London cancer workshop9th March 2011

AgendaTime Session2.00pm Welcome and objectives

2.10pm The model of care

2.25pm Provider network development

2.45pm Question and answer session

3.00pm Coffee

3.15pm Workshop sessionIncentives, strategy and practicalities

4.00pm Feedback and discussion

4.20pm Closing remarks and next steps

4.30pm End of session

Objectives

• To inform providers of the implementation programme• To engage providers in the development of the provider

network model and specification• To outline to providers the timeframe for specification

development and provider network bids • To prompt providers to begin provider network

discussions and bid development

The model of care Chris Harrison

Developing the proposals

• 45 clinicians working over 12 months • Three work areas: early diagnosis; common cancers

and general care; rarer cancers and specialist care• Case for change: December 2009• Model of care: August 2010• Extensive 3-month engagement on proposals – over

85 per cent of survey respondents supportive

The case for change

• Later diagnosis has been a major factor in causing poorer relative survival rates

• There are areas of excellence in London but inequalities in access and outcomes exist

• Treatment and care should be standardised• Specialist surgery should be centralised: common

treatments should be localised where possible • Comprehensive pathways should be commissioned;

organisational boundaries should not be a barrier

The model of care

• Improve early diagnosis by addressing public awareness, GP access to diagnostics, screening uptake rates and health inequalities

• Extended local provision of common cancer services, such as chemotherapy, non-complex surgery and acute oncology

• Further consolidation of surgical services for rarer cancers into specialist centres

• A small number of networks of providers delivering standardised pathways

Provider networks

• Model of care recommends the split of commissioning and provider networks

• Provider networks to deliver comprehensive pathways in response to fragmentation of services

• Concept right but language of networks clouds issue• Integrated cancer systems containing all NHS

organisations delivering cancer services from diagnosis to end of acute care

Workstream Phase oneDec 10–Mar 11

Phase two Apr 11–Mar 12

Phase three Apr 12–Mar 13

1. Public health and primary care

2. Best practice

3. Radiotherapy commissioning

4. Provider network designation

5. Provider network development

Implementation workstreams

Workstream Phase oneDec 10–Mar 11

Phase two Apr 11–Mar 12

Phase three Apr 12–Mar 13

1. Public health and primary care

2. Best practice

3. Radiotherapy commissioning

4. Integrated systemdesignation

5. Integrated systemdevelopment

Integrated system developmentRachel Tyndall

Integrated system designation

• Providers will be asked to respond collaboratively to a integrated system specification

• There will be more than one and fewer than five• Which system they are in will be the provider’s choice• Only providers in a system will provide cancer services• Legal status required for contracting

Services

• Integrated systems will be required to demonstrate how they will contribute to the delivery of the model of care:– Early diagnosis – General care– Common cancer – Rarer cancers and specialist care

Specification

• In addition to services, the integrated system specification will cover 6 areas:– Scope – Governance– Information– Incentives – Culture – Research and education

Standards

• Commissioners will set measures and thresholds to assure quality and drive excellence

Patient experience

Patient safety Effectiveness

Structure

Process

Outcome

Incentives

• Money – Commissioning incentives – Within integrated system – E.g. stroke tariff

• Workforce – Cross boundary working – Clinical leadership

• Reputation – Of system versus of organisation – Performance info across pathway

The givens

• We will change the way we commission to commissioning by pathways

• Only those part of an integrated system will provide cancer services

• Will contain as a minimum all secondary and tertiary care providers

• Some pathways will cross systems• Will demonstrate commitment to implementing model

of care for common and rarer cancer services • Clinically led with an overarching governance board

will manage system as single entity

Timeline

Event/task ByLondon Delivery Group 31st January 2011

Announcement of specification development process 8th February 2011

Individual meetings with providers Feb/Mar 2011Specification development events Early March 2011

Publication of specifications April 2011Support for bid development Apr/May/Jun 2011

Individual or group meetings with providers Apr/May/Jun 2011

Deadline for bid submission 30th June 2011

WorkshopIncentives, strategy and practicalities Rachel Tyndall

The givens

• We will change the way we commission to commissioning by pathways

• Only those part of an integrated system will provide cancer services

• Will contain as a minimum all secondary and tertiary care providers

• Some pathways will cross systems• Will demonstrate commitment to implementing model

of care for common and rarer cancer services • Clinically led with an overarching governance board

will manage system as single entity

Group session - incentives

Tables 1 and 4• How should tariffs for the whole pathway be set? • How should prices for the interventions within the

pathway be set? • Should commissioners be involved in setting these

prices? • What are the future capital funding arrangements to

ensure that the required investment takes place?

Group session - strategy

Table 2• How would financial accountability work across the

integrated system? • How would being part of an integrated system with

pathway pricing affect an organisation’s financial strategy?• Will the impact on business models be significant enough

to prompt Monitor’s involvement, particularly for FT applications?

Group session - practicalities

Table 3• What are the information requirements to make the

system work? • What form of contracting will be required for intra-system

activity and flows? • What influence will MFF have on the distribution of work

within the system? • How can it be ensured that the creation of integrated

systems does not add costs to service delivery?

Feedback session

Next steps

• Further workshops with your colleagues• Ongoing work in March on commissioning an

integrated system• Outline specification published in April • Ongoing development of the model beyond April• Bidding stage from April to June • Tailored support available during bid development

• For further information on the case for change and model of care visit www.csl.nhs.uk/publications