This presentation was developed in the fall of 2010 following on from the UK Government's publication of "Equity & Excellence: Liberating the NHS". Whilst much has changed since then, a number of the key elements and challenges remain the same. For an up-to-date view on the risks and opportunities these changes represent, please contact Simon Morioka or Jonathan Ellis in our UK Health team.

1. Overview of “Equity and excellence: liberating the NHS” This presentation was developed in 2010 following the UK Government's publication of: "Equity & Excellence: Liberating the NHS" Whilst much has changed since then, a number of core elements and challenges remain the same. For an up-to-date view on the risks and opportunities these changes represent, please contact Simon Morioka or Jonathan Ellis in our UK Health team. www.privatepublic.co.uk

2. Overview of “Equity and excellence: liberating the NHS” Parliament Department for Health NHS Commissioning Board GP Consortia Monitor Providers Patients, Citizens, Customers, Voters Care Quality Commission Local Authorities Local HealthWatch HealthWatch England Public Health Service Regional Partnerships Greater London Authority The White Paper Equity and Excellence: Liberating the NHS sets out the Government’s strategy for the NHS. Our intention is to create an NHS which is much more responsive to patients, and achieves better outcomes, with increased autonomy and clear accountability at every level. Department of Health Consultation Document July 2010

4. The NHS Commissioning Board will allocate resources to GP consortia on the basis of need.

5. Practices will have flexibility to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality.

6. The NHS Commissioning Board will have a duty to ensure comprehensive coverage of GP consortia, and we envisage a reserve power for the Board to assign practices to consortia if necessary.

7. a maximum allowance to cover management costs

8. ...a proportion of GP practice income should be linked to the overall outcomes that practices achieve collaboratively through their role in a commissioning consortium

9. This means practice-level budgets combined at consortia level, separate from GP practice income but affecting it based on consortia outcomes

11. Replacing 151 Primary Care Trusts (with 80% of the NHS’ budget) and 10 Strategic Health Authorities

12. New shadow organisations from April 2011, with full responsibility from April 2012

14. urgent and emergency care

15. out-of-hours services

16. most community health services

18. other family health services

19. dentistry, community pharmacy and primary ophthalmic services

20. national and regional specialised services

21. maternity services

23. information: we will work with the profession and the wider NHS to identify how best to support consortia in the significant challenge of accessing accurate, real-time data that can be translated into information to support efficient and effective care along the patient pathway and to understand the relationship between patient needs, service provision, health outcomes and financial expenditure

28. Local Authorities and GP Commissioning “Doctors are a powerful professional group whom councils will need to approach with both firmness and care.” Tony Travers, Director, Greater London Group, London School of Economics, LGC July 2010 Survey Source: LGC 29 July 2010, Survey of Adult Social Services Directors, 22 respondents

30. All NHS trusts to become Foundation Trusts (social enterprises)

31. No more private patient cap on income

32. It will be made easier for Trusts to merge

33. There will be an “any willing provider” model for community services

35. Implies some organisations will be successful, including current NHS providers which will be able to grow both the public and private sector sides of their businesses

37. Choice of named consultant-led teams and treatment by April 2011

38. Choice of treatment and provider for certain mental health services by April 2011

39. Choice of practice - patients to register with any GP “with an open list” from 2012

40. Choice of care for long-term conditions and end-of-life carePatient choice of treatment and provider for the “vast majority” of NHS services should be the norm no later than 2013-14 Source: Department of Health White Paper, “Equity and excellence: liberating the NHS”

42. Our proposed model will not mean all GPs, practice nurses and other practice staff having to be actively involved in every aspect of commissioning... It is likely to be a smaller group of primary care practitioners who will lead the consortium and play an active role in the clinical design of local services, working with a range of other health and care professionals.

43. ...consortia will be able to employ staff or buy in support from external organisations, including local authorities, voluntary organisations and independent sector providers, for instance to analyse population health needs, manage contracts with providers and monitor expenditure and outcomes.

45. Current projections for PCT provider arms Vertical Integration Acute Trust Vertical Integration Mental Health Trust Brent City & Hackney Barking & Dagenham Croydon Bexley Ealing Camden Haringey Enfield Harrow Greenwich Islington Community Foundation Trust Havering Lambeth Social Enterprise Hillingdon Lewisham Westminster Newham Southwark Bromley Kensington & Chelsea Redbridge Sutton & Merton Kingston Waltham Forest Wandsworth Hammersmith & Fulham TBC Richmond Barnet Tower Hamlets Hounslow

46. Areas of community healthcare focus social care mental health rehabilitation services minor injury district nursing nursing homes podiatry family planning respiratory nursing child protection offender health specialist nursing diabetes TB nursing rapid response health visiting occupational health school nursing sure start respite nursing 24 hour nursing physio continence dietics dental dermatology learning disability speech therapy anti-coagulation copd tissue viability

47. Potential competition to existing providers and competitive factors NHS Commissioning Board GP Consortia Buyers Local Authorities Introduction of Tariffs GPs Local Authorities European Union Charities Social Enterprises Private Sector

48. contact details Private Public Ltd The Pyramid 31 Queen Elizabeth Street London SE1 2LP Tel 020 7692 4851 Fax 020 7788 3455 Web www.privatepublic.co.uk Email info@privatepublic.co.uk For furtherenquiries, please contact: Simon Morioka, Managing Director simon.morioka@privatepublic.co.uk Jonathan Ellis, Senior Consultant jonathan.ellis@privatepublic.co.uk Private Public Ltd is a limited company registered in England and Wales no. 6405704 VAT Registration no. 924 1781 25