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Long term conditions represent 55% of GP appointments, 68% of outpatient attendances, 72% of inpatient bed days, 58% of A&E attendances, 59% of Practice Nurse appointments and 40% of calls to the 111 service.

The LTC QIPP workstream is driving forward the changes needed to improve patient care:

The current NHS requires a paradigm shift in the provision of health care to meet the needs of a population in which most of the disease burden is attributable to chronic diseases. The shift calls for a radical reappraisal of current patterns of investment in health care if changing population needs are to be met effectively.

The QIPP challenge, therefore, is not only to transform the way we deliver care to those people with long term conditions and contribute to the current financial imperative of £20 billion savings, but also to set the NHS itself in a better position to remain viable for the future.

No healthcare system as it is currently configured for long term conditions care is sustainable - it is everyone's responsibility to help change this. Unless we work together to achieve this change for long term conditions care, - clinicians and managers, primary and secondary care, health and social care – the NHS is not sustainable.

The workstream is delivering a national support and improvement programme that is enabling local geographic areas to implement an evidence based system for supporting patients with LTCs. The programme is designed to facilitate and enable local health economy teams to deliver change at pace, in a measured and supported way. To support the workstream there will be a number of strands of work;

1. 3 drivers:

·         To encourage the adoption of the 3 key drivers in each local health economy

2. Changing the financial model

A commissioning group has designed a number of recommendations for changes to PbR and tariff that will ensure that the commissioning model supports the delivery model being promoted through the workstream, with a particular focus on realising efficiencies. This work will be ongoing.

3. Third Sector Group

A group of seventeen of the leading third sector organisations allows patient groups to have an ongoing input into the development of the workstream. This group is central in helping to create the „pull‟ from patients that is required within the system to systematise supported self care / shared decision making.

4. Workforce

We are analysing the implications that the LTC care model will have on the workforce. The intention is to assist workforce planners with information regarding the appropriate skill mix and competencies for the future workforce.

5. LTC Commissioning Pathway

Developed to support health and social care teams participating on the QIPP LTC workstream to implement a generic LTC care model and tackle the increasing demand in care needs. Developed with the help of various experts and supported by NAPC, NHS Alliance and the DH Commissioning Directorate amongst others. The pathway provides different levels of information to support implementation for all the different stages of the patient’s health; Patient pathway, Commissioning, Workforce, Technology, Financial flows and incentives, data and information.