Better, sooner, more convenient health care in Midlands

88. Funding requirements“If clinicians are to be held to account for the quality outcomes of the care that they deliver, thenthey can reasonably expect that they will have the powers to affect those outcomes. This meansthey must be empowered to set the direction for the services they deliver, to make decisions onresources, and to make decisions on people.” - Professor of Surgery, the Lord Darzi, ParliamentaryUnder Secretary of State, Department of Health UK. NHS Next Stage Review Final Report, 2008.To support the establishment of a regional view and commissioning approach some brave stepsneed to be taken with existing agreements. The Midlands Network will require a one contract, oneplan starting point. To facilitate this the following arrangements will need to be in place byJuly 1 st , 2010.• Consolidation of the national PHO agreement for the five PHOs in one Midlands RegionalAgreement. This contract would exist between the Midland Commissioning Board and a LeadDistrict Health Board.• Existing essence of services within A-I to be retained – however greater flexibility agreed around“the rules” for a range of service lines eg: CarePlus, SIA , HP etc.• Removal of FFS lines and replaced with capitation arrangements linked to performance againstregional promises.• Schedule J local variations to be retained by agreement and passed directly through to existinglocal services.• New schedule ‘M’ to capture a range of new arrangements including:a. Pharmaceuticals and Laboratories arrangements;b. Devolution of service funding to enable MCB to “purchase” services to support theachievement of the regional promises. (the actual service lines transferred will be linked tothe individual business case development);c. Regional quality plan;d. Integrated Family Health Centre service specifications and related funding (this will be linkedto the greater flexibility in sections A-I and J);e. “Capital Credit line” 0 to low % interest for capital developments linked with agreedIntegrated Family Health Centre establishment (up to $3.47m);f. Establishment funding for the MCB and MCGG.For the MCB and the network to be effective all conversations around service planning and fundingwill need to be lifted to the regional level as the starting point. Within this process will be themechanisms for developing and retaining local solutions at a local level.Proof of concept and effective due diligence around fresh ways of doing things and devolution willbe key prior to the rebuilding of any services. In many cases while the budget is being moved to theMCB the current providers will remain provider arm based, but with a stronger link to primary andthe patients in the community. To manage concerns and risks associated with this, a no change ofprovider period of two years will be locked in.Flexible funding streams will be applied to see the development of true interdisciplinary teams inboth co-located and virtual settings.• The current base level of funding will be maintained across all first level setting.• As geographical localities indicate a willingness and desire to develop Integrated Family HealthCentre capacity a range of assessment tools will be applied to identify key indicators such as ASRdemographics, disease burden, existing service configuration costs, workforce elasticity etc.• Stocktaking of surrounding services will also occur to draw in other interested parties but alsoidentify referral pathways.116