The Chairman of the PCT, Fred Hucker, Sonia Mills, the Chief Executive and Jonathan McWilliam, Director of Public Health, will brief the Committee on the latest developments in relation to the restructuring of NHS services in Oxfordshire. John Jackson, Director for Social and Community Services and Nick Welch, Head of Major Programmes for Social and Community Services will also attend for this item.
The purpose of this item is to help members understand the latest developments in the restructuring of local NHS services including the possible implications of “clustering” Oxfordshire PCT with Buckinghamshire and Milton Keynes PCTs (the latter may be moved to a different cluster).
Minutes:
The Chairman and Chief Executive of the PCT were joined by the Director of Public Health and the Head of Major Projects from the County Council to bring the Committee up to date on the latest position with regard to the restructuring of the local NHS and other matters.
The PCT Chairman emphasised the fact that, whatever is happening in changes to the local health economy, the PCT will remain accountable for commissioning quality services until April 2013. There are three main tasks at present:
i Managing the local health economy – i.e. the “day job”
ii Developing the Oxfordshire GP consortium
iii Creating the “cluster” authority with Buckinghamshire as required by he Department of Health
The Chief Executive expanded on these comments as follows:
GP Consortium
Following a report at the last HOSC meeting the GPs choice to create one countywide Consortium has now been confirmed with strong localities as a significant component. Six or seven localities will have devolved budgets within the Consortium with leaders appointed at locality level who would sit on the Consortium Board.
£2.5m will be available to the Consortium for 2011/12 to pay for additional running costs for the Consortium to develop its delivery capacity. This reflects the £2 per head required to be allocated as per the NHS Operating Framework which also indicated a financial figure for Consortium of £25 – £35 per head when fully established, but this would include all running costs including, for example, leases and external contracts.
The Consortium will have to deliver national priorities. How delivery takes place will be decided by the locality groups and patients should have an input into those decisions.
It is planned that the consortium will develop into its form during 2011/12 and run in shadow during 2012/13 and will formally come into being from April 2013 when PCTs finally are abolished as the statutory base. The launch of the Consortium, its plans and work plan is scheduled for 27 January at the Kassam Stadium. All GPs in Oxfordshire are invited, together with relevant external bodies. The HOSC Acting Chairman will be attending the launch.
PCT Consortium Transfer of Responsibilities
The Consortium will have to take on the work programme of the PCT related to the national funding position and the need for service redesign to release resources to fund emerging and new priorities. Consequently, the internal structure of the PCT is changing to reflect this merging of work functions as GPs become increasingly engaged in the mainstream PCT objectives. The PCT will also be seconding staff to work directly as Consortium staff to speed up the transition and involvement, particularly in the £35m savings programme the PCT has to achieve in 2011/12.
Everything must be done against the background of a reducing budget.
PCT Clustering Arrangements
The clustering in this part of South Central will be Oxfordshire, Buckinghamshire and Milton Keynes [Note: this has subsequently been changed to Oxfordshire and Buckinghamshire only] and there will be Chief Executive and Executive Team appointments commencing in March. There will be one Chief Executive for the cluster. Consequently the PCT functions will be reshaped under a new Executive Team although the PCTs will remain as the formal legal structure until their abolition in 2013.
Compared with the 151 PCTs there are likely to be 500 GP consortia and so a number of them will be too small to be internally sustainable and will need to commission support from other organisations to deliver their key functions. Oxfordshire will have choice due to the size of the Consortium and that was one of the reasons that this solution was pursued. The impact of clustering will increase the speed of transition and indeed the role of the cluster is to ensure consortium development and also to have oversight of 2011/12 and 2012/13 Operating Plans and ensure successful delivery.
Provider Organisations
a NOC/ORH Merger
The PCT is supportive of this merger as clinical benefits should be derived and also internal savings which will support the providers in achieving their tariff efficiency challenge, i.e. all providers are subject to a 2% price drop in 2011/12 compared with 2010/11. Timetable for the merger is understood to be summer 2011.
b CHO/OBMHFT
This is proceeding well. Co-operation and Competition Panel approval had been gained prior to Christmas and Monitor is positive that the merger can proceed. That confidence arises from their latest investigations and trust meetings. Timetable is April 2011.
c Foundation Trust Pipeline
All providers have to attain Foundation Trust status or alternatives which allow the same goal to be achieved and so ORH is aiming for this in April 2013. From the PCT perspective issues which have to be resolved are:
d Ridgeway Partnership
This Trust is aiming for FT status. It will be marginal due to its size and the potential downside of losing contracts, particularly those related to social services; those which are more price sensitive than the more fixed tariff world of the NHS. Its goal, if successful, is November 2011.
PCT Restructuring
Meanwhile the PCT is required to reduce its running costs and this week issued a consultation document within the PCT for changes to its structure which enables it to reduce posts to meet its savings target. £4.3m has to be saved and this, after a range of measures, could mean a number of posts being removed compulsorily should other means not be successful.
County Council Perspective
The Head of Major Projects explained that the County Council, the PCT and GPs are working positively to develop the consortium. The present Health and Wellbeing Board and Children’s Trust will have to change and joint arrangements and pooled budgets will need to be carefully managed.
The new Health and Wellbeing Board will be the subject of a formal paper soon with an aim for it to be established by April. Members agreed that they would expect that the Board would be subject of scrutiny by the HOSC.
HealthWatch would be represented on the Board and would ensure that patient experiences and views would inform the Board’s work.
Public Health
The Director of Public Health presented a paper that identified the following strengths, weaknesses, threats and opportunities;
Implications of Coalition Proposals for Public Health in Oxfordshire : January 2011
Overall since the last HOSC update in August, the strengths and opportunities have increased and the weaknesses and threats have diminished.
Further information following member questions
The following statements were made in answer to a number of questions from members:
In the summer GPs will elect locality leaders to form the board of the new consortium and they will create the leadership model. The model will then have to be agreed by the national NHS Commissioning Board.
Budgets will be devolved as far down as possible to GPs but consideration of just what would be devolved and to whom is still going on.
The cluster will have a single Chief Executive and executive team but local issues and partnership working will continue to be dealt with locally as will Public Health. Pooled budgets and joint arrangements would be unaffected.
The cluster should not lead to any increase in costs. So far Oxfordshire PCT has remained comparatively stable but this could change as the cluster comes into being and staff begin to move across to support the consortium. Senior managers continue to work hard to maintain staff morale and motivation.
Locality working should not lead to a “post-code lottery” although there will inevitably be variations across the County simply because, for example, the City is very different from Henley and Goring. However the principles of providing the best quality health services for all would be maintained. The national Operating Framework will set priorities and consortia will be required to deliver those priorities. How that is done would be decided locally and patients would have an input into those decisions.
Accountability and leadership will sit with GPs but they will need the support of skilled and experienced managers. Consultation with patients and the public is very high on the agenda and GPs will have to decide how they intend doing that.
The change to consortium commissioning should not put small rural practices at risk. Work is ongoing to decide how funding would be allocated but, if it were to be done via a formula that relied on population, there could be difficulties related to the volatility of cost at a small population level.