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What is a DTC? What are the policy issues? and the models?

Pippa Bagnall – Principal Advisor (Health), Prime Minister’s Office for Public Services Reform

The Prime Minister regards DTCs as a high profile development for the NHS. This was underlined by the fact that he had hosted a breakfast to discuss the subject for public and private sector stakeholders.

There are three strands to be considered in relation to the reform of health and social care:

• quality of care
• people who provide the care
• where the care is provided.

It is important to get the environment right. This can be achieved through stakeholder partnerships.

Partnership is seen to be the way forward. There are five types of current provision/partnership:

1. Public sector default (the public sector provides all services)
2. Private sector rescue (when the public sector is deemed to be failing in some way and a private provider is ‘parachuted in’ to sort things out)
3. Level playing field (a balanced approach involving public and private sector)
4. Public sector rescue (the private sector provides all services unless it fails and the public sector steps in)
5. Private sector default (the private sector provides all services).

The NHS plan puts a strong emphasis on flexibility. That is a driving force behind the DTC agenda.

It is important to see DTCs not as just a way to solve waiting list problems: they are about providing better care and more efficient care, using the workforce more effectively and efficiently and responding to what the consumer wants – rapid treatment, convenient care from the patient’s point of view.

Trusts need to be creative in their thinking about how to develop DTCs. Primary, acute and independent models are all evolving.

Points from the discussion

• There is an assumption that by improving efficiency you can bridge the gap between healthcare need and resources, but as needs are met, more needs appear.
• The DTC programme is primarily about increasing capacity and decreasing waiting.
• Patient input should be at the centre of DTCs.
• There is a business case for good design, particularly in terms of safety, environment and sustainability.
• Is there/should there be a role for alternative medicine in DTCs?
• Although there is often a resistance to change, with DTCs people seem to be more welcoming of change. This may be a reason why the initiative will succeed.
• It is easier to define what a DTC isn’t than what it is. It is about ways of working, multi-skilling, integration, buildings and patient focus.
• There is need to share best practice, involve designers as early as possible, thing about where DTCs will be located, work with planners, work with patients and users.
• Need to increase/improve use of technology

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