Commissioning Newspaper Issue 3 by Commissioning Show 2012

Latest programme inside SEE PAGES 6 & 7

Make a new CONNECTion

SEE PAGE 3

Alastair McLellan to chair CCG debate SEE PAGE 12

A familiar face on Long Term Conditions SEE PAGE 20

www.commissioningshow.co.uk

Issue 3

1000’s of commissioners, 4 healthcare leaders, 1 big debate

4 in 10 doctors need more knowledge The biggest challenge as CCGs work towards authorisation will be to get practices and individual GPs to feel involved, believes Dr Peter Swinyard, Swindon GP and chair of the Family Doctor Association (FDA). ‘If I knew the answer to that I would be one up on Barbara Hakin (managing director of commissioning development at the Department of Health) who said that it will be very difficult to get people to feel it’s ‘their’ CCG rather than ‘the’ CCG,’ he says. The all-consuming nature of the day job and the disillusionment of senior doctors resulting from government reforms of the NHS pension, means that a lot more work still needs to be done to persuade doctors that the new system is going to work.

si, Dr Charles Alestional Chair of the NaPrimary Care Association of

yard, Dr Peter Swin mily Doctor Fa e th of r Chai Association

xon, Dr Michael Di S Alliance Chair of the NH

e Field, Professor Stev S Future NH e th of r Chai Forum

Four healthcare leaders to debate the challenges facing CCGs The quality and patient safety agenda whilst managing finances is set to be a key theme of a leaders symposia sponsored by Capita which closes the first day of the conference. Four national healthcare leaders will give their opinion on the immediate implementation challenges facing clinical commissioning groups (CCGs) and how these problems can be overcome. The debate promises to be stimulating with the speakers including Dr Charles Alessi, Chair of the National Association of Primary Care, Dr Peter Swinyard, chair of the Family Doctor Association, Dr Michael Dixon, chair of the NHS Alliance and Professor Steve Field, chair of the NHS Future Forum. The session will be chaired by Beverley Bryant, managing director of Capita Health.

“The opportunity to share the experience of others facing the same challenges, for me is the most compelling reason to attend.” Dr Charles Alessi The leaders symposium will begin at 18.30 on the 27th June, preceded by a drinks reception. If you would like to attend please contact our delegate team on 02476 719 686.

A FDA survey of its members earlier this year revealed that only four in ten doctors felt they had sufficient knowledge about commissioning and 27% wanted more information to help them participate. continues on page 12

STOP PRESS......... Stephen Dorrell MP to speak at CCG debate

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Complete the Roadmap Competition at the Commissioning Show for your chance to win a car! See our website for more details.

continues on page 9

In association with:

Event sponsors:

Media partners:

STILL TIME TO BOOK

Call 02476 719 686 or visit www.commissioningshow.co.uk/book

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Commissioning is organised by: Unit 17, Exhibition House, Addison Bridge Place, London W14 8XP www.commissioningshow.co.uk Tel: 0207 348 5250 Ralph Collett, Show director Ralph.collett@closerstillmedia.com James Hall, Sales manager j.hall@closerstillmedia.com Dan Harding, Event executive d.harding@closerstillmedia.com Alice Andrews, Delegate manager a.andrews@closerstillmedia.com Sophie Holt, Marketing and PR manager s.holt@closerstillmedia.com Julia Danmeri, Head of operations j.danmeri@closerstillmedia.com Vanda Vokes, Conference and speaker manager v.vokes@closerstillmedia.com Rebecca Royal, Event administrator r.royal@closerstillmedia.com Jo Farrimond, Accounts j.farrimond@closerstillmedia.com Andy Center, Chief Executive a.center@closerstillmedia.com Michael Westcott, Business Development Director m.westcott@closerstillmedia.com Phil Nelson, Commercial Director p.nelson@closerstillmedia.com Jonathan Wood, Director of Finance j.wood@closerstillmedia.com Phil Soar, Chairman

NHS INFORMATION REVOLUTION?

The long awaited information strategy is due to be published in the next few weeks with a promise by the Government that it will bring about an ‘information revolution’. Delegates at the Commissioning Show will be able to find out first hand whether this information revolution really will be delivered. Ailsa Claire, Transition Director Patients and Intelligence for the NHS Commissioning Board Authority, which will be implementing the strategy, will be giving a talk explaining the far-reaching implications of the strategy. Ms Claire says they have been doing a lot of work attempting to understand how data might assist the NHS to do things differently, including changing its relationship with the public. ‘The directorate that we’re trying to set up is about enabling people to make the best decisions they possibly can, whether they are a commissioner, a patient or anyone else in the system. We have been working to gain an insight into how patients want to engage and relate to care services and how the care services can support them to make their own decisions,’ she explains. The Commissioning for Intelligence Programme, which Ms Claire has been leading, has been conducting research into different channels of communication and how informatics can support the business model of clinical commissioning groups (CCGs). ‘We have been looking at what data standards and quality we need to put in to the strategy to enable information to flow through the system. We are working to help CCGs to directly relate to the health of the population they are working with. The information strategy will focus on enabling people to make the best decisions and it will place IT as an enabler.’ Ms Claire says her talk will be directly aimed at clinical

MEDICINES OPTIMISATION AT STAND AA51

commissioners and it will explain what the impact of the information strategy is likely to be. To inform the new strategy, her department has been examining how CCGs get intelligence and information. She says CCG leaders they have talked to have told them that they want a very different flow of information and processes from the ones previously provided by primary care trusts (PCTs). ‘The real problem has been that the primary source of information for PCTs was contract information and what the CCGs want is patient based information which exists but is difficult to get at, so that is what we have got to try and get for “We are working them. ‘Some of the information will be facilitated by the new role of the Information Centre which will be a given a specific new responsibility for data linkage for health and social care. It will therefore become a safe haven where patient data will be made unidentifiable and available for CCGs.

to help CCGs to directly relate to the health of the population they are working with” Ailsa Claire

‘Data will improve. In the past it has been very separate for the NHS and the business model has often had to adapt to informatics instead of the other way around. We now have an opportunity to turn that around and make the provision of data and information a support mechanism for the NHS and not for it to become something imposed on the NHS,’ she promises.

Lansley and Hakin to deliver keynotes Secretary of state for health, Andrew Lansley and Dame Barbara Hakin, national director of commissioning development, will be delivering the closing keynotes on day one and two of Commissioning 2012.

FDB MEDICINES OPTIMISATION AT THE COMMISSIONING SHOW STAND AA51 First Databank’s (FDB™) innovative new Primary Care solution, providing: • Improved prescribing practice • Better patient outcomes • Medication cost savings • Medicines use analytics

‘Productivity through Technology’ stream 27th June at 2.15pm. Come and listen to FDB’s Product and Marketing Director, Mark Treleaven on why the time and technology is right for a sea change in Primary Care medicines management.

fdbhealth.co.uk Tel + 44 (0) 1392 440 100 • info@fdbhealth.com First Databank Europe Ltd is a subsidiary of Hearst Corporation

Andrew Lansle

Dame Babara

Hakin

Dr Charles Ales

Both sessions are expected to deliver the latest insights into national policy and direction, combined with a vision for the NHS going forwards. A Q&A session will follow giving delegates the opportunity to put their questions to the speakers. So no matter what your position on the politics of healthcare, these sessions promise forthright views and some lively debate. Chaired by Dr Charles Alessi, Chair of the NAPC, the keynotes will be held in the 600 seater CCGs of the Future theatre, with coverage streamed live to other theatres to cater for overflow. Andrew Lansley will be taking to the stage at 17.00 on Wednesday 27th June with Dame Hakin on Thursday 28th at 15.35

SEE THE LATEST SHOW NEWS AT www.commissioningshow.co.uk

www.commissioningshow.co.uk

Connect with delegates at Commissioning The Commissioning Connect platform is live for Commissioning Show delegates.* Unique to the healthcare event sector, Connect allows delegates to set their own agenda for the show, ensuring they get to talk about what matters most to them. From fast paced team updates to lively debates, delegates can set a topic, reserve an area in the networking space and search for attendees to invite. It will also bring social networking to the show, allowing delegates to share their discussion groups through Twitter, Facebook and LinkedIn - even inviting their networks and colleagues to join the debate!

Find out more at www.commissioningshow.co.uk

In partnership with

*Connect is for our NHS and public sector delegates, expert partners, associations and media partners.

Federated Sharing in the “Liberated NHS” In the “Liberated NHS”, the need for federated sharing of information is growing. Information needs to flow across CCGs, member practices, Health and Wellbeing Boards, LMCs and hospital Trusts. It must be instantly disseminated and usable, avoiding irrelevance and confusion over versions and accuracy. Traditional solutions are already failing to meet the challenge. Emails with long distribution lists get lost, ignored or deleted when mailboxes are full. Websites can drown the materials relevant to you, or they join a long list of external places to visit for important information. GPTeamNet offers an information management solution for CCGs that instils confidence in information. Our federated approach operates, without duplication, across the CCG and its practices, localities, provider groups and related bodies. Every team has their own GPTeamNet portal providing a robust, secure platform for collaboration. Many CCGs are already reaping the benefits GPTeamNet offers. GPTeamNet provides specific modules for day to day operations. Rather than asking colleagues to visit a CCG site and search for information, offering limited incentive to do so, it delivers benefits to practices as part of their daily activity. CCGs can centrally manage referral guidance for the practices to drive consistency, saving time and money. Users can track who has read and acknowledged information, and use collation and submission features for statutory frameworks. To see GPTeamNet in action and to learn how we can support you, visit us at Stand AA61 at The Commissioning Show 2012 or email ContactUs@gpteamnet.com.

@CommShow

Xarelto®

NOW AVAILABLE FOR

Prevention of stroke and systemic embolism in eligible patients with non-valvular atrial fibrillation

help put a stop to

complicated

ant l coagulation

Visit us at stand B41

to find out which patients could benefit from Xarelto®

Xarelto®15 and 20mg film-coated tablets (rivaroxaban) Prescribing Information (Refer to full Summary of Product Characteristics (SmPC) before prescribing) Presentation: 15mg tablet: Red, round, biconvex film-coated tablets containing 15mg rivaroxaban. 20mg tablet: Brown-red, round, biconvex film-coated tablets containing 20mg rivaroxaban. Indication(s): Prevention of stroke & systemic embolism in adult patients with non-valvular atrial fibrillation with one or more risk factors such as congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischaemic attack. Posology & method of administration: Dosage – 20mg orally od with food. Continue therapy long term provided benefit of prevention of stroke & systemic embolism outweighs risk of bleeding. Refer to SmPC for information on converting to/from Vitamin K antagonists (VKA) or parenteral anticoagulants. Renal impairment: mild (creatinine clearance 50–80ml/min) – no dose adjustment necessary; moderate (creatinine clearance 30–49ml/min) – reduce dose to 15mg od; severe (creatinine clearance 15–29ml/min) – limited data indicates rivaroxaban plasma concentrations are significantly increased, reduce dose to 15mg od & use with caution. Patients with creatinine clearance <15ml/min – use not recommended. Hepatic impairment: Do not use in patients with hepatic disease associated with coagulopathy & clinically relevant bleeding risk (including cirrhotic patients with Child Pugh B & C patients). Elderly, body weight & gender: No dose adjustment. Paediatrics: Not recommended below 18 years of age. Contra-indications: Hypersensitivity to active substance or any excipient; clinically significant active bleeding; hepatic disease associated with coagulopathy & clinically relevant bleeding risk (including cirrhotic patients with Child Pugh B & C); pregnancy & breast feeding. Warnings & precautions: Clinical surveillance in line with anticoagulant practice is recommended throughout the treatment period. In studies mucosal bleedings & anaemia were seen more frequently during long term rivaroxaban treatment compared with VKA treatment – haemoglobin/ haematocrit testing may be of value to detect occult bleeding. Following sub-groups of patients are at increased risk of bleeding & should be carefully monitored after treatment initiation. Use with caution – in patients with severe renal impairment (creatinine clearance 15–29ml/min) or in patients with renal impairment concomitantly receiving other

One tablet, once daily Xarelto®: simple stroke prevention in atrial fibrillation vs warfarin

medicines that are potent inhibitors of CYP3A4 (PK models show increased rivaroxaban concentrations in these patients); in patients treated concomitantly with medicines affecting haemostasis; in patients with an increased bleeding risk such as congenital or acquired bleeding disorders, uncontrolled severe arterial hypertension, active ulcerative gastrointestinal disease (consider appropriate prophylactic treatment for at risk patients), recent gastrointestinal ulcerations, vascular retinopathy, recent intracranial or intracerebral haemorrhage, intraspinal or intracerebral vascular abnormalities, recent brain / spinal / ophthalmological surgery, bronchiectasis or history of pulmonary bleeding. Use is not recommended in patients: with creatinine clearance <15ml/min; receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors; with prosthetic heart valves; for treatment of acute pulmonary embolism. If invasive procedures or surgical intervention are required, stop Xarelto use at least 24 hours beforehand. Restart use as soon as possible provided adequate haemostasis has been established. See SmPC for full details. Xarelto contains lactose. Interactions: Concomitant use with strong inhibitors of both CYP3A4 & P-gp (e.g. ketoconazole, itraconazole, voriconazole, posaconazole, ritonavir) is not recommended as increased rivaroxaban plasma concentrations to a clinically relevant degree are observed (may increase risk of bleeding). Avoid co-administration with dronedarone. Use with caution in patients concomitantly receiving other anticoagulants (e.g. enoxaparin), NSAIDs (including acetylsalicylic acid) or platelet aggregation inhibitors due to the increased bleeding risk. Strong CYP3A4 inducers (e.g. rifampicin, phenytoin, carbamazepine, phenobarbital, St. John’s Wort) should be used concomitantly with caution as they may reduce rivaroxaban plasma concentrations. Pregnancy & breast feeding: Contra-indicated. Effects on ability to drive and use machines: Adverse reactions like syncope & dizziness are common. Patients experiencing these effects should not drive or use machines. Undesirable effects: Common anaemia, dizziness, headache, syncope, eye haemorrhage, tachycardia, hypotension, haematoma, epistaxis, GI tract haemorrhage, GI & abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, pain in extremity, urogenital tract haemorrhage, fever, peripheral oedema, decreased general strength & energy,

increase in transaminases, post-procedural haemorrhage, contusion. Uncommon thrombocythemia, allergic reaction, allergic dermatitis, cerebral & intracranial haemorrhage, haemoptysis, dry mouth, abnormal hepatic function, urticaria, cutaneous & subcutaneous haemorrhage, haemarthrosis, renal impairment; feeling unwell, localised oedema, increased: bilirubin, blood alkaline phosphatase, LDH, lipase, amylase, GGT; wound secretion. Rare jaundice, muscle haemorrhage, increased conjugated bilirubin. Frequency not known pseudoaneurysm formation following percutaneous intervention, compartment syndrome secondary to a bleeding, renal failure/acute renal failure secondary to a bleeding sufficient to cause hypoperfusion. Occult or overt bleeding from any tissue or organ which may result in posthaemorrhagic anaemia and complications with variable severity (including fatal outcome). Prescribers should consult SmPC in relation to full side effect information. Overdose: Rare cases of overdose up to 600mg have been reported without bleeding complications or other adverse reactions. Due to limited absorption a ceiling effect is expected at supratherapeutic doses of 50mg rivaroxaban or above. No specific antidote is available. Use of activated charcoal to reduce absorption may be considered. For management of bleeding complication associated with rivaroxaban please refer to the SmPC. Legal Category: POM. Package Quantities and Basic NHS Costs: 15mg – 28 tablets: £58.80, 42 tablets: £88.20, 100 tablets: £210.00; 20mg – 28 tablets: £58.80, 100 tablets £210.00. MA Number(s): EU/1/08/472/011-21. Further information available from: Bayer plc, Bayer House, Strawberry Hill, Newbury, Berkshire RG14 1JA, U.K. Telephone: 01635 563000. Date of preparation: November 2011. Xarelto® is a trademark of the Bayer Group.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Bayer plc. Tel.: 01635 563500, Fax.: 01635 563703, Email: phdsguk@bayer.co.uk

UK.PH.GM.XAR.2012.205 May 2012

BAY01J11011_new_Xarelto _CPJ_A4_0503.indd 1

Simple, proven, predictable anticoagulation

09/05/2012 11:52

www.commissioningshow.co.uk

One to one surgeries will offer insight from industry experts

Thinking about business intelligence? Think about SystmOne.

Expert surgeries sponsored by Experian where delegates can book one-to-one sessions with an expert partner will run throughout the day on both days of the Commissioning Show. time. The resulting poster campaign was hugely successful in increasing awareness of services available for pregnant teens and a pregnancy information website experienced a 38% increase in traffic.

Aimed predominantly at CCG and PCT cluster board members and finance directors they will provide an insight into how demographic data can be used for strategic planning and targeting wellness campaigns.

Another highly targeted campaign reduced inappropriate attendances at A&E departments by identifying problem groups and the GP catchment areas where they lived. Experian’s Health Needs Assessment Service can help CCGs to identify local health needs using the most comprehensive, accurate and consistent view of the UK population’s health risks.

Experian, an information services company, has a track record of success gained from three decades of experience in managing and interpreting consumer and business data. In one successful project Experian used customer insight to help Great Yarmouth and Waveney PCT to increase consumption of fruit and vegetables in a deprived population at greatest risk of heart attacks, strokes or “The Experian diabetes.

team had the right level of technical expertise and innovation that resulted in work that was more thorough than other providers”

Using a data-led strategy the PCT was able to introduce a mobile food shop which gave people access to wholesale price produce, information about food preparation and directed them to lifestyle improvement programmes in their area.

Using data from the Mosaic Public Sector lifestyle David Long segmentation, National Hospital data and the Health Survey for England, the PCT was able to identify the people who would most benefit from the initiative, the best times for the service to run and the best route for the truck to take. During the first five months the project achieved a 26% increase in people consuming the recommended five a day and 137 customers were referred to other health services such as breast feeding, stopping smoking and the Health Trainer service. The insight Experian has provided to NHS Barking and Dagenham has helped with a range of campaigns across the London borough including improving access to services. With help from Experian the PCT was able to identify where groups most likely to have teenage pregnancies spent their free

In the new world of GP commissioning there’s a temptation to spend thousands on new software for business intelligence and risk stratification. But if you choose to deploy SystmOne, there’s simply no need.

Greenwich PCT commissioned Experian to review their existing service provision and future needs in order to improve services for those with the greatest health risks and to increase pharmacy network efficiency. A Health Needs Assessment for planned housing developments identified where current services were sufficient for the new population and where gaps may occur, informing future planning of health services in the area. ‘The Experian team had the right level of technical expertise and innovation that resulted in work that was more thorough than other providers - a 10/10 in terms of recommending them to others,’ was the verdict of David Long, joint community pharmacy lead at NHS Greenwich.

Along with our extensive clinical reporting functionality, which comes as standard when you deploy SystmOne, we can also offer you regular data extracts and analysis tools. That means everything you need to assess efficiency and quality is included in the same clinical system you use every day. Whether you want to report on Trust-supplied SUS data or analyse coded data to isolate problematic conditions, SystmOne can help. Want data monthly? Or perhaps just once or twice a year? The very best thing about SystmOne is that it’s completely configurable. Whatever your requirements are, and however large (or small) your patient population is, we have the right tools on hand. Moving to SystmOne is the easiest way to get all the right tools and share the right information, across your entire Clinical Commissioning Group. To find out more, visit us on stand E21.

Visit us at stand AA67 to find out how we can care for your patients.

For premier healthcare – refer to us www.hcahospitals.com

HCA is the private hospital group of choice for the successful treatment of serious and complex medical conditions. Our six world-class hospitals, three private patient centres in partnership with top NHS teaching hospitals and ten outpatient medical centres achieve some of the highest patient outcomes and lowest infection rates in the UK. Our internationally recognised Centres of Excellence provide the latest in cardiac care, neurology (brain and spine injuries), women’s health, paediatrics, IVF and fertility, and we are the UK’s largest private provider of cancer care.

Using the latest technology, drugs and therapies, we ensure our patients always have access to the best possible treatment and leading specialists and doctors from NHS teaching hospitals. We have direct access to the latest clinical trials, and more intensive care beds than any other private hospital group in the UK, achieving consistently high patient survival rates. We treat patients from London, the UK and all over the world and promise privacy, respect, comfort, cleanliness and the highest standards of treatment.

Sandwell PCT is pioneering active case-finding for undiagnosed heart failure.

www.commissioningshow.co.uk

Finding hidden heart failure Sandwell PCT is pioneering active case-finding for undiagnosed heart failure. Following a successful pilot project it is planned to use MSDi Clinical Manager software to identify patients who are likely to have heart failure or Left Ventricular Dysfunction (LVD), which is a common precursor of heart failure. The identified patients are invited for echocardiography and assessment in their own GP practice. Those who need it are referred for specialist management of heart failure or to their GPs if they need other changes to their medication.

Accommodation at the Commissioning Show 2012

existence. Treatment changes helped improve quality of life quite noticeably.

The outward signs of heart failure include breathlessness, fatigue and ankle swelling. Alongside this, patients have evidence that the heart is not functioning efficiently. It is a serious condition, patients are frequently admitted to hospital with episodes of breathlessness and only half of patients survive five years from their initial diagnosis. However if it is identified early then it is also a treatable condition and both the symptoms and survival can be improved. The three most important interventions are cardiac rehabilitation, treatment with beta-blockers and treatment with either ACE inhibitors or Angiotensin Receptor Blockers.

The cost savings from this work are via prevented emergency admissions, which are often the way in which people with previously undiagnosed heart failure are detected. Better medical management in the community is an improvement both for patients’ quality and length of life. For more information come along to our workshop: LVSD case finding improves patient quality and length of life and saves hospital admissions - Thursday 28th June 2012, at 14:20.

Xarelto®

NOW AVAILABLE FOR “The patients thought that is was a good thing that the GP practice was trying to identify things that could help them live a longer and healthier life” The biggest problem with LVD is that it is not detected. The definitive test for LVD is an echocardiogram. This is painless, non-invasive and can be carried out in a primary care setting, but it is not cheap (£86 per echo plus management and clinical assessment costs). Because LVD is more common in people who have had heart disease, in recent years it has become normal practice for hospitals to ensure that every patient discharged from hospital after a MI has an echocardiogram. But this still leaves a problem. Patients who had their MI in the past may not have had an echocardiogram. Indeed there is a substantial backlog of MI survivors who could benefit from review. The Sandwell pilot project started from this point. In collaboration with the University of Birmingham an algorithm was developed to identify the patients most likely to have LVD. Local Cardiology support to review findings was enlisted. The algorithm prioritises older male patients who have survived an MI. The process was then piloted in a volunteer general practice. Every patient over 45 was assigned a risk score using this algorithm and those with the highest risk were invited for echocardiography and a cardiac assessment in the practice. The results were a great success. Of 19 patients invited, 16 attended for the echocardiogram and check up. Those who attended were all male with an average age of 78.5 years. They had a history of MI on average 11 years before. As a result of the assessment we referred 5 for management of heart failure. 7 patients needed adjustments to their treatment. Patient views were elicited through a combination of questionnaire and an informal discussion with the CHD nurse at the review. The main findings were that the invitation did not cause alarm or worry, the patients thought that it was good that the GP practice was trying to identify things that could help them live a longer healthier life. The next most striking comment from the patient feedback was that the patients thought that a specialist should review how they were doing at some unspecified but periodic interval. This didn’t reflect dissatisfaction with the GP but more the notion that something like a heart attack should be monitored and managed by a cardiologists or specialist nurses who only dealt with heart attacks. Of the three that did not attend one had been admitted to hospital and the other two had recently been seen as part of a routine CHD review at the surgery. Of the patients who had been identified as having moderate or severe LVD there was a general feeling of reassurance that a management plan was in place. One patient who had a section of lung removed due to cancer had assumed that his breathlessness was entirely due to this and as such had not informed the GP of his increasing breathlessness. He had been leading an ever more restricted

Are you looking for accommodation in London for your stay at the Commissioning Show? Did you know you can get preferential rates on a range of hotels through our accommodation partner Event Express? There are also great value options for NAPC members. Visit the Commissioning Show website... www.commissioningshow.co.uk/accommodation to find out more.

Treatment of deep vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism (PE) following an acute DVT in adults

help put a stop to

complicated

ant l coagulation

Visit us at stand B41 to

find out more about cost saving opportunities in DVT treatment

Xarelto®15 and 20mg film-coated tablets (rivaroxaban) Prescribing Information (Refer to full Summary of Product Characteristics (SmPC) before prescribing) Presentation: 15mg tablet: Red, round, biconvex film-coated tablets containing 15mg rivaroxaban. 20mg tablet: Brown-red, round, biconvex film-coated tablets containing 20mg rivaroxaban. Indication(s): Treatment of deep vein thrombosis (DVT) & prevention of recurrent DVT & pulmonary embolism (PE) following an acute DVT in adults. Posology & method of administration: Dosage – 15mg bd for 3 weeks followed by 20mg od for continued treatment & prevention of recurrent DVT & PE; take with food. Refer to SmPC for information on duration of therapy & converting to/ from Vitamin K antagonists (VKA) or parenteral anticoagulants. Renal impairment: Mild (creatinine clearance 50–80ml/min) – no dose adjustment necessary; moderate (creatinine clearance 30–49ml/min) – 15mg bd for 3 weeks, reduce maintenance dose to 15mg od; severe (creatinine clearance 15–29ml/min) – limited data indicates rivaroxaban plasma concentrations are significantly increased, 15mg bd for 3 weeks, reduce maintenance dose to 15mg od & use with caution. Patients with creatinine clearance <15ml/min – use not recommended. Hepatic impairment: Do not use in patients with hepatic disease associated with coagulopathy & clinically relevant bleeding risk including cirrhotic patients with Child Pugh B & C patients. Elderly, body weight & gender: No dose adjustment. Paediatrics: Not recommended below 18 years of age. Contra-indications: Hypersensitivity to active substance or any excipient; clinically significant active bleeding; hepatic disease associated with coagulopathy & clinically relevant bleeding risk (including cirrhotic patients with Child Pugh B & C); pregnancy & breast feeding. Warnings & precautions: Clinical surveillance in line with anticoagulant practice is recommended throughout the treatment period. In studies mucosal bleedings & anaemia were seen more frequently during long term rivaroxaban treatment compared with VKA treatment – haemoglobin/haematocrit testing may be of value to detect occult bleeding. Following subgroups of patients are at increased risk of bleeding & should be carefully monitored after treatment initiation. Use with caution – in patients with severe renal impairment (creatinine clearance 15–29ml/min) or in patients with renal impairment concomitantly receiving other medicines that are potent inhibitors of CYP3A4

(PK models show increased rivaroxaban concentrations in these patients); in patients treated concomitantly with medicines affecting haemostasis; in patients with an increased bleeding risk such as congenital or acquired bleeding disorders, uncontrolled severe arterial hypertension, active ulcerative gastrointestinal disease (consider appropriate prophylactic treatment for at risk patients), recent gastrointestinal ulcerations, vascular retinopathy, recent intracranial or intracerebral haemorrhage, intraspinal or intracerebral vascular abnormalities, recent brain / spinal / ophthalmological surgery, bronchiectasis or history of pulmonary bleeding. Use is not recommended in patients: with creatinine clearance <15ml/min; receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors; with prosthetic heart valves; for treatment of acute pulmonary embolism. If invasive procedures or surgical intervention are required, stop Xarelto use at least 24 hours beforehand. Restart use as soon as possible provided adequate haemostasis has been established. See SmPC for full details. Xarelto contains lactose. Interactions: Concomitant use with strong inhibitors of both CYP3A4 & P-gp (e.g. ketoconazole, itraconazole, voriconazole, posaconazole, ritonavir) is not recommended as increased rivaroxaban plasma concentrations to a clinically relevant degree are observed (may increase risk of bleeding). Avoid co-administration with dronedarone. Use with caution in patients concomitantly receiving other anticoagulants (e.g. enoxaparin), NSAIDs (including acetylsalicylic acid) or platelet aggregation inhibitors due to the increased bleeding risk. Strong CYP3A4 inducers (e.g. rifampicin, phenytoin, carbamazepine, phenobarbital, St. John’s Wort) should be used concomitantly with caution as they may reduce rivaroxaban plasma concentrations. Pregnancy & breast feeding: Contra-indicated. Effects on ability to drive and use machines: Adverse reactions like syncope & dizziness are common. Patients experiencing these effects should not drive or use machines. Undesirable effects: Very common urogenital tract haemorrhage (in women <55 years in DVT-T trials). Common anaemia, dizziness, headache, syncope, eye haemorrhage, tachycardia, hypotension, haematoma, epistaxis, GI tract haemorrhage, GI & abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, pain in extremity, urogenital tract haemorrhage, fever, peripheral oedema, decreased general

Xarelto®: the first oral single-drug approach for DVT treatment strength & energy, increase in transaminases, post-procedural haemorrhage, contusion. Uncommon thrombocythemia, allergic reaction, allergic dermatitis, cerebral & intracranial haemorrhage, haemoptysis, dry mouth, abnormal hepatic function, urticaria, cutaneous & subcutaneous haemorrhage, haemarthrosis, renal impairment; feeling unwell, localised oedema, increased: bilirubin, blood alkaline phosphatase, LDH, lipase, amylase, GGT; wound secretion. Rare jaundice, muscle haemorrhage, increased conjugated bilirubin. Frequency not known pseudoaneurysm formation following percutaneous intervention, compartment syndrome secondary to a bleeding, renal failure/acute renal failure secondary to a bleeding sufficient to cause hypoperfusion. Occult or overt bleeding from any tissue or organ which may result in post-haemorrhagic anaemia and complications with variable severity (including fatal outcome). Prescribers should consult SmPC in relation to full side effect information. Overdose: Rare cases of overdose up to 600mg have been reported without bleeding complications or other adverse reactions. Due to limited absorption a ceiling effect is expected at supratherapeutic doses of 50mg rivaroxaban or above. No specific antidote is available. Use of activated charcoal to reduce absorption may be considered. For management of bleeding complication associated with rivaroxaban please refer to the SmPC. Legal Category: POM. Package Quantities and Basic NHS Costs: 15mg – 28 tablets: £58.80, 42 tablets: £88.20, 100 tablets: £210.00; 20mg – 28 tablets: £58.80, 100 tablets £210.00. MA Number(s): EU/1/08/472/01121. Further information available from: Bayer plc, Bayer House, Strawberry Hill, Newbury, Berkshire RG14 1JA, U.K. Telephone: 01635 563000. Date of preparation: November 2011. Xarelto® is a trademark of the Bayer Group.

UK.PH.GM.XAR.2012.204 May 2012

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Simple, proven, predictable anticoagulation

09/05/2012 11:36

www.commissioningshow.co.uk

The definitive event for clinical commissioning is back this June – There is still time to book for one of the UK’s largest healthcare events.

Registration is now open for one of the UK’s largest GP events. With the changes well underway that will bring about a primary care-led health service, you can join over 3000 GPs and primary care professionals leading the way in delivering better patient service. Take a look at the latest programme for our conference sessions and speakers. But the Commissioning Show is about much more than listening to the key issues debated by some of healthcare’s most influential figures. It’s really about the commissioners themselves and the experience they can offer each other, all the successes and cautionary tales from those on the road to authorisation - however far along.

Day 1 27 June

Commissioning gives you the perfect platform to put your burning questions to policy makers, experts, local authorities and most importantly your healthcare peers. So what do you need to know to deliver the best service for your patients in 2012 and beyond? Managing Long Term Conditions

Integrated Care

Productivity Through Technology

CCGs of the Future

HWB: Productive relationships

Chair’s welcome

Patient and professional perspectives on living with LTCs

If “culture eats strategy for breakfast”, how do we change it?

Moving towards authorisation: Cumbria in 2013 Meeting the intelligence needs of CCGs

Quality, Productivity and Prevention in cardio-metabolic disease through an Innovative clinical change management programme*

Battle plans and care pathways*

Networking

Preparing for CQC

The anatomy, physiology and embryology Farbe/colour: PANTONE 288 CV of health and wellbeing boards

Supporting commissioning intelligence*

Building blocks of integrated care*

National guidelines: translating them into local practice*

Networking

Improving patient care and service efficiencies through partnership working

Here’s one I made earlier: Case studies on integrated care

Systems to support the next generation of commissioning

Developing multi-disciplinary working

Another ‘talking shop’? A case study on the rise of the decision-making HWB

Lunch

Predictive modelling to reduce risk and admissions

How can GPs avoid conflicts of interest

What will success look like? Measuring performance on health and wellbeing in Cornwall

QIPP showcase: LTC management that works

Continuity of GP care, the bedrock of integration Sponsored session*

Realising the financial benefits of commissioning DVT and Heart Failure Services in Primary Care*

Medicines Optimisation* Models for Stable Angina*

How working with pharmacy can improve quality and support integration in LTCs

Networking

Sponsored session*

The big wins for integration

Measuring meaningful improvement in LTC: how will we do it?

Integration in practice

Networking

Setting up the optimum commissioning support

Alive and clicking: Social media and the NHS

Mental Health care management enabled by technology

Networking

Identifying opportunities for CCG efficiencies

Health Protection Services for the next decade: from HPA to PHE* Networking How to overcome tribal loyalties? Panel discussion on cooperative HWB working The co-production model – a shared population approach to health and wellbeing reflecting all interests and assets

Plenary session: Secretary of state for health Leaders symposia and reception - Sponsored by - Capita Managing Long Term Conditions

Integrated Care

Productivity Through Technology

CCGs of the Future

HWB: Productive relationships

Chair’s welcome

Outside the box: innovative approaches to improving outcomes in LTCs

5 high impact changes that achieve integration

Integrated high quality care: NHS Future Forum’s vision for making it happen

Networking

Insurance risk and service risk: what do you need to know?

PANTONE 288 HWBs CV How can transform services and outcomes?

Protect your income whilst improving patient access

Networking

Day 2 28 June

Exploiting technology to drive efficiency Optimising current anticoagulation therapy in atrial Fibrillation - The role of TTR*

The lessons learned in improving outcomes for patients with Asthma*

Networking

How can commissioners improve experience of care?

Mental Health Services: How do we commission together?

Lunch

Who can add value to commissioning for LTCs

Lunch System leadership and integrated commissioning, experiences from the front line

Quality initiatives that improve care, save lives and reduce expenditure Networking Telehealth to challenge the status quo - the need for evidence Lunch Mobile solutions. Communication at the point of care

Networking Developing multi-disciplinary working within commissioning Lunch Seeking outside help with commissioning: outsourcing options

Don’t Buy IT*

Farbe/colour:

Sponsored session* Networking The Future of Public Health – a new landscape Lunch Birmingham: improving outcomes in a complex environment LGC: Joint working debate

CCG Leaders: The big debate

Walk in my shoes: how co-designing strategy and service drives innovation and integrated care in stroke prevention*

Sandwell LVSD Pilot*

Networking

Networking Networking

Plenary session: Dame Barbara Hakin National Director of Commissioning Development

*Content provided by our event sponsors, visit www.commissioningshow.co.uk for more details

www.commissioningshow.co.uk

Andrew Lansle

nja

Michael Soba

A programme featuring the who’s-who of Commissioning: Andrew Lansley, Secretary of State for Health Dr Charles Alessi, Chair of the NAPC Dr Michael Dixon, NHS Alliance Dame Barbara Hakin, National Director of Commissioning Development Dr Nick Hicks, Director of Public Health, Milton Keynes NHS Goran Henriks, Chief executive of learning & innovation, Jonkoping County Council Ailsa Claire OBE, Transition Director Patients and Intelligence, NHS Commissioning Board Dr Hugh Reeve, Chair of Cumbria Clinical Commissioning Group Peter Brambleby, Joint Director of Public Health, NHS Croydon & Croydon Council Dr Sam Barrell, Chair of Baywide Clinical Commissioning Group Stuart Cowley, Director: Personalisation & Partnerships, Wigan Council Kim Carey, Corporate Director for Adult Care & Support Professor Martin Cowie, Professor of Cardiology, Imperial College London (Royal Brompton Hospital) Hugh Janes, Fareham and Gosport CCG Manager David Colin-Tomé, DCT Consulting Edna Robinson, Chair of The Big Life Group, Managing Director of the Clinical Commissioning Community Programme Phil Da Silva, QIPP Right Care Programme Paul Hodgkin, Chief Executive, Patient Opinion Dr Matt Fay, General Practitioner, Westcliffe Medical Centre, Shipley Dr Gillian Leng, Deputy Chief Executive, NICE Dr Rosie Benneyworth, GP, Somerset Clinical Commissioning Group Jeremy Nettle, Chair, Intellect Health and Social Care Council Andy Brogan, Wellbeing Practice Lead, Vanguard Consulting

Dr Alison Hill, Managing director NHS Solutions for Public Health and Director SEPHO Sir Muir Gray Hazel Stutely OBE, Exeter University Professor Chris Drinkwater CBE, Independent Chair, Newcastle Bridges CCG Mandy Wearne, Director of service experience, North West Health Region Sue Harris, Worcester County Council Ray Johannsen Chapman, SLAM Stephen Johnson, Head of Long Term Conditions, DH Lindsey Davies, President of the FPH Don Redding, Director of policy, National Voices Stephen Foster, Chair Health Care Professionals Commissioning Network Dr Howard Freeman, GP, Assistant Medical Director at NHS London Dr Mike Warburton, Director, Capita Jill Foster, Practice manager, Beacon Primary Care Mrs Geraldine Taggart Jeewa & Dr Simon Abrams, Joint Honorary Secretaries of the Family Doctor Association Dr Kam Singh, GP, Thurmaston Practice Cynthia Bower, Chief Executive, Care Quality Commission Alan Lotinga, Director of Health and Wellbeing at Birmingham Council Professor Steve Field, NHS Future Forum Dr James Kingsland, National Clinical Commissioning Network Lead Stephen Dorrell, MP Mike Farrar, Chief Executive NHS Confederation Niall Dickson, Chief Executive, General Medical Council Plus many more… Final speaker programme is subject to confirmation

Dr Nick Hicks

Sir Muir Gray

Dr Johnny Mar

shall

a Hakin

Dame Barbar

WHAT’S NEW FOR 2012? Listen, learn, debate: New for 2012, the facilitated learning area will allow you to join a facilitated workshop where you can work with colleagues and other groups on real life scenarios. Lead by a professional facilitator, each session will have a set task to complete as a group, with the objective of leaving with practical solutions that can be implemented in your locality.

Commissioning’s hottest debates: Commissioning 2012 will be covering the hottest topics of the day, though we may not know what they all are yet! Our round table programme will allow delegates, partners and experts to table hot topics and watch the debate unfold. These lively, less structured discussions are an ideal way to gain insight into current practice and opinion.

The social network An innovative delegate booking platform opens up new opportunities for networking, both in the run up to the show and beyond. Delegates will be able to create a bespoke conference programme for themselves, combining their selections from the formal sessions with facilitated networking and face to face meetings with peers.

Get face to face with your commissioning heroes: New for 2012, the facilitated networking area will allow delegates to build their own programme of meetings around the main conference programme. Identify experts and peers with practical experience in your key areas. You can even create your own sessions around the topics that matter most to you and invite like-minded colleagues to join you.

You can view full programme details online at www.commissioningshow.co.uk but here are just some of the highlights... MOVING TOWARDS AUTHORISATION A CCG pioneer shares its experiences of moving towards authorisation in 2013, offering practical tips to those facing the same challenges. Dr Hugh Reeve, chair of Cumbria Clinical Commission Group and GP Partner, Nutwood Surgery, Grange-over-Sands.

Dr Hugh Reev

5 HIGH IMPACT CHANGES THAT ACHIEVE INTEGRATION: LEARNING FROM INTERNATIONAL BEST PRACTICE The Nuffield Institute published a seminal report on integrated care, which analysed how four successful health economies have made integration happen. This session provides insights and lessons for CCGs wanting to achieve the same. Dr Rebecca Rosen, Senior Fellow, Nuffield Trust

Dr Rebecca Ro

sen

PATIENT, CARER AND PROFESSIONAL PERSPECTIVES ON LIVING WITH LONG TERM CONDITIONS This session explores the perspectives of professionals and contrasts them with the perspective of a person and carer with experience of living with a long term condition that is reaching epidemic proportions - dementia. Dr Amit Bhargarva, GP Principal, Southgate Medical Group and Fiona Philips, Ambassador, Alzheimer’s Society

Fiona Philips

MEASURING MEANINGFUL IMPROVEMENT IN LTC: HOW WILL WE DO IT? An overview of COF indicators and their role in CCG accountability. Dr Gillian Leng, Deputy Chief Executive, NICE

Gillian Leng

ANOTHER ‘TALKING SHOP’? A CASE STUDY ON THE RISE OF THE DECISION-MAKING HEALTH AND WELLBEING BOARDS Wigan has used an approach in developing its Health and Wellbeing Board that has majored on new commissioning leadership relationships. GPs and Councillors have been building the foundations of a common purpose and vision for health and wellbeing. As CCGs come into being the intention is that the Health and Wellbeing Board is placed to be able to put strategic commissioning for change and improvement directly into action. Integrating wellbeing, social care and clinical pathways is at the centre of the work. Stuart Cowley, Director: Personalisation & Partnerships, Wigan Council

STILL TIME TO BOOK

Call 02476 719 686 or visit www.commissioningshow.co.uk/book

Stuart Cowley

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2012 - Strategies for a game change Bureaucracy gone mad The last 20 years, pressure on general practice has increased exponentially with the introduction of the GMS/PMS contract; QOF; Information Governance; Nice Guidelines; and new levels of Health & Safety and Employment legislation. From 2012, we can look forward to commissioning; Revalidation and CQC Registration (Care Quality Commission), the major difference this time being that not only will all this be compulsory, but it will be actively policed. With the CQC, failures risk your licence to trade. CQC changes nothing and yet changes everything. Contrary to popular belief, it does not introduce new regulation, but merely rehashes and re-labels old ones. The real change will be in the way your practice will operate at every level from the ground up. Add commissioning to this mix and gone are the days when the entire system could have got away with revolving around just one or two managers. The annual ritual of getting PRS372 Brendon Ad Hoc Ad 297x210 AW 29/09/2011 10:07 Page 1

all the compliance and clinical performance targets filled out just in time for the March deadline will be redundant as the organisation will have to prove performance and evidence at every level, 365 days a year. If anyone said this is a great opportunity, you would be tempted to lock them up, once you stop laughing. In fact there is a kernel of truth in this. One opportunity lies in the willingness of primary care to rise up to the challenge of a culture change and this means reforms at every level. Freeing up the most valuable members of the management team to concentrate on business development; enhancing services; and increasing practice capacity is a must. Delegating some responsibilities down the line happens to be exactly what new regulations demand. Whereas clinical record keeping has come leaps and bounds with new technology, general quality assurance still remains in the doldrums, a constant paper chase entirely dependent on one or two managers. New technologies offer automation of all these quality processes, with new levels of efficiencies and intelligence, with the potential to revolutionise your resource management.

NOW AVAILABLE: PROSTAP DCS All the benefits of Prostap with the added simplicity of a Dual Chamber Syringe (DCS)

come as standard Prostap DCS is indicated for all stages of prostate cancer1,2 and provides a package of care for your patients. Not only is Prostap DCS simple to use,3 it is also cost-competitive4 and most importantly, Prostap DCS delivers well-documented, long-term efficacy in all stages of prostate cancer5-7 and is supported by survival evidence, in combination with flutamide, in high-risk localised and locally advanced prostate cancer 8,9 With Prostap DCS’s package of care, Great Expectations come as standard.

Taking this to the next level

Bharat Patel

A major strength of primary care in England comes from practices being very local, community-based. At the same time, primary care will have to cope with increasing demand while funding is getting tighter. Practices also need to up their game in consistency of care quality and patient experience while clinical care is getting ever more complex.

ath

Dr Oliver Bern

Can practices cope with this or is this the end of general practice as we know it? General Practice CAN survive and, for the sake of healthcare, has to! By forming GP Provider Organisations, practices can gain access to “industrial strength” management capabilities, processes and governance while still maintaining their independence. Such GPPOs can bring much better care process control into primary care, which ensures greater consistency in quality and patient experience while also freeing up GP time to focus on patients with needs that go beyond a standard protocol. Beyond improving practice productivity, this approach also allows GPs to protect and strengthen their role as “Prime Provider” along an integrated care pathway. This does also allow practices as a group to take on additional services that individual practices alone would not be able to provide. Management support, tools, systems and processes can be brought to GPPOs by a central partner at higher quality and lower cost than individual GPPOs as a central partner can benefit from scale efficiencies. This article co-written by: Bharat Patel – CEO of X-Genics (bharat.patel@xgenics.com) and Dr Oliver Bernath CEO of Integrated Health Partners (oliver.bernath@ihpclinics.com). More information on www.xgenics.com & www.ihpclinics.com

‘‘Don’t Buy IT”

InMedical Seminar at Commissioning.

healthcare technologies.

In this seminar we will be assessing the changing world of information and data and the economics that surround

We will discuss how technology is delivered now and how it will be delivered in the future. We will look at an alternative model for funding - mitigating the risks and costs of implementation for CCG’s. IMPORTANT CHANGE: Prostap DCS is replacing Prostap, which will be discontinued by the end of October 2011, so it is necessary for prescriptions to reflect this change of name. To find out more visit: www.ProstateCancerUpdate.co.uk or contact Takeda UK Medical Information on 01628 537900 PRESCRIBING INFORMATION PROSTAP* SR DCS/ PROSTAP* 3 DCS Leuprorelin Acetate Depot Injection 3.75mg/11.25mg Presentation: Powder and solvent for prolonged-release suspension for injection in pre-filled Dual Chamber Syringe (DCS). Prostap SR DCS Powder: contains 3.75mg of leuprorelin acetate, equivalent to 3.57mg base. Prostap 3 DCS Powder: contains 11.25mg of leuprorelin acetate, equivalent to 10.72mg base. Indications: Prostap SR DCS/Prostap 3 DCS: as an adjuvant treatment to radical prostatectomy in patients with locally advanced prostate cancer at high risk of disease progression; as an adjuvant treatment to radiotherapy in patients with high-risk localised or locally advanced prostate cancer; locally advanced prostate cancer, as an alternative to surgical castration; metastatic prostate cancer; management of endometriosis including pain relief and reduction of endometriotic lesions. Prostap SR DCS is also indicated for endometrial preparation prior to intrauterine surgery; preoperative management of uterine fibroids to reduce their size and associated bleeding. Dosage and Administration: Prostate Cancer: Prostap SR DCS: 3.75mg administered every month as a single subcutaneous or intramuscular injection. Prostap 3 DCS: 11.25mg every 3 months as a single subcutaneous injection. Do not discontinue when remission or improvement occurs. Response to therapy should be monitored clinically. If response appears to be sub-optimal, it should be confirmed that serum testosterone is at castrate level. Endometriosis: Prostap SR DCS: 3.75mg administered as a single subcutaneous or intramuscular injection every month. Prostap 3 DCS: 11.25mg as a single intramuscular injection every 3 months. Treatment should be for a period of 6 months only and initiated during the first 5 days of the menstrual cycle. If appropriate, hormone replacement therapy (HRT - an oestrogen and progestogen) should be co-administered with Prostap DCS to reduce bone mineral density loss and vasomotor symptoms. Endometrial Preparation Prior to Intrauterine Surgery: Prostap SR DCS: 3.75mg as a single subcutaneous or intramuscular injection 5-6 weeks prior to surgery. Therapy should be initiated during days 3 to 5 of the menstrual cycle. Preoperative Management of Uterine Fibroids: Prostap SR DCS: 3.75mg as a single subcutaneous or intramuscular injection every month, usually for 3-4 months but for a maximum of six months. Elderly: as for adults. Children (under 18 years): Not Recommended - safety and efficacy in

children have not been established. For chronic administration, the injection site should be varied periodically. Contraindications: hypersensitivity to the active substance, any of the excipients or to synthetic GnRH or GnRH-derivatives. Women: lactation, pregnancy, undiagnosed abnormal vaginal bleeding. Precautions and Warnings: General: development or aggravation of diabetes may occur; therefore diabetic patients may require more frequent monitoring of blood glucose. Hepatic dysfunction and jaundice with elevated liver enzyme levels have been reported; therefore close observation should be made and appropriate measures taken if necessary. The ability to drive may be impaired due to visual disturbances and dizziness. Men: a transient rise in levels of testosterone may occur initially. This may be associated with tumour flare, sometimes manifesting as systemic or neurological symptoms. These symptoms usually subside on continuation of therapy. An anti-androgen may be administered to reduce the risk of flare (see SmPC, section 4.4). Patients at risk of ureteric obstruction or spinal cord compression should be closely supervised in the first few weeks of treatment. These patients should be considered for prophylactic treatment with anti-androgens. Should urological/neurological complications occur, these should be treated appropriately. Women: whilst ovulation is usually inhibited during therapy, contraception is not ensured. Patients should therefore use non-hormonal methods of contraception. During the early phase of therapy, sex steroids temporarily rise, possibly leading to an increase in symptoms, which dissipate with continued therapy. Menstruation should stop with effective doses of Prostap DCS; therefore the patient should notify her physician if regular menstruation persists. The induced hypo-oestrogenic state may result in a small loss in bone mineral density over the course of treatment, some of which may not be reversible. However, during one six-month treatment period, this bone loss should not be important. In patients with major risk factors for decreased bone mineral content, Prostap DCS may pose an additional risk. Before treating these patients for fibroids, their bone density should be measured, and where results are below the normal range, Prostap DCS therapy should not be started. In women receiving GnRH analogues for the treatment of endometriosis, the addition of HRT (an oestrogen and progestogen) has been shown to reduce bone mineral density loss and vasomotor symptoms. Prostap DCS may cause an increase in uterine cervical

resistance. This may result in some difficulty in dilating the cervix for intrauterine surgical procedures. Diagnosis of fibroids must be confirmed prior to treatment, by laparoscopy, ultrasonography or other investigative technique. In women with submucous fibroids there have been reports of severe bleeding following administration of Prostap DCS, as a consequence of acute submucous fibroid degeneration. Patients should be warned of the possibility of abnormal bleeding or pain, in case earlier surgical intervention is required. Side Effects: Refer to section 4.8 of the SmPC in relation to other side effects - very rare cases of pituitary apoplexy have been reported following initial administration in patients with pituitary adenoma. General: adverse events which have been reported infrequently include peripheral oedema, pulmonary embolism, hypertension, palpitations, fatigue, muscle weakness, diarrhoea, nausea, vomiting, anorexia, fever/chills, headache (occasionally severe), hot flushes, arthralgia, myalgia, dizziness, insomnia, depression, paraesthesia, visual disturbances, weight changes, hepatic dysfunction, jaundice, and increases in liver function test values (usually transient). Reactions at the injection site have been reported rarely. Changes in blood lipids and alteration of glucose tolerance have been reported which may affect diabetic control. Thrombocytopenia and leucopenia have been reported rarely. Hypersensitivity reactions including rash, pruritus, urticaria, and rarely, wheezing or interstitial pneumonitis have also been reported. Bone mass reduction may occur. Anaphylactic reactions are rare. Spinal fractures, paralysis, hypotension and worsening of depression have been reported. Men: if tumour flare occurs, symptoms and signs due to disease may be exacerbated e.g. bone pain, urinary obstruction, weakness of the lower extremities and paraesthesia. These symptoms subside on continuation of therapy. Impotence and decreased libido will be expected with Prostap DCS therapy. Hot flushes and sometimes sweating are often associated with administration with Prostap DCS. Orchiatrophy and gynaecomastia have been reported occasionally. Women: side-effects reported are mainly those related to hypo-oestrogenism e.g. hot flushes, mood swings, including depression (occasionally severe) and vaginal dryness. Breast tenderness or a change in breast size, and hair loss, may occur occasionally. A small loss in bone density may also occur, some of which may not be reversible (see Precautions and Warnings). Vaginal haemorrhage may occur due to acute degeneration of submucous fibroids. Legal Category: POM.

Package Quantities: Prostap SR DCS: one dual chamber pre-filled syringe containing 3.75mg leuprorelin acetate powder in the front chamber and 1ml of sterile solvent in the rear chamber. One 25 gauge needle, one syringe plunger and one injection site swab are included in a single injection pack. Prostap 3 DCS: one dual chamber pre-filled syringe containing 11.25mg leuprorelin acetate powder in the front chamber and 1ml of sterile solvent in the rear chamber. One 23 gauge needle, one syringe plunger and one injection site swab are included in a single injection pack. Basic NHS Cost: Prostap SR DCS £75.24; Prostap 3 DCS £225.72. Marketing Authorisation Numbers: Prostap SR DCS: 16189/0012; Prostap 3 DCS: 16189/0013. For full prescribing information and details of other side effects, see Summary of Product Characteristics. Full prescribing information is available on request from: Takeda UK Limited, Takeda House, Mercury Park, Wycombe Lane, Wooburn Green, High Wycombe, Bucks, HP10 0HH, UK. Telephone: 01628 537900; Fax: 01628 526617. Date of Prescribing Information: September 2011. *Registered Trademark of Takeda. PS110937.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Takeda UK Ltd on 01628 537900. References: 1. Prostap SR DCS. Summary of Product Characteristics. 2. Prostap 3 DCS. Summary of Product Characteristics. 3. Takeda UK Ltd. Data on file. DF110503. 4. MIMS. September 2011. 5. Jocham D. Urol Int 1998; 60: 18–24. 6. Kienle E & Lübben G. Urol Int 1996; 56: 23–30. 7. Bischoff W et al. J Int Med Res 1990; 18(Suppl. 1): 103–113. 8. D’Amico AV et al. JAMA 2004; 292: 821–827. 9. D'Amico AV et al. JAMA 2008; 299: 289–295. PS110939i Date of preparation: September 2011

We will explore the concept and the reality of creating new and exciting partnerships where risks and rewards are shared. We will investigate how the need for time consuming large capital expenditure projects can be removed and replaced with real time managed services where results are rewarded with payment. Clinicians are paid by results - so should your IT and Information providers! Combining data and information generates knowledge. When used this will lead to better management of the medicine and economics that surround the patient. This new environment will unlock the latent clinical knowledge within the CCG community allowing it to focus on the patient. With so many different sources of data how can you find the information you are looking for in a timescale that makes a difference. We will look at the opportunities and threats of multisource and multi system data and – by using the right tools – the knowledge that can be extracted.

We call this a TotalCare™ Platform. Fundamentally we will explore ways to ensure can focus on being clinicians, providing them information for them to plan medicine and pathways now and make informed decisions impact on the health economy of the future. InMedical and CMA Group are on stand D42

that clinicians with the right develop new that positively

www.commissioningshow.co.uk

Specialist cardiac pharmacist helps count the cost of chest pain. Consultant pharmacist for cardiovascular disease, Helen Williams, will be taking to the stage for the Menarini-sponsored session on stable angina. As part of the Managing long term conditions stream, this session will highlight the burden of stable angina within the UK population. It aims to increase delegate’s understanding of how optimal medical therapy, in line with NICE guidelines, can help deliver best care across the patient pathway. NICE Guidance on Stable Angina was published in July 2011 and emphasises the importance of optimal medical therapy for the first-line management of patients with stable angina. Williams will highlight the potential opportunities to optimise the management of these patients in a primary care setting to improve the overall patient care pathway. Helen worked as a specialist cardiac pharmacist at King’s College Hospital for 15 years before taking up her current

role as Consultant Pharmacist for CV Disease working across the South London Sector for a number of PCTs, acute trusts and the South London Cardiac and Stroke Network. She is involved in a wide range of activities including developing s pharmacist-led Helen William clinics in primary care to manage hypertension and vascular risk, supporting community heart failure services and contributing to the NHS Health Checks roll-out.

continued from page 1

Whilst current attention is inevitably focused on the need to achieve authorisation, the underlying challenge facing CCGs remains the need to sustain patient safety and quality whilst realising £20bn of efficiency improvements. In addition many CCGs across the country will inherit health economies that are either already financially challenged or unsustainable over the long term in their current configurations. To address this challenge, Capita believes that CCGs will need to embrace and implement innovative forms of commissioning. This is where Capita’s experience and commissioning capabilities can help CCGs to make change happen. Capita is currently helping commissioners in Leeds to achieve real returns by using an ambitious new predictive modelling tool and clinical commissioning portal to identify patients with long term conditions who are most at risk. Working with three CCGs and NHS Leeds the predictive modelling tool is enabling multidisciplinary teams to focus clinical resources on those with the greatest need and proactively intervene early to reduce unnecessary emergency admissions. The Capita Portal has been so successful it is now also being deployed across North Yorkshire.

SEE THE FULL PICTURE WITH VISION 360 Vision 360 is a complete IT solution that builds local healthcare communities around centrally stored, shared patient records. Vision 360 provides: • Shared patient records between authorised clinicians and healthcare workers to encourage fast and accurate clinical decisions away from the patient’s registered practice • Remote access for GPs and business continuity for practices

Vision 360 complements existing systems so there is no need to ‘rip and replace’. It has its own central data repository and patient data is streamed into Vision 360 from Vision and EMIS systems as a background task throughout the day. GP practices can continue to use their existing systems - avoiding the cost and disruption of system migrations.

• Cross-practice reporting on referrals, commissioning and other business aspects of healthcare provision for PCTs, GP consortia and local health boards

Andrew Lawre

nce

• Central task management between care providers within a local community • Interoperability with other clinical systems

What mood are you in? IE is a multi-award winning digital marketing agency specialising in the health sector. IE helps clients strengthen and deepen their online presence through sector-leading, interactive web sites and web apps that engage with audiences, communicate expertise and deliver measurable value. IE will be showcasing their recent work with 2gether NHS Foundation Trust on Moodometer – a responsive web app version of the Trust’s already successful iPhone app. Moodometer is an interactive mood diary which helps users monitor, understand and manage their emotional wellbeing as well as smoothing the pathway to tele-health and face to face clinical support. Other notable projects include brand repositioning work for Central Surrey Health, award winning websites for Solihull NHS Care Trust and West Midlands QI, hospital intranets and CCG websites. So if you’re looking for Open Source content managed websites, web and mobile apps or branding and design – IE is a perfect partner. www.iedesign.co.uk/health

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Patients presenting to their GP with symptoms suggestive of heart failure or DVT are usually referred to hospital for specialist assessment and for a scan. Typically this can cost primary care in the region of £500 per patient and often more if admitted as an emergency referral. However, ample evidence based on the commissioning of DVT and heart failure diagnostic services proves that about 50% of these patients do not have a DVT or heart failure therefore do not need to be referred and a simple blood test in the GP surgery when used with clinical examination can rule out these patients. This decreases unnecessary referrals and saves primary care significant sums of money. The session on June 27th at 2.30pm hears from a CCG manager who has successfully implemented such diagnostic services in primary care and a consultant cardiologist who recently chaired a consensus panel on this subject. They will welcome any questions on the why and how to commission heart failure and DVT diagnostic services and what level of savings can realistically be achieved with real life examples. With the introduction of new oral anticoagulants there is increasing debate over the place in therapy for aspirin and warfarin in managing atrial fibrillation. In a recently published consensus from the Royal College of Physicians Edinburgh, aspirin should no longer be routinely recommended, whilst warfarin should be standard first choice paying close attention to achieving optimal control. To see how the management of this long term condition can be implemented in practice join the symposium titled ‘Optimising current anticoagulation therapy in atrial fibrillation – the role of TTR’, on the 28th June at 10.00am

Andrew Lawrence, Capita’s managing director for commissioning, says: ‘Post-authorisation is when the task of implementing innovative forms of commissioning begins in earnest. The need to embrace new ways of working will be vitally important to bring long term stability to many health economies.

‘It needs to start with applying commissioning techniques which are grounded on practice populations and help better coordination across health and care services. CCGs will also demand information tools increasingly driven by realtime data, enabling clinicians to anticipate patients’ needs for healthcare services before, rather than after, they are incurred. ‘Better information coupled with the increasing use of outcome-based contract levers and incentives, means CCGs have a real opportunity to influence priorities and drive improved provider performance.

‘This is when the work of authorised CCGs really begins.’

The Sound Doctor is a website. It’s an audio-visual selfmanagement tool for people with long-term conditions. The aims are to reduce the number of avoidable hospital admissions, to reduce the number of GP consultations and to improve patient experience. The Sound Doctor is working to the QIPP agenda on long term conditions. Each condition covered on the website (currently diabetes and COPD) consists of about sixty short films giving information on key areas of healthcare that will help patients manage their condition more effectively. The films are all 3-5 minutes in length and are organised so as to provide a structured learning programme. The site is fully interactive and designed with the help of a leading health psychologist specifically to encourage behavioural change. The editorial director is Dominic Arkwright, a BBC presenter with twenty years’ distinguished time served on the Today programme, Newsnight and other national programmes.

Personal 3 Diagnostics

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University of LogixX Westminster Pharma

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Always think about continuity of care

CCGs: The Big Debate HSJ editor, Alastair McLellan will be ensuring all the tough questions get answered in a balloon debate on the future of CCGs. The session promises some lively debate with Commissioning Show delegates adding their views to those of some of the most vocal figures in healthcare. It’s a must attend for anyone interested in hearing the latest strategies from some of the bodies making the healthcare reforms happen.

continued from page 1 Another challenge for the new NHS, working within a financial straitjacket, will be managing patient expectations. A point that Dr Swinyard says he has stressed repeatedly at meetings in Whitehall is that the Department of Health must work with commissioners to help yard Dr Peter Swin patients understand that while they can’t have everything they want they will be able to have everything they need.

The hot topics: • Is ‘assumed liberty’ for CCGs a good idea – should it (and will it) be more of case of ‘earned autonomy’ • Will CCG decisions drive the efficiency agenda or vice versa? • Providers have always held the upper hand over commissioners. Will the future by any different? • What are ethical dimensions of clinical commissioning?

Looking to the future, Dr Swinyard is an optimist: ‘I personally happen to believe that clinical commissioning is the best option we’ve ever had and it is the best chance that has been handed to us of influencing what happens. ‘GPs are really quite good at adapting to an environment- we are quite Darwinian in our ways and old lags like me have seen all sorts of systems come and go and yet the basic continuity of the doctor-patient relationship survives. If you ask a patient what they value it is always that they know who their doctor is and that they have a single named person they can go to for healthcare advice.’

• How will CCGs manage risk – indeed, do they even understand the risks they face? • Are CCGs likely to take lay representation more seriously than past commissioners?

The Panellists Stephen Dorrell, Chair, House of Commons health committee The man that HSJ called everybody’s fantasy health secretary,

it was Mr Dorrell’s incisive critique of Andrew Lansley’s health reforms that - along with professional and Lib Dem unrest - led to the “pausing” of the Health Bill. Mike Farrar, Chief executive, NHS Confederation One of only four people to have appeared in the top half of the HSJ100 for its entire, six-year history. A former SHA chief executive and influential commentator on NHS reforms. Sir Robert Naylor, Chief executive, University College London Hospitals Foundation Trust Academic health science centres and the trusts that form their base are more influential than ever. None has a higher profile than UCL Partners and its bedrock trust University College London Hospitals. Niall Dickson, Chief executive, General Medical Council The figure behind the revalidation requirements being imposed by the General Medical Council. In addition, Mr Dickson has extracted assurances from government on language testing for doctors. Dr Jennifer Dixon, Director, Nuffield Trust As the DH slims down its research and policy capability, the more organisations such as the Nuffield Trust increase their influence. Jeremy Taylor, Chief executive, National Voices National Voices is the leading coalition of health and social care charities. Its influence was recognised in Mr Taylor’s appointment as co-chair of the Future Forum’s information workstream.

Amidst all the upheaval of the reforms Dr Swinyard is adamant that continuity of care and the individual ethos of each practice should be preserved. ‘My message to delegates coming to the Commissioning Show is to think about continuity of care and always think of the patient first whatever service you are commissioning,’ says Dr Swinyard. Continuity of GP care, the bedrock of integration, is the subject of the session on Wednesday June 27 which will be addressed by joint honorary secretaries of the FDA - Mrs Geraldine Taggart Jeewa a senior practice manager from Southport and Dr Simon Abrams, a Liverpool GP.

Stephen Dorrell

Mike Farrar

Sir Robert Naylor

Niall Dickson

Dr Jennifer Dixon

Jeremy Taylor

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AstraZeneca evolves to meet healthcare challenges

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neca UK Marketing Company I’m Lisa Anson, President of AstraZe n important vative prescription medicines for seve lop, manufacture and market inno deve , rointestinal, over gast disc ar, we scul neca iova aZe card Astr er, At most serious illnesses: canc ld’s wor the of e som de inclu h areas of healthcare, whic and inflammation. infection, neuroscience, respiratory As a partner in healthcare, we wish beyond our innovative medicines. s goe , ever how care nt patie to Our commitment s National Health Service for patients. to support the delivery of a world clas to release up to 20 billion pounds of deficit and growing debt, and aims nal natio our to cially as une imm n bee not The NHS has realize those efficiency savings, espe nd the challenges the NHS faces to ersta lenge und We chal . 2014 omic by econ ngs and savi y ery ienc effic ditions, provides a service deliv Con Term Long with nts patie ngst increasing prevalence amo for the NHS. that to be more patient and lthcare environment, we recognise hea UK ging chan t and ing leng In this increasingly chal ourselves to support the NHS to mee We are adapting and better aligning ve. evol to inue cont t mus we ric customer cent rations. policy, productivity and efficiency aspi orting the lives of patients and are supp the NHS, we are helping to improve with s for urce ome reso outc or and lity qua skills on ling By poo out compromising and efficiency improvements, with as a king Wor t Join ugh thro arily organisations to deliver productivity prim with the NHS facilitated hip ners part er clos this well as ered lth, end Hea I and Department of patients. We have eng achieve its goals as set out by the ABP NHS the help to h roac app valid credible and as other forms of collaboration. more ernment’s wish to see a closer and on Joint Working confirm the Gov s eline clear guid out lth set Hea has of ent NHS the artm The Dep ical industry. In fact, een the NHS and the pharmaceut ctives obje their eve achi to liers mature working relationship betw supp with their rs to consider closer Joint Working recommendations for NHS Manage within the new NHS. ary to ensure that patients, as the prim evement of NHS goals by helping achi the ort supp to ded inten lth. is Joint Working positive difference in their hea consistent care, and experience a beneficiaries, receive better, more m. was with ESyDoc pathfinder consortiu project AstraZeneca has undertaken king nt Wor t patie Join a ul of essf ent succ a lopm of ple deve One exam urces for the joint ed to pool skills, expertise and reso agre and ey and Surr ds as nee such their s to lder ned eho liste stak r We g with othe national guidelines. Together, alon Easy we focused COPD pathway in line with st Ambulance Trust and Breathe Coa East h Sout lth, Hea ity mun Com ey Surr ns in t, issio Trus adm NHS D re COP Sussex Healthca e were 210 emergency for this project highlighted that ther lts Resu th of lts. leng resu age tive aver posi an e and som days achieved D hospital bed there was a 21% reduction in COP with fied” satis y ”ver e wer they that 2009 versus 225 in 2010.1 However rted 1 of 487 COPD patients repo out 463 , ition add s In . step days next 5.0 the to t stay fell from 6.8 days were ”totally aware” of wha out of 487 COPD patients said they 433 and , ived rece had they that the care .1 were in their self management plan as that of ts in our corporate reputation, as well t Working may include improvemen Join of e and/or neca mor aZe ugh Astr thro to efit efits ben of ben The ects can also be eral. In addition, Joint Working proj practice. cal clini in use iate ropr app the Pharmaceutical Industry in gen their neca’s through supporting aZe Astr of e thos ding nership inclu part s, in icine king better use of med d commitment to wor , through demonstrating our continue king Wor t hips Join tions that rela ve ble belie aina we sust ntly, Importa orm which supports patient benefit, helps to provide a platf with the NHS on a shared agenda for e. with the NHS both now and in the futur

File 2011. (DOF\099\Apr2011)

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PSUK is the largest supplier of pharmaceutical and consumable products to GP practices in the UK. Our extensive product portfolio covers pharmaceuticals, consumables, disposable instruments and medical equipment at the most competitive net pricing available. We are continually expanding our product range and are delighted to quote for refurbishments and new builds. Additionally, to enhance the purchasing experience PSUK offers innovative management solutions to over 7000 GP practices. We work closely with GP Consortia to streamline purchasing and facilitate relationships with suppliers to ensure a win/ win outcome for the NHS and the practice. Our management services encompass medicine optimisation and contract negotiation and implementation. Furthermore, we hold over 40 study days that are CPD accredited to increase profitability, efficiency, patient care and staff contentment For further information on PSUK please contact Heidi Barrett on 01904 732274/07501 683574 or visit www.psuk.co.uk

UnitedHealth UK: Building partnerships for commissioning support In its guidance to the NHS about delivering service excellence, the NHS Commissioning Board makes clear that the new commissioning system needs to be “better and more efficient than anything that has gone before” and that it can “only be achieved by doing things differently”. Commissioning Support Services that are customer focused and can help improve outcomes for local populations will be critical in realising this vision for the NHS. In our conference session, The Building Blocks of Integrated Care: Commissioning Support Partnerships to Enhance Collaboration we will look at how working in partnership to provide commissioning support can not only deliver effective and efficient commissioning, but drive improvements in patient care and integration of services across providers.

As Clinical Commissioning Groups consider how best to exercise their right to choose the commissioning support that will help them meet the needs of their patients and NHS Commissioning Support Services develop their services and are subject to assurance – developing and building effective partnerships will play an important role. With so many factors still to be determined, the establishment of meaningful relationships with external partners might not seem like a top priority. However, independent research undertaken by the King’s Fund concluded that used appropriately, external support can play a role in raising the standard of commissioning in the NHS, and in doing so help the system to achieve the improvements in quality and productivity needed over the coming years.

Lisa Anson, g Company President of AstraZeneca UK Marketin

References: 1. AstraZeneca Data on Date of preparation: May 2012 1846903

Call 02476 719 686 or visit www.commissioningshow.co.uk/book

The combination of the experience and knowledge of NHS commissioners with the capabilities, insights and capabilities of external partners provides great potential in ensuring innovative, customer focused and responsive commissioning support services can deliver improvements for NHS patients. Drawing on our experience of partnering with the NHS for over 10 years, our session will share some of the key lessons learned in building effective partnerships and discuss practical examples about how: • Using the right data to drive decision-making can improve quality and reduce cost • Defining the health needs of local populations can lead to innovation as well as better budget management • Making contracts with providers can be an opportunity to enhance care coordination and redesign clinical pathways and improving outcomes

www.commissioningshow.co.uk

Ingrid Saffin, Partner at Mundays LLP, talks about:

HIDDEN BENEFITS OF THE HEALTH AND SOCIAL CARE ACT 2012 The passing of the Health and Social Care Act 2012 is welcome news to forward thinking leaders and members of Clinical Commissioning Groups. There is a good deal of detail yet to come from the Government but at last CCGs and the GP practices that are part of them can get on with organising themselves with confidence and taking up the challenge of being at the forefront of the new look NHS. Much has been made of the undeniable challenges that face CCGs but help and guidance is available from legal advisors like Mundays LLP, with whose help CCGs can:

LEGAL EXPERTISE FOR HEALTHCARE THAT GETS STRAIGHT TO THE POINT At Mundays our clients want us to be on their side as a legal partner – more than just a provider of legal advice. This means we understand not just their needs today, but their needs in the future. At Mundays we have a nationally recognised team of approachable and enthusiastic lawyers. We understand healthcare businesses and offer practical advice and commercial solutions to a wide variety of clients.

• set up their constitutions • put in place safeguards and processes to facilitate good governance • deal with conflicts of interest • identify and deal with any liability issues where CCGs have commenced to operate without forming a separate the legal entity • once clear details have emerged as to what the Government has in mind in terms of their legal identity going forward, unwind and transfer liability where CCGs have formed a separate legal entity through which to operate in the meantime • advise on and deal with property issues arising from the transfer of PCT property to NHS Property Services Limited So far, so predictable, but what about the hidden benefits that working together with an eye on value for money can bring? Not many column inches have been dedicated to these opportunities but as CCGs develop and become more sophisticated, Ingrid Saffin of Mundays LLP believes that CCGs and their members will recognise the benefits of working effectively as buying groups for goods and services that are consumed by their member GP practices but fall outside the scope of CCGs’ primary role. This could encompass anything from stationery and office furniture to legal services such as conveyancing, partnership matters, employment advice and wills. Mundays LLP is ready to partner CCGs and GPs to bring these benefits now, with packages of cost eﬀective legal services for members of CCGs that roll out the services to their members and their members employees. Mundays LLP will be at the Commissioning Show on stand D73 so why not take a few minutes to stop by and talk to them.

Whatever your business, we will be talking your language. Contact Ingrid: ingrid.saffin@mundays.co.uk 01932 590 535

healthcare@mundays.co.uk www.mundays.co.uk/healthcare

To find out more about Mundays LLP legal advice please visit www.mundays.co.uk

www.commissioningshow.co.uk

NUMERA ADDS SOLUTIONS TO ITS PRODUCT RANGE Numera has now added a combined telecare and telehealth solution to its product range following the acquisition of BlueLibris LLC – the company behind a small, wearable device that allows two-way, hands-free voice communication through a cellular network as well as GPS location tracking.

to upload biometric measurements from a variety of health devices through the mobile personal health gateway. Users will also receive personalised reminders to take medications, upload measurements, and health coaching specific to their health condition. BlueLibris is a leader in personal health monitoring and safety technologies and the acquisition adds a novel, mobile telecare platform to Numera’s existing telehealth products, social engagement solutions, and professional services portfolio. The combined telecare and telehealth offering enhances Numera’s existing business partners’ offering with the goal of improving outcomes through its Transitions in Care, Independent Ageing, and Long-Term Condition management programmes.

“The market for telecare and telehealth is expected to grow to over £3 Billion by 2017,” said Tim Smokoff, CEO of Numera. “Often, a person will need telehealth-related services for general wellness or long-term condition management, and later have a need for the personal safety and immediate response offered by a telecare platform. This acquisition makes it possible for Numera’s customers to have both, as they need them, on the same scalable platform.” “As we continue development of the BlueLibris products, we will extend the capabilities of the device with additional, innovative sensing capabilities to enrich activity monitoring and feedback for behaviour change and lasting engagement for those living with chronic and long-term health conditions,” said Bill Reid, Head of Product Development at Numera.

“By combining the capabilities of BlueLibris with our existing family of PC, Smartphone, and home hub gateways and the Numera Social engagement platform, families, friends, and caregivers are equipped to participate in and deliver sustained engagement, which is critical for lasting behaviour change.” Bill Reid The BlueLibris device also features a unique, automated fall detection algorithms for Personal Emergency Response Services (PERS).

Numera plans to market the product through new and existing distribution and business partners by Q4, 2012.

The acquisition means the devices will now be equipped with Numera’s telehealth gateway technology, allowing the end user

Numera will be demonstrating the product at The Commissioning Show in London.

Passionate about People, Performance & Health

Measure, understand and improve

Medicology’s vision is to be an inspirational catalyst to healthcare improvement in the face of unprecedented economic, demographic and disease challenges. This vision is underpinned by our guiding ideal - Passionate about really making healthcare work. This tells you nothing about what we really do. Whether you are a commissioner, a clinical leader or working in the upper echelons of management, you will understand that knowing what to do is a far cry from making it happen. Medicology makes it happen. We make it happen faster. We make it happen with less resistance. We make it happen at far less cost and we make it happen with far, far less drama. As true experts in behavioural change (or perhaps more accurately; removing behavioural blocks to change), we can catalyse the achievement of your reform at a speed you never thought possible. www.medicology.co.uk/commissioning

The meter of Choice Do you know how much your practice spends on blood glucose test strips? Surprised? Then come and visit us at stand I32 at the Commissioning Show where we will show you how to reduce the cost of blood glucose testing without compromising on quality and accuracy. GlucoRx is a leading global manufacturer of blood glucose machines and the GlucoRx Nexus blood glucose meter and test strips have now been successfully adopted as the meter and strip of choice by a number of PCT and hospitals nationally. The GlucoRx Nexus test strips are up to 36% cheaper than the market leaders such as One Touch, Freestyle, Aviva and Contour strips. We offer a range of support to practices in helping you to make patient switches easy and painless so allowing GP’s to reduce their spend on test strip both quickly and effectively. Come and discuss how we can help you.

Immediate access to patient history Air Products Healthcare provides a scalable, fullymanaged telehealth service without the need for capital expenditure. We have extensive experience of providing in-home services to patients with long-term-conditions. Since 2006 we have successfully provided this support to over 200,000 patients. Air Products is a leading homecare service provider who manages all the non-clinical aspects of telehealth leaving the clinician to focus on managing the patient’s health and wellbeing. We offer Risk Stratification, nurse led monitoring, a 24/7 support care-centre and a team of dedicated homecare service engineers to support patients in their homes. There is no capital outlay; you only pay for what you need. You have easy, immediate access to patient history and vital signs; and receive qualified clinical alerts for early identification of an acute event. And, with access to the most appropriate technologies, you can secure the service and equipment that best suits your needs. To find out more call 0845 602 0776 or visit www.airproducts.co.uk/telehealth

The NHS is currently expected to make unprecedented efficiency savings while improving quality of care and health outcomes – and the new commissioning consortia are the bodies tasked with overseeing the process. Doing that job requires robust, wide-ranging, up-to-date, indepth information. And that is what Dr Foster can provide, helping you to: • Assure the quality of your providers • Control costs and ensure value for money • Identify patients most at risk of multiple admissions to hospital • Profile your population on the basis of current and future need Dr Foster Intelligence provides web-based solutions to healthcare organisations to help them measure, understand and improve the quality and cost-effectiveness of their services. Our unique access to Secondary Uses Service (SUS) data and the ability to link this to local datasets, combined with our long-term proven experience and understanding of the NHS and the vital role of analytics, enables us to provide a unique and valuable insight to NHS organisations. This can support and underpin all areas of performance, measurement and improvement. We currently manage datasets for our own informatics products, with over 825 million records in our data warehouse. Every month, we undertake a data staging process where we collate, cleanse and standardise millions of new SUS returns before adding them to our live data warehouse, where they become instantly accessible in our online business intelligence tools. We are now making this data staging and processing capability available to CSOs as a fully managed service.

Meet employers from “Down Under” Elmvia Australia would like to welcome you to the 2012 GP Commissioning show. We have travelled from Brisbane this week to support the event. At Elmvia we have over 6 years’ experience of working closely with UK and Irish Doctors, dentists and Nurses looking to find a new job Down under. We are based in Queensland and have a national network of clients all over Australia. As migrants ourselves we have a great deal of personal experience in moving from the UK and our service will allow you to have a stress free and seamless move. We will support all your registration and Visa application paperwork from the start of the process and be there with open arms to welcome you when you arrive. With us this week in London we have a most valuable client interested in meeting you to discuss their current needs. If you have time come along and see us when you can.

www.commissioningshow.co.uk

Our research.Your business. The perfect MATCH What MATCH does

About MATCH The Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) is a well-established research collaboration between four leading UK universities (Birmingham, Brunel, Nottingham & Ulster) and is funded since 2003 by the Engineering and Physical Sciences Research Council and partner contributions.

MATCH helps improve decision-making for technology

Assesses value …

suppliers and procurement agencies. It enables

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greater confidence that the value to patients and others

Optimises product development and manufacture…

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…by researching processes for improving information and

To this end, MATCH delivers: standardised methods for

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establishing clinical value; new approaches to capturing

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user needs for early design and in-use upgrades; best of

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breed research into production and decision-making

Engages end users…

processes; and a forum for engaging regulators and

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related benefits to inform value models and develop methods for engaging with users at the conception and design stages. Focuses on Industry… …by maintaining a strong industrial perspective, and using real industrial problems to drive and ground its research activities.

How can MATCH help my business? The MATCH Affiliate Scheme will provide you with access to experts who will support your staff, helping

them transform your company's competitive performance by embedding flagship techniques, derived from best-practice in healthcare technology assessment and user needs analysis.

For further information please contact Elizabeth Deadman match@brunel.ac.uk 01895 266050 or check the MATCH website: www.match.ac.uk/sme.php

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www.commissioningshow.co.uk

Meet the Chairs

Collectively our faculty of stream chairs represent over 300 years of healthcare and management experience. They will be on hand throughout the show to ensure the debate flows and the important questions get answered. CLINICAL COMMISSIONING GROUPS OF THE FUTURE Dr Charles Alessi, Chair, NAPC

Dr Charles Alessi

Dr Nick Hicks

Dr Johnny Marshall

Ed Harding

Michael Sobanja

Dr Michael Dixon

Andrew Hartshorn

Sir Muir Gray

Jeremy Nettle

Beverly Bryant

INTEGRATED CARE Dr Johnny Marshall, Joint Chair, NAPC NHS Alliance Coalition Michael Sobanja, Policy Director, NHS Alliance PRODUCTIVITY THROUGH TECHNOLOGY Andrew Hartshorn, Vice Chair, Intellect Health and Social Care Council Jeremy Nettle, Chair, Intellect Health and social Care Committee

HEALTH AND WELLBEING BOARDS Dr Nick Hicks, Director of Public Health, Milton Keynes Ed Harding, Partner, HK Consulting MANAGING LONG TERM CONDITIONS Dr Michael Dixon, Chair, NHS Alliance Sir Muir Gray KEYNOTE CHAIR Dr Charles Alessi, Chair, NAPC LEADERS SYMPOSIUM CHAIR Beverly Bryant, MD, Capita

“At the forefront of the manufacturing and worldwide distribution of cost effective and innovative diabetes products, Ypsomed Ltd is a total solution provider for the management of diabetes care. The company’s current product portfolio consists of Blood Glucose Meters, Lancets, Pen Needles, and Tubeless Insulin Pumps.

STROKE PREVENTION

Ypsomed Ltd are currently helping Clinical Commissioning Groups, PCTs and Consortia save as much as £400,000 per annum on prescribing blood glucose test strips, pen needles and lancets, based on an average size PCT. Voted as a test winner in an independent study the mylife Pura blood glucose meter is used confidently by people with diabetes worldwide. It is precise, accurate and out performs the most established strips available. Our mylife OmniPod insulin pump is one of the first tubeless pumps on the market, and is proving revolutionary for all its users.”

The first new oral anticoagulant for stroke prevention in atrial fibrillation in 50 years

Leading trade association partners with Commissioning

Pradaxa® For prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation with one or more of the following risk factors: • Previous stroke, transient ischaemic attack or systemic embolism (SEE) • Left ventricular ejection fraction <40% • Symptomatic heart failure, ≥ New York Heart Association (NYHA) Class 2 • Age ≥75 years

BCS, the chartered institute for IT, have partnered with the Commissioning Show in support of the Productivity Through Technology stream. The aim of the institute is to foster links between experts from industry, academia and business to promote new thinking, education and knowledge sharing, making them a perfect fit for the Commissioning Show “Primary care has more challenges now than ever, with the expectation that CCGs will deliver high quality services and cost savings. When we asked GPs what were their top priorities for 2012, over a quarter believed the innovative use of technology would be one of the most effective solutions to improving productivity and patient care.” Advises James Hall, stream manager.

• A ge ≥65 years associated with one of the following: diabetes mellitus, coronary artery disease or hypertension

Please refer to the SPC before prescribing this product, particularly in relation to side-effects, precautions and contra-indications. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Boehringer s Drug Safety on 0800 328 1627 (freephone). Legal category: POM Further information is available from: Boehringer Ingelheim Limited, Ellesfield Avenue, Bracknell, Berkshire. RG12 8YS For an educational pack, go to www.pradaxa.co.uk/SPAFeducationalpack or call the Pradaxa® information line on 0845 601 7880 Date of preparation: March 2012 Job code: UK/DBG-121156

Inspired by this swell of interest, this stream looks at different uses and solutions that technology can offer primary care and social services. The stream offers case studies and expert advice, with a particular focus on mobile and tele-health solutions. 19438 BIP SPAF Brain commioning A5 Ad.indd 1

12/03/2012 15:14

www.commissioningshow.co.uk

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www.commissioningshow.co.uk

CCGs of the Future

Progress towards implementing the health service reforms is so rapid, now that the legislation has received Royal Assent that CCGs are having to run very hard to keep up with all the changes.

Professor Stev e

Professor Steve Field, chairman of the NHS Future Forum and chairman of the National Health Inclusion Board, who is a keynote speaker in the CCGs of the Future stream, says: ‘Now there is political certainty that it’s going to happen, the health service is changing almost daily.’ Field

He says he can’t predict yet what he will be talking about at the Commissioning Show because he says the atmosphere between now and June will have changed. ‘What I can guarantee though is that what I will be saying will be bang up to date, very relevant. ‘People are in the middle of forming and storming CCGs and the issues they are going to be dealing with in eight or twelve weeks time are going to be very different to those they are grappling with now. CCGs have been working with draft guidance but they haven’t yet seen a lot of the detail about how their groups should be structured. All of these policy papers on these issues can now be released and talked about.

‘Everybody involved in commissioning should come to this conference because they will be able to find out the most up to date information and be able to network with colleagues and this will really help them develop their local commissioning.

“People will come because they will want to hear about commissioning, where the politics is going and there will be loads of things they will want to talk about”

Cumbria is recognised as being at the forefront of many of the current NHS changes. This pioneering CCG has been created from six locality commissioning groups and is seeking to devolve responsibility as much as possible to local level while gaining the advantages of being part of a large group.

Delegates will have the chance to discuss the results and share their views on the outcomes, ready for the upcoming focus report in the title. This will be one of the first studies of its kind to draw on the views of both local authority and health service figures to get a snap shot of how joint working is progressing. Director of the Health and Wellbeing stream and session facilitator, Mike Broad comments: “Whilst there has been excellent pioneering work in some areas, many others are still in the early stages of building their relationships with local authorities. This session will offer a candid insight into respondents priorities and concerns and hopefully generate some lively debate as to possible solutions. I would urge anyone involved in HWB development to come along and air their views.”

A SPECIALIST employment law helpline operated by MDDUS will help practices cope with the increasing demands of commissioning.

responsibilities.

The service is available to practice managers within MDDUS group schemes or members who have employment

An experienced team of in-house advisers is on hand to provide specialist employment law and HR advice for those experiencing difficulties with employment matters. The advice service operates mainly during core hours but is available 24/7 for urgent enquiries. And as the service is unlimited, members can speak with the team regularly for follow-up on developing situations. MDDUS employment law adviser Liz Symon said: “This service is already proving very popular with our members who are looking for advice and support that complies with the latest employment law legislation.

This CCG is well on the way towards gaining authorisation Professor Steve Field in 2013, and in this talk delegates will hear some of the key lessons already learned and be offered practical tips on making progress. The learning points will include: being clear about where you are heading; how to keep members on board CCGs; the importance of focusing on clinical quality and not just balancing the books and building partnerships with specialists, the third sector and patients.

Pro-Cure - New year Air your views brings new wave of on Health and Wellbeing as part of commercial support NHS PRO-CURE has kicked off 2012/13 national survey with a series of high-profile projects Leading public sector title Local Government Chronicle will be presenting the initial findings of their survey into the progress of Health and Wellbeing Boards at a special session at the Commissioning Show.

Employment law helpline for practices

‘People will come because they will want to hear about commissioning, where the politics is going and there will be loads of things they will want to talk about. Delegates who attend this speaker stream will also be able to gain inspiration from Dr Hugh Reeve, Chair of Cumbria CCG and GP Partner, Nutwood Surgery, Grange-over-Sands.

supporting commissioners.

Our specialist team is leading the procurement for a national children’s epilepsy surgery service, ‘111’ single-point-of-access initiatives, healthcare and dentistry in prisons and payment by results procurements for drug and alcohol support services. PRO-CURE works with Primary Care Trusts (PCTs) and Clinical Commissioning Groups (CCGs) to meet their objectives and support the delivery of high quality healthcare and better outcomes for patients. Experienced NHS procurement professionals, our team can guide commissioners step-by-step through the most effective competitive procurement or any qualified provider (AQP) process, supporting the shaping of service specifications and maximising value for money. We also offer commercial advice, project and performance management. For more information, contact: Caroline Thomsett, Assistant Director of Corporate Services, Telephone: 0118 916 7945 Email: caroline.thomsett@pro-cure.nhs.uk

“Contractual issues have been a real hot topic for our members when contacting MDDUS for advice and we also receive a number of calls on policy issues such as maternity and sick pay. We expect these issues will be brought to the fore as more practices become involved in commissioning in line with the planned NHS reforms. This will likely mean an increased demand for the expert service we provide at MDDUS.” In addition to the helpline, MDDUS is also offering to practice schemes - where all employing GP/GDP partners are members of the Union - the option of a Legal Support, Representation and Indemnity package (LRI) which will be available for a small additional fee per head of employer. The LRI package provides access to assistance in matters that go beyond simple advice and guidance.

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Call 02476 719 686 or visit www.commissioningshow.co.uk/book

www.commissioningshow.co.uk

i-healthbooker set to transform CCG communication

The HWBs are coming... Each top tier and unitary authority should now have set up their own health and wellbeing board (HWB) which will be operating in shadow form and preparing to take on their statutory functions by April 2013. HWBs are the centrepiece of the machinery that will see local authorities taking responsibility for improving the health of their local populations.

A web application which creates a unique online community for clinical commissioning groups (CCGs), their clinicians and the service providers they work with, will be showcased at the Commissioning Show.

The HWB will be the strategic forum that sets the priorities for their clinical commissioning groups (CCGs) and will bring together representatives from primary care, public health, social care plus elected representatives and patient groups.

i-healthbooker is the brainchild of West Yorkshire GP Dr Chris Jones, managing director and owner of IQUS, the company which developed Rota Master the software application which automates complex duty rotas for unscheduled healthcare providers.

This stream of the conference will focus on successful early joint working between local authorities, HWBs and healthcare organisations.

The Facebook-style system is built around a flexible, locally managed service directory which enables networks of users to create and share the content they need to survive in the new NHS. Through i-healthbooker commissioners can build their own service directory which enables them to communicate directly with their clinicians, guide referral decisions through user-defined pathways and keep service information up to date. The system enables them to create groups for task or topic orientated collaboration and communication, build a library of CCG-specific content and monitor referrals in real time. They can also link and share information with other CCGs. Clinicians can use the system to build a personal profile, write a blog, communicate with colleagues in their own CCG as well as those around the country and enjoy real time clinical networking. The system gives them access to CCG-specific pathways to guide their referrals, a knowledge base set up and managed by local colleagues and up-to-date information regarding service providers. Service providers can maintain their own record within i-healthbooker to ensure CCGs and referrers always have up to date information and patients can book appointments online and rate services. Dr Jones, who is CCG commissioning lead for his practice in Ossett, says the idea for i-healthbooker came as he realised there was a need for the hundreds of people involved in each CCG community to be able to communicate with each other in real time and have ready access to the deluge of information that is being created by the new commissioning process. ‘My aim has been to produce an integrated system so that everything that commissioners and clinicians need is available in one online place. i-healthbooker is a framework that will be developed over time to become richer and deeper in functionality as it adapts to the needs of its users,’ he says.

“They will create a real opportunity for people to work together to achieve things they haven’t before” Dr Nicholas Hicks

Dr Nicholas Hicks, Director of Public Health, Milton Keynes NHS, who is chairing the stream on June 27, says people coming to the Commissioning Show who are involved with HWBs will be at the stage of wondering what they are supposed to be doing with their new organisations.

‘Some will have the answer and will want to tell everybody else, others will be thinking – how are we going to make this work and - what can we do, what can’t we do?’ ‘HWB Boards will bring people together with a sense of purpose. They will create a real opportunity for people to work together to achieve things they haven’t before. The challenge will be making sure that the aspirations and ambitions that will be discussed really do translate into practical change that affects the live of individuals, families and communities. ‘CCGs and Councils will have a duty to pay due regard to Joint Health and Wellbeing Strategies. How this plays out in practice will be a key test of the effectiveness of HWB Boards. Will the HWB strategies have the power to change council policies? ‘For example, if a council policy had previously promoted

the night time economy with a liberal stance on licensing applications and approval of a larger casino and the icks health and wellbeing Dr Nicholas H strategy subsequently prioritised mental health and reducing alcohol related harm, would the influence of the HWB strategy be sufficient to change council decisions? How would that play out? What do HWBs need to do to become powerful? I hope these are the sorts of questions the meeting might address.’ Dr Hicks says he would like to see everyone involved with HWBs coming to listen to the talks in this stream - elected members, council officers, local authority chief executives, people involved with CCGs and Health Watch, who represent the public. ‘By June, people involved in HWBs will be looking for inspiration from examples of good practice that are already up and running and will be wanting to make sure they really do understand the rules and regulations and the powers they have. They will want to know what they really can do that they couldn’t do before,’ he says. Case studies in this stream include early HWB implementers Wigan, Birmingham and Cornwall. In Wigan integrating wellbeing, social care and clinical pathways is at the centre of their work. In Birmingham the HWB is getting to grips with meeting the needs of a young diverse population and some challenging health inequalities. One of the challenges for the new HWB in Cornwall has been identifying which outcomes will be priorities and what success looks like. Keynote speakers include John Wilderspin, National Director, Health and Wellbeing Board Implementation at the Department of Health, who will explore how CCGs can use HWBs to develop a strong partnership with local government and Dr Alison Hill, Managing Director NHS Solutions for Public Health, who will outline some of the building blocks that HWBs should be putting in place to achieve better health outcomes.

Fiona Phillips calls for joined up care pathways for Alzheimer’s patients Alzheimer’s Disease is a much misunderstood condition starting from the moment the patient first walks into their GP’s surgery. more. She was really frightened and was crying all the time – she knew something was catastrophically wrong with her,’ she says.

Visit the Commissioning Show exhibition to meet the IQUS team who will be on hand to demonstrate how i-healthbooker works. For further information, contact enquiries@iqus.co.uk

The journey of Fiona’s parents’ through the medical and social care services were both different and both lacking in many areas. Her father ended up living in squalor after her mother died and received very little help from social services. Hospital staff had little understanding of his problems - when he was admitted to hospital with pneumonia staff asked him long lists of questions, which he couldn’t answer.

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When the GP came to see him at home to treat his leg there was a great deal of concern about his leg but not his dementia. ‘People with Alzheimer’s just slip between health and social care and both services are often inadequate,’ says Fiona.

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Her plea to clinical commissioners is: ‘Just consider what it means to have a devastating diagnosis like Alzheimer’s. It is a cruel disease that can make families fall apart under the burden of caring.’

or visit www.commissioningshow.co.uk/book This is the view of broadcaster and TV presenter Fiona Phillips who will be giving a talk on her experience of caring for both her parents over a period of 14 years while they battled the disease. Fiona reckons her mother, while still only in her fifties, had had the disease for six years before she realised – something she still feels guilty about today. ‘She never told me because she had forgotten she had been to the GP and hadn’t taken the information in. I wished I could have been around for her

She will tell CCGs that they should be commissioning integrated pathways of care. The pathway should start with early diagnosis and informing next of kin so that they know early on what is happening. Patients and carers should be given clear, written information about the disease, about what help and support is available, and how they can access it. Every patient should be entitled to good quality care in their own home. ‘What happens at the moment is that you are literally left to get on with it and, as happened to me, you just try find out things along the way, often by making terrible mistakes,’ says Fiona.