Webinar: Integrated Care Pathways in Pharma

Webinar: Integrated Care Pathways in Pharma2022-02-22T14:56:16+00:00

Watch our free webinar as Triducive partner with Pharma Field to share ‘Ways to make your Pharma brand more relevant in integrated care systems’ with founder, Tim Warren and partner, Nick Williams.

If you don’t have the time to watch the full webinar, click on the + to read the full transcription of the webinar to ensure you don’t miss out on important points.  Otherwise make sure to check out our Webinar with Co-Partner of Triducive, Nick Williams on the importance of shaping the market in healthcare to add real brand value.

 

Introduction

Good afternoon, everyone. My name’s Nick Williams, co-director of tri who are partnering with pharma field with this webinar series. And I’m delighted to be moderating today’s first event, making brands relevant within an integrated care system. Thank you all for joining us today. And thanks also to E four H who are support in the production of the event. We hope that this will be one of three very relevant topics for pharma and healthcare organizations right now. And we hope that you and your colleagues can join us for the other two sessions as well. We’ll have time at the end of the session to answer your questions and to share any reflections that you have that contribute to the conversation in hand. So it’s with great pleasure that I’m handing over to my colleague, Tim Warren, the speaker today to lead the discussion. Tim has led a career spanning over 20 years in the industry where he’s mastered a number of commercial leadership and communications disciplines.

He founded Triducive 10 years ago where his focus and expertise with commissioning and nonclinical decision-making audiences has accumulated significantly working across numerous therapy areas and national healthcare systems. Hundreds of brands, thousands of healthcare stakeholders, Tim and the Triducive team have developed countless programs that provide practical supports for integrated care approaches and help brands gain and remain relevance. You’re in great hands today over to you, Tim.

Tim Warren

Thank you, Nick. And thank you everyone for, for joining us today. It’s very much appreciated. We’re looking forward to spending the next sort of 40 or so minutes just going through this topic of how we can think about making brands relevant to NHS integrated care systems. The outcomes from participation today are essentially threefold. We want to just explore a little bit more about the emerging role of integrated care systems and some of the goals that they’ve set themselves, we then want to align how integrated care pathways will help support of goals that ICSs have.

And as a consequence of that, to consider how, where and why pharmaceutical brands can engage in a way that is both beneficial and relevant to the emerging integrated care systems that are approaching the NHS. What I wanted to do, if I may is just open up a very quick poll, just to get a, a view from people that have participated, just to understand how confident are you in your brand’s ability to engage relevantly with ICS organizations so that the use of that brand will increase. Maybe we could just take a few moments to look at those five options there and please select one that’s most relevant to you.

Excellent. Thank you for participating. Interesting. A mixed bag. There is certainly some elements of confidence, 23%, which is great. But the majority are either not sure or are quite unconfident or indeed unconfident outright in terms of their ability to engage relevantly with ICS organizations in order that market share and brand use will increase. Thank you. I appreciate that. Interesting to see the views of the participants that have joined us, essentially, we’ve got two topics that I wanted to cover off. Two, three letter acronyms, two TLAs one is the ICS, the integrated care systems. And secondly, another TLA, another three letter acronym being ICPs integrated care pathways. The two are very much related and relevant to one another focusing on ICSs as you will all appreciate very new organizations that are emerging throughout the NHS in England and leaning very much on some of the, the way that care is integrated and delivered.

In some of the devolved nations. There is a definition of an integrated care system set out by the N a system, an NHS organization that works in partnership with local councils, councils and others, and overall taking a collective responsibility for managing the resources, the people, the staff, the locations, the costs of care for delivering against NHS standards with the ultimate aim, improving the health of a population rather than an individual. The population that they serve, these integrated care systems have been in existence in other parts of Europe. And some would say are modeled on some of the care models that exist out in the states, but it’s certainly a structure of care that is emerging very strongly within the NHS. The components of ICSs are complicated and numerous. They are there absolutely to deliver against the national policy and the targets and aspirations that are set, but the ICS based on the previous STP footprints want to integrate care delivery at a subnational level, which again, may they lend itself to variance.

And certainly an element of complexity. As we know the level below, this is occupied by joint commissioning, between CCGs historically employed by the NHS and local authorities, social care that are looking at the populations that they’re accountable for and working very closely with provider trusts, hospital and foundation trusts that deliver secondary care of course, an opportunity that presents itself to improve the population. Health levels is working with alternative locality providers, the third sector, charity sectors, social care to improve the experience that the population and the patients experience. And of course, all of that is backed up with a, a primary care service and a range of GP expertise increasingly delivered through primary care networks. What’s interesting to notice here is that the populations that are served by ICSs are larger than those that were historically served by clinical commissioning groups. Typically, an ICS would serve a population anywhere between 200,000 patients up to a million, whereas alternative locality providers, the subset would treat anywhere between 30 to 70,000.

This absolutely creates an opportunity for pharma and healthcare companies to engage relevantly, to help understand where why, and how certain interventions fit and the benefits that can be there to achieve outcomes for populations. The change of the NHS towards I S is something that has gathered a lot of pace all the way back to 2017. The ambition that the NHS has set itself is substantiated by the long term plan. And the aspiration is by April of next year, integrated care systems will cover the entirety of the population. It’s a big organization to range, and it won’t happen quickly, but the pace of change is certainly accelerating. There will be common commissioning arrangements that exist between CCGs the NHS and local authorities and social care. There will be shared decision making amongst the people that are paying for the healthcare and the outcomes they aspire to with the people that are providing it, both within tertiary, secondary and primary care.

And of course, that creates an opportunity to consider different in new ways to communicate brand value substantiating, why, where, and how certain interventions can and should be used given the current health situation that we’re all facing the emphasis due to it has been seen by many to be an accelerator, a catalyst for the emergence of integrated care systems. There is a need, as we know, at any local level to stratify and manage those populations most at most at risk, we know that nice of updated guidance’s on a continual basis at a very rapid rate. We know that there is an impact on waiting lists and certain services such as dermatology being decommissioned in the present state elective surgery is being delayed or postponed. And there is increasing very positive integration with the independent and private sector. Proving the concept that integrating care is possible. And of course, as we are all doing now, virtual delivery will become something that should be seen by many as, as the norm moving forward, D NHS Confederation in April of this year demonstrated their thinking through a paper. They produced saying that the acceleration of the 10 year plan will be driven by the experiences that we’re going through at present and the aspiration to reduce suffering and mortality. Hasn’t got any less the emphasis to integrate care better to do it well is never more important than now. We’ll have to obviously see what this actually plays out like in the future

Integrated care pathways are the second three letter acronym I wanted to run through and something of a rhetoric in terms of a lot of the policy papers that have been produced by the NHS over its history. There are different definitions as to what a part pathway is, what it does, what it’s there for a list of medicines a means of intervening. The reassuring thing is, is that there is an actual, very clear definition of an integrated care pathway that goes all the way back to 1998, a long time ago. But as you can read for yourself, it is something that is agreed locally to determine the roles of multidisciplinary and multi-agency practice. They are built on guidelines and evidence where available for a very specific patient or client group

Integrated care pathways are designed to form all or part of the clinical record and to document the level of care that’s been offered. Of course, it lends itself to audit and continual improvement in evaluation over time. And really in summary, an integrated care pathway is there to reduce variation and to improve outcomes. The very thing that ICSs are put in place to achieve, there are lots of examples of integrated care pathways in accordance with the definition that I’ve just shared in use throughout Britain, they tend to be much better and, and, and easily employed within the devolve nations, Wales and Scotland, certainly sort of spring ahead of the use and, and role of integrated care in England. But that is changing rapidly over time. They started in surgical procedures that had high mortality and very high costs and a clear patient group with a defined start and an end considerations like prostatectomy knee joint replacements, abdominal hysterectomies, there are integrated care pathways that sort and, and structure these surgical seizures over time, they’ve moved into medical conditions things like MIS unstable angina, peritoneal dialysis, C O P D asthma neuropathic pain.

The multitude of pathways that exist and are required are increasing at a rapid rate and increase singly. Now with the advent of mobile health and digital health solutions and devices, the role of pathways in structuring, the way that care is delivered for certain patients and cohorts of groups is now becoming something that we are seeing.

The NHS is pretty stringent in the way that it employs and uses integrated care pathway ways. And this was based on a document that was produced by NHS west Midlands in 2006, and has now formed the structure of the European pathways association of best practice, the integrated care pathway assessment tool IAT regarded. Now internationally is the most effective way to ascertain whether an ICP is suitable and fit for purpose. There’s a number of criteria that an integrated care pathway must contain. It needs to meet the definition. It needs to have the right documentation to allow for, or the commissioning and provision of care. It needs to be developed for the right reasons with the right people. And we need to absolutely start with the end in mind, how, and who will it be implemented with, in best practice? The ICP should be maintained at a local level over a period of time. Learning from that constant reevaluation to an sure that things are improving and getting better, that variance is reducing and outcomes are improving, and the roles of the organization need to be absolutely clear. And of course, this is paramount. If we consider the role of ICSs and the constituent parties that may form an ICS throughout England.

The NHS are also very helpful in sort of providing a consideration of where ICPs are needed. There’s a list of eight criteria. And according to them, with NHS Wales taking a lead, they’ve kind of suggested that if at least four of these criteria are reached, then the need for an ICP is more evidence. What I wanted to do was ask another poll. And just before I get to that, I was just wondering whether you could take a look at those eight criteria on the screen and just consider how many of those eight are relevant to the main brand that you work on. Just take a moment to have a look, which ones are relevant to the main brand you work on and having done that. I was just wondering whether you’d be willing to participate in this poll. Thank you. Interesting results. It would appear that there is a role for integrated care pathways in the context of integrated care systems for the vast re vast majority of the respondents participating in this poll. It’s really interesting fee back. Thank you very much for taking the time to do that.

Integrated care pathways came about from the HMO organizations in the states, the health maintenance organizations, they were very much driven by the insurance based care that’s on offer in the states. And obviously we’re very keen to understand some of the resources and the costs that were involved. Other proponents would say that in the UK, we are far more focused on quality. Which I think is something I wholeheartedly agree with the outcomes that are retrieved from those interventions, but of course, we need to balance those outcomes with affordability and with finite budgets that exist within the NHS. So the HMOs certainly develop this model, Kaiser, Mente, and organizations like that came up with the term care pathway recognizing, and it’s not rocket science or any surprise, but if you can treat and prevent conditions earlier in their cascade and keep people maybe in primary care, rather than having to go into hospital resources would be less.

The patient experience would be better and the outcomes could be improved. And as I’ve already mentioned, the term integrated care pathway was really sort of developed from that seminar paper in 1998. That definition that I showed earlier, without risking to repeat myself, the criteria of an integrated care pathway should be for a specific clinical topic, a patient group, a certain cohort. It should provide an expected progress along the structured plan of care for that patient, that individual, according to the evidence that’s available to substantiate the use and the interventions, the procedures that are required, it will allow itself for clinical audits and should help maintain and improve the standards that are set for both the commissioning and the delivery of care to the populations that it serves, the whole development. And the advent of having integrated care pathways improves the communication between different providers, different commissioners, alternative providers, and new providers of care within the ICSs.

The benefits of ICPs are increasingly well sighted in the context of commissioning audiences. We’ve seen a lot of utility with this kind of thinking, this kind of approach, as it provide a very clear framework for service specification, very clearly defining the outcomes that the commissioners are willing to pay for, and to build a specification as to how they can achieve that in practice, what healthcare professionals, what allied services are they going to use to ensure that they’re getting the most impact for the finite budgets they have of available all in accordance with the evidence, the best practice, the standards, whatever it is that substantiates the aspirations that need to be put behind improving outcomes and reducing variants. And in practical use, we’ve seen a lot of utility with integrated care pathways to help improve communications. You can read the list for yourself, but that improved integration and clarity about what needs to be done and why for a certain patient along a certain part of that journey, again, meets that aspiration of reducing variance and improving outcomes we’ve seen with the ICSs that we’ve engaged with to date the appetite for structuring and clarifying the way care is delivered is something that they find a very necessary part of their, their future.

We talked about the I process and the fact that the documentation needed to be there. It needed to be in accordance with those standards. Any ICP has a defined start and a defined end, and that needs to be crystal clear. There needs to be a patient journey, and a patient process map, really to understand the, the sequence of that journey that the patient is likely to go on. And having mapped that out, having a very clear set of forms, checklists prompts, ways of collating the right data to ensure the right activity is prescribed and the right outcomes are achieved. Now, of course, science or art is, is often the question that surrounds medicine. So to accommodate the variance that may need be needed again, for audit purposes, an integrated care pathway should allow for that. It’s not telling everyone hearing what needs to be done for an individual patient per se.

They are allowed to use their clinical judgment and accommodate that variance in the tracking of the patient as they go along that pathway. And each of those steps will have a very similar structure in terms of what needs happen all substantiated by the evidence that exists, the standards that are, are being aimed for the guidance that’s out there within clinical practice. We don’t often see integrated care pathways, rewriting the rule books as it were, but really providing a clear and structured means of achieving that in accordance with best practice, all in the way to reduce variants and to improve outcomes where possible those three components, just so you can get sight of, of what a draft one would look like. As you can see a, a process map, a relatively straightforward one, not a decision tree, not an algorithm, but a very clear visual representation of the patient journey and the steps of care. It are required. Part two being the forms, the things that need to happen. It doesn’t define necessarily who does them. That’s the opportunity for the commissioner to work out the pathway, the service model, how they’re going to achieve that outcome based on the providers they have available to them. And all of that is substantiated in a user guide and space so that people that weren’t involved in the production of the integrated care pathway understand the thinking and the evidence that substantiates the content.

The beauty of this is, and the utility again, with integrated care systems, commissioning audiences is that we’re able to consolidate the costs of care into the three buckets that tip the NHS commissioners, look at the heads, the beds and the meds, the staff costs the consultations. There are tariff costs that are available for that, the location comparing virtual clinics with primary care clinics, comparing it with secondary or tertiary care clinics, the costs of those and how they can differentiate again with that aspiration of reducing variance, improving outcomes. And of course, the consumables of which according to the, a BPI only 16% of the NHS budget at most is spent on pharmaceuticals and medicines. So the biggest challenge and opportunity for commissioners working within ICS is, is to understand a, how they can consolidate the overheads they’ve got in terms of the staff that are delivering care and the locations where they’re delivering that care.

If they can understand that and map the journey out in a way that is fit for purpose and the patient journey, then the experience, the outcomes and the reduction in variants should be more attainable. And there’s a multitude of ways that this can be modeled, but for visual purposes, this is an example of a resource allocation model that works on the insights and the, that the findings from integrated care pathways to struck and consolidate what scenario a may look like and scenario B the future. And of course, if needs be to put a line in the sand, this work working with healthcare professionals does allow itself for publication citation really sort of setting the benchmark as to how, where and why so certain care models should be used. So integrated care systems are very relevant now to the NHS, as we all know, reassuringly, the appetite for integrated care pathways are built on a lot of experience of some people using them with good effect, certainly in the DUL nations, they are a concept of tool that have been available and in existence for years in various levels of quality.

But now the NHS has got a very strict standard that it measures integrated care pathways against the two very much align the need for integrated care systems to reduce variants where possible and allow for equity of care to manage the resources, the finite budget that they have to balance the split of costs between the NHS and the local authority commissioners to develop and, and evolve new models of care and to engage and communicate with a larger and maybe more disparate list of providers for healthcare, not too dissimilar to the, as integrated care pathways and what they’re looking to achieve the implementation of guidelines to provide consistency in the way that care is managed to support local commissioning decisions and to inform service design at a local level, and to ensure that the right customers are engaged for the right reasons at the right time, understanding really what responsibilities and outcomes they’re responsible for.

We’ve seen integrated care pathways, having developed over a hundred of them in my, in my career used in a, multitude of ways by pharmaceutical clients, both within the UK and within Western Europe. They’re certainly there to help shape markets, to build hub and spoke models to very clearly define patient cohorts and to clarify the right level of care for the right patient at the right time, in the right setting, to engage commissioners and clinicians, to have a very informed discussion about what’s right with what they’re doing and what could be improved, and to provide a model of care that they can use and adopt at a local level. And obviously they’re very effective at setting up new care services or alternative care services with new providers from a brand position, a very good way of clarifying the role in the position of the medicine with specific and distinct patient cohorts, establishing a standard of care in the means of delivering that and to help support the development or rather the implementation of national frameworks.

And when it comes to implementing best practice and to engage the commissioners in a way that can catalyze some of those clinical decisions, they do provide good strong content for medical education programs that access and value added services. Of course, thinking beyond the pill to think about the heads, beds, and meds, the ramifications of when a medicine may be used. And they’re very good at supporting formulary implementations rather than payers being nervous that certain medicines may go very widely out of use being very use being a very useful tool to clarify clearly the rationale as to why and who should use certain medicines for certain reasons. I’d just like to invite you for, for one final whole, if I may a relevant ICP would be most helpful for a brand in the following situation. I’d just be keen to get your, your perspective if I may on this.

Great, thank you. Thank you. All of these situations, that would certainly be our experience very much so it works across the, the, the, the brand life cycle very much so we need to consider from a commercial perspective, why an integrated care pathway would be of benefit to a certain pharmaceutical agent. But of course, we need to align that with the needs of the ICS, the customer group and the clinical appetite, but indeed we’ve seen these being developed for new brands, new technologies, new molecules brands that are looking to grow to define their market share and shape it from that perspective of market leaders who are looking to expand the market and the utility of their therapy for the right reasons. It goes without saying, and I, I don’t mean to labor on this point, but, but we, we so certainly have experience.

And as Nick suggested at the beginning of the call, we would be delighted and very able to, to talk further if so if so, invited to do so, but there is a handout section and I thought it may just be useful just to leave you a little bit of a, sort of a top line view of the role of integrated care pathways, what they’re there to do and how, and why they can align with integrated care systems. So you’ll find that on the handout section of your details of this webinar, but Nick, I didn’t want to take up too much more time. I didn’t know if there are any questions we’ve got sort of 15 minutes to address anything. But if there are any questions that we maybe need to cover at this stage, thank you, Tim.

Questions

That was great. And I’m sure you have given our audience plenty of food for thought. We’ve already received some great questions but we’d welcome more so please, everyone, if you have, have a question for Tim please, please do jot it down into the questions section of the, the webinar console while you’re doing that. Maybe Tim, if I could share a couple of those questions that we’ve got already with you. Please, the first one is I guess in view of the sort of digital transformation that’s accelerating at the moment, but do, and how do the NHS implement ICPs digitally on their systems? That’s a great question. That’s a great question. Yes, they do. And have done very much so implemented it on their it systems with the clients that we’ve been fortunate enough to work with.

That’s been very recognized and the, the documentation that, that exists not too dissimilar to the, the draft examples I shared earlier they provide a specification for local commissioners to speak with their, it leads adapt the records and the, the information that they are capturing based on their existing sort of pathway and update it from that perspective. But we’ve seen these used very easily by practice managers in primary care or service managers within secondary care. And we are not an it company and our pharmaceutical, all clients, aren’t it companies either. But to provide that specification that starter and get them put onto the digital systems is something that we’ve seen a lot. I’ve got examples of those, but I didn’t share them in this presentation. But we see that that’s a relatively straightforward thing for an it professional to be able to, within the NHS, interestingly, we do still see in some pockets of England the reliance on PDF documents, word documents, hard copy pathways which again is, is easily doable.

But again, we need to understand the needs of the customers, but they can be digital in a relatively straightforward manner. Nick. Great. Thank you. There’s a question here, which is of a different nature, and it’s as follows. There’s been some CCG mergers in April, 2020. Some of these new CCGs are no longer aligned geographically with the ICSs. Could you some insight on how this may Mo work moving forward CCG? Yes, there were some that weren’t aligned and the, the short answer is I’m not sure what, what, what they I’ve decided with regards to that. The thinking is, is that any CCG that is in alignment with an ICS will have to be by April, 2021? I’m not sure when that will happen between now and then, but I’m led to believe as well. You know, Nick from the payers that we engage with, that every CCG will either be redundant or will be subsumed by the larger ICS from that perspective.

And I’m led to believe they’re having to make a business case as to which ICS they feel most appropriate for. Great, thank you. And another call question, which is, is there an overlap between ICPs and right care? There is an overlap. Yes, yes. There is a lot of the right care initiatives the Atlas of variation, et cetera. The need to reduce variance is absolutely something that has acted as a need to reduce variants through the use of integrated care pathways. And actually when I when we develop the, the user guides, et cetera, alignment with that policy and how it’s used locally is something that’s a very key driver to these, these kind of pathways used. It provides very clear rationale as to why there is overlap yes. In different areas of medicine. Great. Thank you. Could you tell us again, why you think COVID is accelerating the move to ICSs? This question is, is the, the person asking this question saying isn’t, COVID a major to extraction from the integration agenda.

Yes. And, and when I was doing sort of the due diligence I was conscious not to engage with people that were working in the NHS. I didn’t want to distract any of them, but we have access to about, well, just, just over 600 payers for use of, of a better term within the NHS. So I’ve only had a few conversations with, with, with friendly people that we know. But by all accounts, people that aren’t working in a, a clinical function of course COVID is taking a priority, but so is the need to, to achieve everything against the, the long term plan and the direction of travel that’s been set out since 2017 about integrated care systems. I’m sure that has slowed down. And what did become fairly evident in the, the secondary research that I did in preparation for this is that there were fairly polarized views.

There were other people going COVID we’ve got to sort all this out. And there were other, such as the NHS Confederation going, this has now got to happen quicker. It’s got to focus our minds to make sure that integration is successful based on the learnings that we’ve been forced to, to Gar virtual working, et cetera closed GP practices, that kind of stuff. So I think it is still something of a polarized view, but the most robust citation I could find was the NHS Confederation from the 14th of April. And that was backed up by the, the handful of conversations I’ve had with commissioning colleagues that we know where they’re still very much working on that, that ICS development. Thank you, Tim. There are a couple of questions about specialized commissioning. It, it wasn’t mentioned, mentioned specifically in your in your conversation.

This person mentions that their understanding is that ICSs will have access to the CCG local authority and specialized commissioning bus budget. Is that correct? And I think I saw another question of a similar nature, which says, do you still see national specialized commissioning, for example, cancer continuing post April 21st? Yes. To, to, to both those answers again, based on, on the insights and the conversations that we’ve had many of which were prior to COVID. But those, those ICSs will have access to NHS England funds very much so that, that will continue great. Nick was about specialized commissioning. I mean, for specialized commissioning, the example I showed was for a condition called hereditary Angio Dina, and that is a specialized commissioned. It’s a rare disease. There are service specifications that do provide some would argue they’re not as clear as they could be. And integrated care pathways are applicable to specialized conditions as much as they are non-specialized conditions.

Thank you. There are a couple of questions Tim, about where to start I guess for want a, at a way to put it where to start, if you’re thinking about an ICP, who in the NHS should you approach how do you go about it and what’s the best way to do it? Yeah, it’s, it’s a great question. And, I think it’s a vital part to do. I mean, at an adversary level, those eight factors suggested by NHS Wales are a, barometer, a red light green light as to whether it’s even an idea worth exploring. What we tend to do is, is work with steering groups of, of commissioning and clinical audiences. And there are a set number of questions that the I pap process sets itself and sets others to address what is wrong at the moment?

What are the shortfalls in terms of commissioning opportunities? What are the disadvantages that providers are experiencing and what is in the impact on the patient experience and understanding some of those, those shortfalls what’s wrong at the moment, it then asks converse questions about what would be the benefit structuring care, who would it benefit? What are the likely outputs, et cetera, and working with those experts through a consultative approach using that as validation, it becomes fairly evidence pretty quickly as to whether an integrated care pathway is worth developing or, or not. So we don’t develop these in isolation. We work hand in hand with NHS professionals following the IAT process to absolutely ensure that we’ve answered yes to the right questions for the right reasons. And indeed the green light is the one that’s Sean And Tim, there’s been a couple of comments about integrated care providers. So one which simply says what about them? But the second one related to that would be I guess to that point, is it worth clarifying the other meaning of an ICP integrated care provider?

So yeah, I don’t know whether you want to comment on that. Yes. I don’t know what the definition of an integrated care provider is. And I’ve seen it I’ve number of, of definitions of that. I think it probably would be useful to, to define that I haven’t got a definition to hand. I mean, I think there is so much rhetoric that the NHS talks around ICPs ICSs pathways, algorithms, et cetera, et cetera. I think it probably would be useful to, to define that name, but I haven’t got a definition to hand. Great. Okay. And let’s have a look where, where are we again? Yes, I guess a question of timing and legal entity status for CCGs. So at the moment CCGs remain the legal entity, even when ICSs are up and running, when will this change? The thinking is by 2021, April, 2021, and Let’s have a lot primary care networks. Yeah. what role do you see primary care networks having in supporting an integrated care system?

The aspiration for the networks is to really generate economies of scale and to give the providers, the GPS, a larger share of voice with the commissioners that are commissioning their services. And so being able to manage a larger population of people across number of GP practices, GP surgeries, all part of a, an agreed network that can engage with commissioners about what they’re paid for, what services they provide, et cetera, et cetera, will inform their, the enhance their economies of scale at that negotiating table. That’s well, why they were set up to give them a larger share of voice rather than being, you know, I mean, just a small practice or another small practice that was having its services commissioned by CCGs. And of course, if you get joined together the, some of your parts should be greater. So the services that could be offered to certain patients and sold back to CCGs could be increased.

Great. And somebody alarmed, I think, at your statement about dermatology being decommissioned would you be able to expand on, on that Tim? Yeah. Yes, this was a conversation. I had probably about three weeks ago with a client that worked in dermatology and we are running a project in dermatology again, as you know, Nick and it was feedback from one of the participants there saying that they’d actually been asked to go and work in A and E to help triage patients because the dermatology clinic and the elective procedures outpatient visits, et cetera, had been decommissioned from their local by their CCG as the world focused on COVID, I don’t think it’s necessarily a national thing. But that was a decision that was made very, very real there, so more of an example than an absolute, yeah.

Yep. Great. But I mean, we know elective surgery is being decommissioned. I mean, I have type one diabetes and, and my clinic’s been canceled. They’re just, they’re just not seeing those patients at the moment. And I, I think as we’ve read in the press, that that’ll change that, that can’t be good for the, the, the whole health of the population. But I think when we were early into this crisis that was one of the examples that, that, that I heard about very much so. And a question about the well, first of all, the independence of hospital trusts as they fall within ICSs, will they’re remain, retain their independence I’m led to believe they will, they will maintain their foundation trust status. Yes.

And sort of similar question around CCG. So practical question really will payers or prescribing decision makers remain at CCG level or move into an ICS organization. They will move into an CS organization. There may be one or two historic CCGs that exist within that ICS. But the aspiration is by April of next year, the CCGs will be you, I mean, responsible to and accountable of the ICSs. I think the people that work in those C ease will stay there they’ll have a different employer. But no, I don’t think the decisions will be theirs and theirs alone. They will have to work with the commissioners within local authorities to drive the health and social care act. And the, the 10 year NHS long term plan. Thank you, Tim. We’ve, we’ve covered a lot of questions.

Sadly. We haven’t been able to cover them all this this afternoon, but we will have a look at them and we will find a way to find answers and them back to the people asking them we will do that. I’m sure that everybody has enjoyed today’s program. If you’d, as Tim said, if you’d like to discuss this topic with us in more detail in line with your own business goals, we’d love to hear from you. Thanks again, into everyone joining us today, both PF and UC of hope you enjoyed the session, found value in participating. Please let us know what you think in the feedback survey after you leave, and we’ll make the video available on demand on our website shortly. So please do let colleagues know who you think may be interested to view, but couldn’t attend today. And please also, if you can join for the next two free sessions and use the registration link on the PF webinar page to do that. Thanks again, everybody. Thank you, Tim.

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