) NHSCB operating model for primary care NHSCB dental commissioning strategy all dental services Concept and context of local professional networks Focus on local dental networks What we have learned from testing local dental networks Value of clinically led dental commissioning Timescales for sign off and implementation How you can (and should!) get involved 1

2 Primary Care Commissioning: a single operating model

3 Focus for the design and transition The safe transfer of functions that must continue Creation of a system capable of transforming primary care services (and ALL dental services) Prioritising the single operating procedures needed on day 1 Ensuring effective alignment with critical interdependencies Clear outcome measures, indicators and a single accountability framework How to encourage and support the right behaviours for a new system to: Be effective from the start Mature over time through continued co-production, which will continue beyond April 2013 Develop in tandem with those around it e.g. CCGs, HWB, PHE, LETBs

4 Proposed operating model Three elements What happens locally (including regions) What happens nationally The interface and relationships between the two key iterative relationship Key features Single system with a consistent operating model Organising principle of quality and safety Clinically led throughout system with local professional networks at more local level Shared values and behaviours and productive relationships Common policies and procedures Clear outcome measures, indicators and a single accountability framework But do not want to stifle local innovation in service and quality improvement

5 NHS Commissioning Board Structure National Support Centre NHSCB Region NHSCB Region NHSCB Region NHSCB Region Local Area Team Local Area Team Local Area Team

6 NHSCB local area teams The local area teams will be responsible for contract management, service development and support functions leading to overall quality improvement. CCGs anticipated to play major role in improving quality of primary medical care and will have a statutory duty to assist and support the Board in doing so. For the other 3 independent contractor groups (dentistry, optometry and pharmacy) local professional networks will be embedded into the local teams to provide local intelligence and expertise into the quality improvement work for primary care For dentistry, local professional networks will play a key role in the development of care pathways and could be the commissioning vehicle for the Board for dental services.

7 LETBs (Local Education & Training Boards) Health and wellbeing boards Patients, carers and the Public Local representative committees Informing needs, demand, supply in primary care PC providers/ Contractors CCGs LPNs Peer review, benchmarking and development to deliver the contract Local intelligence, clinical expertise, innovation and development of integrated care pathways NHSCB local teams (contracting relationship with individual practices) Maximising performance Aggregation of need and assurance of performance NHSCB central Implementation and development plans to reflect local circumstances 7 Strategy, policy, contract, procedure and assurance of achievement of outcomes

8 NHSCB: Commissioning Dental Services The NHSCB will be responsible for commissioning all dental services, primary, community and secondary (inc urgent care and OOH) Single operating model provides a unique opportunity for consistency where it is required (but must maintain flexibility where it is justified and drives innovation) Opportunity to commission dentistry in an integrated way concentrating on care pathways not care settings Key to this is to maximise quality and performance across pathways against consistent measures, including patient outcomes Quality and consistency of dental services key driver for transformation agenda of the future significant move to a preventative approach (dental contract pilots, oral health programmes) and consistent care pathways (advanced care) Clinical leadership is key to our model to deliver continuous quality improvement, consistency and transformation (innovation!)

9 Local dental networks learning from testing and wider system establishment

10 What have we have learned from the past? The evidence suggests that commissioning dental services as opposed to contract management leads to better services and outcomes for patients. Strong commissioners have improved services for patients and achieved greater value for money through clinical engagement and ownership of performance, inefficiencies and improvement activities Commissioners who have engaged clinicians and patients have come up with innovative solutions to local problems and some of those innovations are now influencing at a national level e.g. new primary care contracts, advanced care pathways A pre-occupation with contracts as opposed to the relationship with and between providers can stifle quality improvement and innovation. That a clinician has a greater impact in conversations with providers than a manager and can evidence change as a result of their intervention.

11 Local professional networks: Context and concept An integral part of the NHS CB local offices (NOT an external body or network) No independent status or constitution part of NHSCB local area teams Accountable to most senior clinician/ commissioner in NHSCB local office with professional accountability to CPO Ensure clinical leadership at the heart of the local operating model Delivering functions where clinical expertise and leadership can add most value Commissioning managers and clinicians delivering NHS CB (and wider) vision together Common purpose grounded in national and local priorities with expertise where needed Potential role of local dental network far greater in commissioning agenda than pharmacy and eye care future vehicle for delivering NHSCB dental commissioning agenda

12 What some testing the LDN concept have attempted

13 Testing has shown that we need to support LDN development within clear framework

14 Local dental networks overarching objectives An NHSCB vehicle for clinically led and clinically owned delivery of; Improving and assuring quality and performance CQC, local offices (networks rather than isolated clinical advisors), performance and links to performer list management Local implementation of NHSCB strategy turning national mandate and local priorities into a deliverable implementation plan (within finite resources) Planning and designing local care pathways and dental services - Best use of NHS resources and advocacy for patients on consistency of NHS offer Oral health strategy and oral health improvement for dental services - Best outcomes for patients that reflects local need via JSNA, oral health strategies turning national and local strategy into local commissioning and improvement plans. Clinical and professional leadership and engagement ensuring engagement across all providers, performers, LDCs and wider stakeholders.

15 Local dental networks operating model All dental providers and performers (influence, communications, roll out, embedding) Clinical Networks (clinical expertise for task and finish projects, quality improvement, pathway re-design, strategic development and planning) Core Local Dental Network Team (commissioning managers, clinical quality and network leaders, public health) Core LDN Team - led by clinicians, with priorities focussed in national and local delivery. Driver should be oral health and oral health improvement plans as priorities. LDN Networks opportunities to engage clinicians to lead specific areas of LDN programme. Delivering short or longer term objectives within and between local office areas. Wider opportunities for other interested clinicians to be involved in projects. Wider engagement opportunities for all providers, performers and wider teams to engage with LPN work, two-way communications, implementation across all providers, learning and sharing best practice.

16 Local dental networks: Core team All dental providers and performers, stakeholders Clinical Networks Core Local Dental Network Team Core LDN Team Small team with ownership of agenda across a local area team and links into national and across other NHSCB areas Accountability at local and national level for delivery Employed/contracted clinical time to NHSCB local area team to deliver NHSCB dental agenda within a clear operating framework Professionally accountable to CDO and links to national dental development agenda, including clinical senates and national networks NHSCB likely to formally appoint clinicians to LDN, so current testing arrangements are interim Role and clinical leadership will evolve and develop over time Key priority is quality and performance assurance and improvement Need to clearly distinguish LDN and LDC role they are not the same. LDC invited stakeholder/partner not key core member

17 Local dental networks: Network delivery models All dental providers and performers, stakeholders Dental Networks example models being collected Many models emerging from testing have common key themes Focus and capacity requirements will depend on national and local priorities networks managed by core team Allows flexible and efficient approach to progressing specific areas of programme some networks may be time limited project specific Opportunities for other clinicians and interested professionals to get involved Networks feed other strategic and operational interdependencies via core team Core Team Clinical Networks Core Local Dental Network Team Restorative Oral Surgery Special Care Dentistry Preventative Quality Assurance And Imp STRATEGIC AND OPERATIONAL INTERDEPENDENCIES Patients, Providers, Workforce, Engagement, HWB, JSNA, Commissioning Priorities

18 Local dental networks: Wider engagement All dental providers and performers, stakeholders Clinical Networks Core Local Dental Network Team Clinical and Professional Leadership & Engagement NHSCB local area teams and national support centre will want to establish efficient and effective engagement with all providers and performers and wider dental provider teams Testing has provided some innovative examples of this local web-based networks providing updates and means to engage for wider clinical community Clinical leaders employed within NHSCB local dental networks need ability to bring the profession with them Clinical consensus (as far as possible) on standard and quality of patient care

19 Clinical leadership What we will need from clinicians in local dental networks A progressive approach in thinking, culture and behaviour A commitment and desire to improve quality and services for patients Population view - public health specialists Evidence based approach to clinical effectiveness Strategic and operational skills Objective advisory and decision making Willingness to take action and responsibility Engaging the local profession and local representative committees Ensuring success in new relationships, behaviour and culture

20 Clinical and professional partnerships Emerging local dental networks have involvement and engagement from a wide range of stakeholders and partners; Primary and Secondary Care Commissioners Dental Public Health Oral health promotion expertise Quality and Performance Improvement Leads clinical and managerial Clinical and Professional Expertise Specialist Clinical Input secondary and community care PC clinicians with a specialist interest Clinical Skill Mix (e.g. dental nurses) Health and Wellbeing Board representation Local Dental Committees Workforce and Development deaneries, CPPE (LETBs) Patient and the Public Representation CCG Representation Interdependencies to support as appropriate e.g. Informatics, Finance, PC regulatory experts

21 Local dental networks: measures of success Delivery of clinically owned quality and performance improvement Clinically owned care pathway approach to commissioning dental services Coordinated move to preventative approach and care pathway commissioning A consistent NHS dental offer for patients A consistent and transparent experience for all providers in their contractual relationship with NHSCB Clinical ownership and relevance to commissioning agenda across dentistry A move in culture from compliance to commitment Iterative, clinically developed strategy and policy at national level developed through experience and needs of local area teams, their providers and patients Strong governance, transparency and management of any conflicts of interest

22 Local Dental Network: involvement and influence Steering group and wider networks Shared narrative and vision Expertise that the commissioning system will need Transition and establishment Don t miss the opportunity for Dentistry!

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