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Lead/Director:
Sally Edwards, Director of Strategic Service Development
Author:
Mark Harris, Head of Planning & Service Development
Elements of Risk:
To be defined within individual projects. Overall risk is that existing methods of providing
activity are unsustainable from the perspectives of capacity and affordability.
Resource Implications:
These will be defined as key measurables against every project.
Communications Plan:
Review through Commissioning & Performance Group
Summary to PEC and Board meetings.
Purpose:
To Note
DEMAND MANAGEMENT FRAMEWORK – AUGUST 2005 (updated)
1.0 Background
The PCTs capacity plan sets out the activity required to meet the NHS Plan targets. The
Local Delivery Plan and subsequent agreement of Service Level Agreements have however
remained a distinct process.
Constraints on commissioners abilities to move funding from secondary to primary care have
inhibited the development of primary and community care alternatives to secondary care
provision and annual referral growth has therefore been managed largely through increased
capacity in secondary care.
This is acknowledged as an unsustainable cycle, which PCTs must break. This paper focuses
on a process within which demand management can be taken forward by the PCT. It does
not detail the specific detail of existing projects, as this is contained within project mandates
and project plans.
1.2 Definitions
Demand management has usually been a term assigned to projects aimed solely at reducing
activity in secondary care for in-year financial risk avoidance. Locally these have largely found
limited success, with pre-implementation evidence being weak and measurement of impact
often non-existent.
In industry, demand management is a term used to describe forecasting and planning for
demand, defining where services are best placed to meet that demand within available
resources and ensuring that actions are taken to be prepared for the demand when it occurs.
In the NHS this is a similar process with the complication that most health economies are
starting from a position where demand is already met by services being provided in a
financially unsustainable manner.
The challenge for PCTs is to ensure in-year activity pressures are managed whilst creating
headroom to implement projects, which address the early stages of a disease pathway and
will have impacts over a longer period of time.
If capacity planning is the tool to define the activity required and where it is to be provided
from,– then demand management is the tool to move from where we are now to the stated
capacity plan.
Surrey and Sussex Strategic Health Authority have undertaken a review of existing demand
management approaches within PCTs and describe the types of projects as set out below.
HARDER TO IMPLEMENT
protocols
Limited GPSI services
O/P follow-up ratios
Review of procedures of limited
value Scoring systems to assist triage
Those projects within the “Easier to implement” boxes are also projects which are more likely
to have impacts visible in the shorter term. Those in the “Harder to implement” are more likely
to demonstrate impacts over a longer time period.
The PCT must therefore ensure projects are underway so that easier to implement projects
are facilitated and the longer term and larger scale projects are not discarded simply because
the impact is more difficult to define.
2.0 Framework for Demand Management
Information needs to be considered against the following questions to scope the projects
required to initiate any change :-
Clinical engagement must be sought in defining any project areas, and where service
changes are envisaged, Patient and Public Involvement in the redesign should be
encouraged.
It is recommended that clinical engagement is initially through the emerging Practice Based
Commissioning locality representatives at the Commissioning and Performance Group, and
through ongoing visits to practices to discuss commissioning more widely.
Identification of projects will be through use of the information analysis and discussions with
Practice Based Commissioning localities. Practice Based Commissioning initiated projects
can therefore interface with the methodology within this framework where it is supportive to do
so.
The PCT is already committed and undertaking a number of projects which address aspects
of demand.
Appendix 1 details existing projects that have been initiated. These projects do not all have
measurable outputs defined and work is underway to ensure that this is in place to support
project implementation.
Additional projects will be added to this list throughout the year and becoming operational or
piloted as soon as it is practical to do so.
Demand management as a process to support capacity planning must remain integrated with
the principles defined within the Enhanced Services Strategy and the emergent Practice
Based Commissioning agenda. It is likely that early practice based commissioners will lead on
some projects defined within this framework, particularly on the outpatient aspects of surgical
specialties and emergency admission avoidance for chronic care.
Action Ref. Description Timescale
B1 Measured benefits of existing projects June 05
defined (ongoing)
B2 PCT activity at local Trusts measured against July 05
10 High Impact Changes (completed)
B3 New projects defined from activity analysis July 05
(ongoing)
Demand management can operate as a programme of work with smaller projects and pilots. It
is recommended that a project approach such as PRINCE2 is used to ensure a structure and
clear accountability to the work. This will enable the “agreed outcomes to be delivered
(acceptance criteria)” to be measured. Using PRINCE2 will provide milestones and project
plans which can be reported through the Dynamic Change software.
It is recommended that the following PRINCE2 products are used as a minimum to enable
accountability, measurable outputs, progress reports and handover to Practice Based
Commissioning.
Product Description
Project Mandate Acts as the trigger for a project and details the
sponsor and accountable manager for delivery as
well as expected outputs of the project.
Project Plan Provides the detail of the project to be undertaken
including milestones, timescales and resource
issues
Highlight reports Provides structured progress against the project
plan for review. It is intended that this is provided
through Dynamic Change Board.
Risk Log Provides a log of the risks and the agreed
countermeasures. Acts to ensure that risks are not
left identified with no action taken.
Issue Log Provides a log of issues that arise and the decisions
taken.
Lessons Learned Log Logs lessons learned for use in similar projects.
Post Project Review Plan Measures whether expectations have been met.
Whilst projects can operate using a formal project management tool, innovation and local
good ideas can be supported within a culture of piloting and testing. Using the Plan, Do,
Study, Act (PDSA) principles championed by the National Primary Care Collaborative will
enable ideas to be tested at an early stage, where awaiting a full project work up would
unnecessarily delay progress.
An integral part of PRINCE2 is the maintenance of a risk log. Where demand management is
used to address capacity or resource difficulties it is therefore vital that impacts are measured
from the outset and that variances from expected profile of change are analysed, understood
and acted upon. This may include the requirement for additional projects to be defined or
existing ones amended.
At the outset of projects, clear measurements of impact in activity and the resource to move
from one setting to another. Service Level Agreements will need to support any movements of
financial resource and activity movements need to be reflected in capacity planning.
Measurements need to collect information of activity passing through the new process as well
as the change in the previous process.
By ensuring expected impacts are defined and start positions baselined, success of projects
or pilots can be demonstrated and where appropriate rolled out or expanded. It is vital to
ensure clinical engagement in the review of the outcomes of a project.
The outputs of projects and any agreed expansions or roll out will need to feed into the
capacity plan which should be a dynamic planning tool reflecting activity in all sectors.
Clinical Engagement
Patient and Public Involvement
Programme Management
Secondary Care Engagement
ATTACHMENT F-1