{"version":"1.0.0","segments":[{"startTime":0.72,"endTime":3.393,"body":"- [Presenter] Welcome to"},{"startTime":0.72,"endTime":3.393,"body":"this Mtech Access webinar."},{"startTime":4.35,"endTime":7.47,"body":"At Mtech Access we"},{"startTime":4.35,"endTime":7.47,"body":"provide health economics"},{"startTime":7.47,"endTime":10.71,"body":"and outcomes research and"},{"startTime":7.47,"endTime":10.71,"body":"market access services"},{"startTime":10.71,"endTime":13.263,"body":"from strategy through to implementation."},{"startTime":14.31,"endTime":16.11,"body":"Our unique NHS relationships"},{"startTime":16.11,"endTime":19.29,"body":"guide and validate"},{"startTime":16.11,"endTime":19.29,"body":"everything we do in the UK."},{"startTime":19.29,"endTime":21.87,"body":"We work with over 80 NHS associates"},{"startTime":21.87,"endTime":24.18,"body":"to bring our pharmaceutical"},{"startTime":21.87,"endTime":24.18,"body":"and medtech clients"},{"startTime":24.18,"endTime":27.0,"body":"authentic insights into the NHS."},{"startTime":27.0,"endTime":30.72,"body":"We can help you answer key"},{"startTime":27.0,"endTime":30.72,"body":"questions related to the NHS,"},{"startTime":30.72,"endTime":33.54,"body":"from how to communicate with"},{"startTime":30.72,"endTime":33.54,"body":"integrated care systems,"},{"startTime":33.54,"endTime":36.12,"body":"places and primary care networks,"},{"startTime":36.12,"endTime":38.283,"body":"to how to capture pathways of care."},{"startTime":39.42,"endTime":43.5,"body":"Get in touch today to discuss"},{"startTime":39.42,"endTime":43.5,"body":"your market access goals."},{"startTime":43.5,"endTime":45.933,"body":"First, though, I hope"},{"startTime":43.5,"endTime":45.933,"body":"you enjoy the webinar."},{"startTime":48.3,"endTime":49.41,"body":"- Good afternoon, everybody,"},{"startTime":49.41,"endTime":52.5,"body":"and welcome to this Mtech Access webinar"},{"startTime":52.5,"endTime":56.31,"body":"on policy, GP contract, and primary care."},{"startTime":56.31,"endTime":58.92,"body":"My name's Karen Cooper and"},{"startTime":56.31,"endTime":58.92,"body":"I'm a senior consultant"},{"startTime":58.92,"endTime":62.64,"body":"in the NHS Insight and"},{"startTime":58.92,"endTime":62.64,"body":"Interaction Team at Mtech Access,"},{"startTime":62.64,"endTime":65.37,"body":"and it's my pleasure to"},{"startTime":62.64,"endTime":65.37,"body":"extend a warm welcome"},{"startTime":65.37,"endTime":67.35,"body":"to our speakers for today's session"},{"startTime":67.35,"endTime":70.32,"body":"and participants that have joined today."},{"startTime":70.32,"endTime":72.51,"body":"For those of us that don't know us well,"},{"startTime":72.51,"endTime":75.99,"body":"Mtech Access is a specialist"},{"startTime":72.51,"endTime":75.99,"body":"market access consultancy"},{"startTime":75.99,"endTime":77.85,"body":"and we provide strategy and solutions"},{"startTime":77.85,"endTime":80.13,"body":"to help pharma and medtech companies"},{"startTime":80.13,"endTime":81.87,"body":"bring interventions to market,"},{"startTime":81.87,"endTime":85.53,"body":"and we also work as a"},{"startTime":81.87,"endTime":85.53,"body":"collaborative partner to the NHS."},{"startTime":85.53,"endTime":89.37,"body":"So today we have Zafran"},{"startTime":85.53,"endTime":89.37,"body":"Azam, Jack Wagstaff,"},{"startTime":89.37,"endTime":92.253,"body":"and Neil Forster, who are"},{"startTime":89.37,"endTime":92.253,"body":"experts in their field,"},{"startTime":93.3,"endTime":95.55,"body":"no pressure, to share"},{"startTime":93.3,"endTime":95.55,"body":"their wealth of knowledge"},{"startTime":95.55,"endTime":97.35,"body":"and experience on primary care,"},{"startTime":97.35,"endTime":99.96,"body":"the GP contract and network DES,"},{"startTime":99.96,"endTime":103.59,"body":"and the NHS priorities and"},{"startTime":99.96,"endTime":103.59,"body":"operational planning guidance."},{"startTime":103.59,"endTime":106.23,"body":"Their insights are sure"},{"startTime":103.59,"endTime":106.23,"body":"to be thought provoking"},{"startTime":106.23,"endTime":110.19,"body":"and provide valued perspectives"},{"startTime":106.23,"endTime":110.19,"body":"that will benefit us all."},{"startTime":110.19,"endTime":112.68,"body":"So I'm thrilled so many"},{"startTime":110.19,"endTime":112.68,"body":"of you could join us today"},{"startTime":112.68,"endTime":114.36,"body":"and let's get right into it."},{"startTime":114.36,"endTime":116.55,"body":"And I'm going to come over to our panel"},{"startTime":116.55,"endTime":119.52,"body":"and ask you to introduce yourselves."},{"startTime":119.52,"endTime":121.287,"body":"So if you could let us"},{"startTime":119.52,"endTime":121.287,"body":"know what your role is"},{"startTime":121.287,"endTime":122.94,"body":"and where you work, please."},{"startTime":122.94,"endTime":126.317,"body":"So I'll come to Neil"},{"startTime":122.94,"endTime":126.317,"body":"first and then to Zafran."},{"startTime":127.47,"endTime":128.37,"body":"- Hi there. Hi Karen."},{"startTime":128.37,"endTime":131.46,"body":"Hi panellist and welcome everyone."},{"startTime":131.46,"endTime":135.15,"body":"I'm Neil Forster GP in Northumberland,"},{"startTime":135.15,"endTime":139.56,"body":"GP partner for 20 years"},{"startTime":135.15,"endTime":139.56,"body":"in the same practice."},{"startTime":139.56,"endTime":142.71,"body":"I've also got interest"},{"startTime":139.56,"endTime":142.71,"body":"in occupational medicine"},{"startTime":142.71,"endTime":145.65,"body":"and also clinical"},{"startTime":142.71,"endTime":145.65,"body":"director of our federation"},{"startTime":145.65,"endTime":146.55,"body":"up in Northumberland."},{"startTime":146.55,"endTime":151.26,"body":"So yeah, I'm interested in market access,"},{"startTime":151.26,"endTime":154.17,"body":"strategic consultancy,"},{"startTime":151.26,"endTime":154.17,"body":"and also thinking through"},{"startTime":154.17,"endTime":157.71,"body":"some of the problems"},{"startTime":154.17,"endTime":157.71,"body":"that face our industries."},{"startTime":157.71,"endTime":158.543,"body":"That's me."},{"startTime":159.51,"endTime":160.763,"body":"- Perfect."},{"startTime":160.763,"endTime":161.95,"body":"And Zafran?"},{"startTime":161.95,"endTime":163.74,"body":"- Yeah, hi, my name is Zafran Azam."},{"startTime":163.74,"endTime":165.06,"body":"I'm Head of medicines optimisation"},{"startTime":165.06,"endTime":167.79,"body":"and delivery at Derby City Place."},{"startTime":167.79,"endTime":170.73,"body":"I'm also lead on a lot"},{"startTime":167.79,"endTime":170.73,"body":"of kind of programmes"},{"startTime":170.73,"endTime":173.67,"body":"like respiratory self-care to name a few."},{"startTime":173.67,"endTime":176.07,"body":"I'm also a qualified coach and mentor"},{"startTime":176.07,"endTime":178.32,"body":"and I'm very interested"},{"startTime":176.07,"endTime":178.32,"body":"in talent management,"},{"startTime":178.32,"endTime":181.38,"body":"workforce development, and"},{"startTime":178.32,"endTime":181.38,"body":"organised system change as well"},{"startTime":181.38,"endTime":183.53,"body":"as part of my kind of"},{"startTime":181.38,"endTime":183.53,"body":"portfolio of working."},{"startTime":185.1,"endTime":187.905,"body":"- Okay. And last but not least, Jack."},{"startTime":187.905,"endTime":189.99,"body":"- Hi, really good to"},{"startTime":187.905,"endTime":189.99,"body":"be here this afternoon."},{"startTime":189.99,"endTime":191.04,"body":"I'm hoping to get the recording"},{"startTime":191.04,"endTime":193.74,"body":"of Karen's billing to"},{"startTime":191.04,"endTime":193.74,"body":"play to my wife at home."},{"startTime":193.74,"endTime":196.2,"body":"So let's see if I can get that at the end,"},{"startTime":196.2,"endTime":198.33,"body":"but that's really, really"},{"startTime":196.2,"endTime":198.33,"body":"good to be with everyone."},{"startTime":198.33,"endTime":200.16,"body":"I'm Jack Wagstaff, I'm the Chief Officer"},{"startTime":200.16,"endTime":203.018,"body":"for a partnership with 11 organisations"},{"startTime":203.018,"endTime":206.55,"body":"in Northwest Surrey just"},{"startTime":203.018,"endTime":206.55,"body":"under Heathrow Airport"},{"startTime":206.55,"endTime":210.3,"body":"across primary care, community"},{"startTime":206.55,"endTime":210.3,"body":"mental health, acute care."},{"startTime":210.3,"endTime":213.78,"body":"I'm the Exec Director"},{"startTime":210.3,"endTime":213.78,"body":"for Surrey Heartlands ICB"},{"startTime":213.78,"endTime":216.48,"body":"covering sustainability"},{"startTime":213.78,"endTime":216.48,"body":"and financial recovery"},{"startTime":216.48,"endTime":218.34,"body":"and the acting Chief Delivery Officer"},{"startTime":218.34,"endTime":219.93,"body":"for Ashford and St. Peter's Hospitals"},{"startTime":219.93,"endTime":222.51,"body":"on our new elective centre here."},{"startTime":222.51,"endTime":225.12,"body":"So if you hear any"},{"startTime":222.51,"endTime":225.12,"body":"drilling, that's apologies."},{"startTime":225.12,"endTime":227.77,"body":"I think we're building"},{"startTime":225.12,"endTime":227.77,"body":"something just over that wall."},{"startTime":229.58,"endTime":230.977,"body":"- Okay."},{"startTime":230.977,"endTime":231.81,"body":"Thank you."},{"startTime":231.81,"endTime":236.31,"body":"So as you can see, we've got"},{"startTime":231.81,"endTime":236.31,"body":"a selection of perspectives"},{"startTime":236.31,"endTime":237.96,"body":"from all different parts of the system,"},{"startTime":237.96,"endTime":240.31,"body":"so I think this is going"},{"startTime":237.96,"endTime":240.31,"body":"to be really interesting."},{"startTime":243.49,"endTime":244.56,"body":"Let's start strategically,"},{"startTime":244.56,"endTime":247.26,"body":"so let's start by talking"},{"startTime":244.56,"endTime":247.26,"body":"about the priorities"},{"startTime":247.26,"endTime":249.24,"body":"and operational planning guidance."},{"startTime":249.24,"endTime":252.99,"body":"So we know that normally this"},{"startTime":249.24,"endTime":252.99,"body":"is published in December."},{"startTime":252.99,"endTime":254.97,"body":"So to give people like yourselves"},{"startTime":254.97,"endTime":257.58,"body":"chance to plan for the next year,"},{"startTime":257.58,"endTime":259.83,"body":"this year it arrived one working day"},{"startTime":259.83,"endTime":261.87,"body":"before the new financial year."},{"startTime":261.87,"endTime":265.44,"body":"So I'd be interested,"},{"startTime":261.87,"endTime":265.44,"body":"because everyone was waiting,"},{"startTime":265.44,"endTime":267.06,"body":"constantly waiting for it to be published."},{"startTime":267.06,"endTime":268.74,"body":"Finally it was published."},{"startTime":268.74,"endTime":270.66,"body":"It'd be interesting to"},{"startTime":268.74,"endTime":270.66,"body":"understand your thoughts"},{"startTime":270.66,"endTime":275.56,"body":"on the impact that had around"},{"startTime":270.66,"endTime":275.56,"body":"your planning for this year"},{"startTime":276.57,"endTime":278.52,"body":"or whether you just carried on regardless."},{"startTime":278.52,"endTime":280.893,"body":"So I'll come to Jack on that first."},{"startTime":282.96,"endTime":283.793,"body":"- Yeah, of course."},{"startTime":283.793,"endTime":285.961,"body":"I was particularly interested"},{"startTime":283.793,"endTime":285.961,"body":"in around this year."},{"startTime":285.961,"endTime":290.04,"body":"I mean, I think we had a lot"},{"startTime":285.961,"endTime":290.04,"body":"of informal sort of assurances"},{"startTime":290.04,"endTime":292.68,"body":"that there wasn't going"},{"startTime":290.04,"endTime":292.68,"body":"to be any drastic changes"},{"startTime":292.68,"endTime":293.76,"body":"in the planning guidance,"},{"startTime":293.76,"endTime":297.04,"body":"so we could make quite"},{"startTime":293.76,"endTime":297.04,"body":"sensible planning assumptions"},{"startTime":297.93,"endTime":299.855,"body":"based on the known factors."},{"startTime":299.855,"endTime":300.93,"body":"And I don't think there"},{"startTime":299.855,"endTime":300.93,"body":"was anything in there"},{"startTime":300.93,"endTime":304.98,"body":"that was hugely, hugely"},{"startTime":300.93,"endTime":304.98,"body":"surprising for organisations"},{"startTime":304.98,"endTime":307.29,"body":"and boards up and down the country."},{"startTime":307.29,"endTime":310.15,"body":"Although I think probably"},{"startTime":307.29,"endTime":310.15,"body":"the biggest challenge"},{"startTime":311.01,"endTime":312.36,"body":"in this planning round really"},{"startTime":312.36,"endTime":316.2,"body":"is the quite, quite significant gulf"},{"startTime":316.2,"endTime":320.07,"body":"between the operational"},{"startTime":316.2,"endTime":320.07,"body":"planning requirements"},{"startTime":320.07,"endTime":322.11,"body":"in terms of what the"},{"startTime":320.07,"endTime":322.11,"body":"NHS and health systems"},{"startTime":322.11,"endTime":325.16,"body":"and public bodies are"},{"startTime":322.11,"endTime":325.16,"body":"asked to do and to deliver"},{"startTime":325.16,"endTime":329.673,"body":"on the financial planning framework,"},{"startTime":330.857,"endTime":333.51,"body":"which is very much about reducing costs,"},{"startTime":333.51,"endTime":338.51,"body":"taking cost control, and"},{"startTime":333.51,"endTime":338.51,"body":"constrained to resources"},{"startTime":339.06,"endTime":341.19,"body":"and workforce and other relevance."},{"startTime":341.19,"endTime":344.91,"body":"And I think it's that"},{"startTime":341.19,"endTime":344.91,"body":"sort of often what feels"},{"startTime":344.91,"endTime":348.09,"body":"like quite, quite contradictory"},{"startTime":344.91,"endTime":348.09,"body":"policy directions,"},{"startTime":348.09,"endTime":350.94,"body":"which I think are really the issues"},{"startTime":350.94,"endTime":353.19,"body":"that the organisations are wrestling with"},{"startTime":353.19,"endTime":355.83,"body":"in terms of what do you prioritise,"},{"startTime":355.83,"endTime":357.87,"body":"where do you really want to see gains,"},{"startTime":357.87,"endTime":360.48,"body":"and what are you probably going to not do"},{"startTime":360.48,"endTime":362.26,"body":"or put on the back burner"},{"startTime":363.401,"endTime":365.22,"body":"as a result of those contradictions."},{"startTime":365.22,"endTime":367.83,"body":"I think is probably the real key challenge"},{"startTime":367.83,"endTime":369.843,"body":"in the planning round this year."},{"startTime":370.861,"endTime":372.746,"body":"- Okay. Thank you."},{"startTime":372.746,"endTime":374.46,"body":"And Zafran,"},{"startTime":374.46,"endTime":376.01,"body":"what about yourself?"},{"startTime":374.46,"endTime":376.01,"body":"- So yeah."},{"startTime":376.01,"endTime":379.26,"body":"So for us, we'd already"},{"startTime":376.01,"endTime":379.26,"body":"had, since July '23,"},{"startTime":379.26,"endTime":382.92,"body":"the making more of medicines optimisation"},{"startTime":382.92,"endTime":385.53,"body":"kind of opportunities document come out."},{"startTime":385.53,"endTime":386.363,"body":"We'd also had"},{"startTime":386.363,"endTime":388.26,"body":"the national medicines"},{"startTime":386.363,"endTime":388.26,"body":"optimisation opportunities"},{"startTime":388.26,"endTime":391.012,"body":"came out in roughly"},{"startTime":388.26,"endTime":391.012,"body":"round about August '23."},{"startTime":391.012,"endTime":391.845,"body":"So we already got a planning"},{"startTime":391.845,"endTime":395.43,"body":"as to what we were doing for '23, '24."},{"startTime":395.43,"endTime":396.99,"body":"And in that document,"},{"startTime":395.43,"endTime":396.99,"body":"we've already got an idea"},{"startTime":396.99,"endTime":399.24,"body":"of what was going for '24, '25."},{"startTime":399.24,"endTime":400.89,"body":"We also understand the four key areas"},{"startTime":400.89,"endTime":402.9,"body":"that all ICBs are working towards."},{"startTime":402.9,"endTime":405.21,"body":"So I think, you know, just like Jack said,"},{"startTime":405.21,"endTime":406.101,"body":"for us it was more about more"},{"startTime":406.101,"endTime":408.84,"body":"of the same, understanding what the ask is"},{"startTime":408.84,"endTime":411.3,"body":"and having already got"},{"startTime":408.84,"endTime":411.3,"body":"a plan for that in year"},{"startTime":411.3,"endTime":413.13,"body":"and having a five-year plan as well,"},{"startTime":413.13,"endTime":414.12,"body":"making sure there's nothing there"},{"startTime":414.12,"endTime":416.19,"body":"that was an outlier that"},{"startTime":414.12,"endTime":416.19,"body":"we needed to then pick up"},{"startTime":416.19,"endTime":419.22,"body":"as a mandatory function or"},{"startTime":416.19,"endTime":419.22,"body":"a core function as an ICB."},{"startTime":419.22,"endTime":421.83,"body":"So for us, we know what's coming"},{"startTime":421.83,"endTime":423.87,"body":"and there's that Johari's"},{"startTime":421.83,"endTime":423.87,"body":"window of unknown,"},{"startTime":423.87,"endTime":424.89,"body":"and making sure there's nothing there"},{"startTime":424.89,"endTime":426.3,"body":"that was a bit of a surprise."},{"startTime":426.3,"endTime":428.13,"body":"And I dare say I don't"},{"startTime":426.3,"endTime":428.13,"body":"think much of it was."},{"startTime":428.13,"endTime":431.94,"body":"I think a lot of it is"},{"startTime":428.13,"endTime":431.94,"body":"it's around the financials,"},{"startTime":431.94,"endTime":433.41,"body":"around the workforce challenges"},{"startTime":433.41,"endTime":434.73,"body":"and it's also around the actual pressures"},{"startTime":434.73,"endTime":436.95,"body":"and it's how we are"},{"startTime":434.73,"endTime":436.95,"body":"trying to unpick all that"},{"startTime":436.95,"endTime":438.393,"body":"in that kind of, you know,"},{"startTime":439.32,"endTime":443.28,"body":"very complex human adaptive"},{"startTime":439.32,"endTime":443.28,"body":"systems that we exist in."},{"startTime":443.28,"endTime":445.38,"body":"So, again, it's been clear for us"},{"startTime":445.38,"endTime":446.85,"body":"from quite early on last year"},{"startTime":446.85,"endTime":448.77,"body":"as to what our kind of pre-priorities were"},{"startTime":448.77,"endTime":450.45,"body":"as a system organisation,"},{"startTime":450.45,"endTime":453.0,"body":"but then also it's compounded by ensuring"},{"startTime":453.0,"endTime":456.03,"body":"that that's aligned to"},{"startTime":453.0,"endTime":456.03,"body":"what then comes along."},{"startTime":456.03,"endTime":459.57,"body":"And so you do get policy,"},{"startTime":456.03,"endTime":459.57,"body":"slight policy change"},{"startTime":459.57,"endTime":461.34,"body":"and therefore that impacts the shift"},{"startTime":461.34,"endTime":463.2,"body":"in terms of the overall system."},{"startTime":463.2,"endTime":465.21,"body":"But the five-year plan"},{"startTime":463.2,"endTime":465.21,"body":"is the five-year plan"},{"startTime":465.21,"endTime":468.24,"body":"and that's what we're trying"},{"startTime":465.21,"endTime":468.24,"body":"to work towards I would say."},{"startTime":468.24,"endTime":470.34,"body":"- Okay. Thanks, Zafran."},{"startTime":470.34,"endTime":471.9,"body":"- You're welcome."},{"startTime":471.9,"endTime":474.24,"body":"- So, Neil, for you, how important"},{"startTime":474.24,"endTime":477.693,"body":"is the operational planning"},{"startTime":474.24,"endTime":477.693,"body":"guidance in your role?"},{"startTime":478.95,"endTime":481.44,"body":"- It's difficult because"},{"startTime":478.95,"endTime":481.44,"body":"there's so many other factors"},{"startTime":481.44,"endTime":484.68,"body":"that are affecting"},{"startTime":481.44,"endTime":484.68,"body":"primary care at the moment"},{"startTime":484.68,"endTime":486.0,"body":"that we didn't see."},{"startTime":486.0,"endTime":488.73,"body":"We weren't really"},{"startTime":486.0,"endTime":488.73,"body":"waiting for this document"},{"startTime":488.73,"endTime":491.04,"body":"to come from on a practice level,"},{"startTime":491.04,"endTime":493.35,"body":"because there's so many other issues"},{"startTime":493.35,"endTime":496.173,"body":"and opportunities to address before that."},{"startTime":498.21,"endTime":499.86,"body":"An appointment within two weeks ask"},{"startTime":499.86,"endTime":502.737,"body":"has already been mentioned"},{"startTime":499.86,"endTime":502.737,"body":"prior to this coming out,"},{"startTime":502.737,"endTime":505.95,"body":"and then the on the same day type access"},{"startTime":505.95,"endTime":507.6,"body":"was already there as well."},{"startTime":507.6,"endTime":508.98,"body":"I think most practices are working"},{"startTime":508.98,"endTime":512.35,"body":"to a on the day demand type model"},{"startTime":514.44,"endTime":518.19,"body":"following on from what the COVID situation"},{"startTime":518.19,"endTime":519.475,"body":"led us into really."},{"startTime":519.475,"endTime":521.31,"body":"So it really changed."},{"startTime":521.31,"endTime":523.53,"body":"So yeah, it's interesting how little of it"},{"startTime":523.53,"endTime":525.21,"body":"is actually about, in"},{"startTime":523.53,"endTime":525.21,"body":"the operational plan,"},{"startTime":525.21,"endTime":527.85,"body":"is about primary care"},{"startTime":525.21,"endTime":527.85,"body":"'cause the vast majority"},{"startTime":527.85,"endTime":530.25,"body":"of NHS activity happens in primary care."},{"startTime":530.25,"endTime":533.67,"body":"You know, there's 1.3"},{"startTime":530.25,"endTime":533.67,"body":"million appointments a day"},{"startTime":533.67,"endTime":535.23,"body":"in GP practises."},{"startTime":535.23,"endTime":537.72,"body":"So there's very, very little of that"},{"startTime":537.72,"endTime":539.223,"body":"reflected in the document,"},{"startTime":540.54,"endTime":544.5,"body":"but that's not really our major focus."},{"startTime":544.5,"endTime":546.54,"body":"Our major focus was"},{"startTime":544.5,"endTime":546.54,"body":"probably the GP contract"},{"startTime":546.54,"endTime":549.99,"body":"and how that was going to be"},{"startTime":546.54,"endTime":549.99,"body":"negotiated and then came out."},{"startTime":549.99,"endTime":553.11,"body":"So that's probably a more"},{"startTime":549.99,"endTime":553.11,"body":"important document for us"},{"startTime":553.11,"endTime":555.06,"body":"rather than the operational plan."},{"startTime":555.06,"endTime":556.83,"body":"Yeah."},{"startTime":555.06,"endTime":556.83,"body":"- Okay."},{"startTime":556.83,"endTime":558.338,"body":"So already we can see the difference,"},{"startTime":558.338,"endTime":560.37,"body":"you know, so Zafran's obviously focusing"},{"startTime":560.37,"endTime":562.92,"body":"on the medicines optimisation"},{"startTime":560.37,"endTime":562.92,"body":"opportunities document,"},{"startTime":562.92,"endTime":564.36,"body":"you are focusing on GP contract"},{"startTime":564.36,"endTime":567.14,"body":"and the planning guidance is, you know,"},{"startTime":567.14,"endTime":571.26,"body":"is more relevant at Jack's"},{"startTime":567.14,"endTime":571.26,"body":"strategic point of view,"},{"startTime":571.26,"endTime":573.331,"body":"although that is-"},{"startTime":573.331,"endTime":575.947,"body":"- It's a much higher level"},{"startTime":573.331,"endTime":575.947,"body":"of like Jack is involved in,"},{"startTime":575.947,"endTime":580.553,"body":"it's a much higher level of"},{"startTime":575.947,"endTime":580.553,"body":"strategy than just practises."},{"startTime":581.61,"endTime":582.443,"body":"- Okay."},{"startTime":583.65,"endTime":585.78,"body":"- I was also going to say Karen, sorry,"},{"startTime":585.78,"endTime":587.905,"body":"I was also going to say we have,"},{"startTime":585.78,"endTime":587.905,"body":"for example, have the IPMO,"},{"startTime":587.905,"endTime":589.86,"body":"Integrating Pharmacy and"},{"startTime":587.905,"endTime":589.86,"body":"Medicines Optimisation,"},{"startTime":589.86,"endTime":593.34,"body":"which is wider than just"},{"startTime":589.86,"endTime":593.34,"body":"our ICB kind of medicines."},{"startTime":593.34,"endTime":595.35,"body":"It's about the kind of workforce delivery"},{"startTime":595.35,"endTime":596.64,"body":"in terms of pharmacy."},{"startTime":596.64,"endTime":600.0,"body":"So there are, like Neil's"},{"startTime":596.64,"endTime":600.0,"body":"already alluded to,"},{"startTime":600.0,"endTime":600.99,"body":"there's different documents"},{"startTime":600.99,"endTime":603.03,"body":"that people are working"},{"startTime":600.99,"endTime":603.03,"body":"through throughout the system"},{"startTime":603.03,"endTime":604.68,"body":"and it's then being able to unpick that,"},{"startTime":604.68,"endTime":606.9,"body":"but there is a wider overarching strategy,"},{"startTime":606.9,"endTime":608.58,"body":"if that makes any sense."},{"startTime":608.58,"endTime":610.71,"body":"So where people will focus on one arm"},{"startTime":610.71,"endTime":612.48,"body":"of that wider strategy and plan,"},{"startTime":612.48,"endTime":614.52,"body":"that plan is being pulled"},{"startTime":612.48,"endTime":614.52,"body":"together centrally."},{"startTime":614.52,"endTime":617.49,"body":"So there is an overarching"},{"startTime":614.52,"endTime":617.49,"body":"system-wide approach"},{"startTime":617.49,"endTime":618.66,"body":"in how we do things"},{"startTime":618.66,"endTime":620.55,"body":"and it's the fact that"},{"startTime":618.66,"endTime":620.55,"body":"you can't do everything."},{"startTime":620.55,"endTime":622.83,"body":"So it's having experts in key areas"},{"startTime":622.83,"endTime":625.02,"body":"to able to deliver that and"},{"startTime":622.83,"endTime":625.02,"body":"deliver that really well."},{"startTime":625.02,"endTime":626.7,"body":"And I think the whole point of the plan"},{"startTime":626.7,"endTime":629.4,"body":"is just to ensure that those stakeholders"},{"startTime":629.4,"endTime":632.61,"body":"and those partners are actually"},{"startTime":629.4,"endTime":632.61,"body":"heard, brought to the table,"},{"startTime":632.61,"endTime":634.91,"body":"and actually they help"},{"startTime":632.61,"endTime":634.91,"body":"to bring the solutions."},{"startTime":635.76,"endTime":637.95,"body":"So the whole point of documents is great"},{"startTime":637.95,"endTime":639.48,"body":"and I get that completely,"},{"startTime":639.48,"endTime":640.86,"body":"but there still needs to be co-creation"},{"startTime":640.86,"endTime":642.78,"body":"and that's what all these"},{"startTime":640.86,"endTime":642.78,"body":"documents are saying."},{"startTime":642.78,"endTime":645.03,"body":"They're not saying that"},{"startTime":642.78,"endTime":645.03,"body":"that shouldn't be done."},{"startTime":645.03,"endTime":647.55,"body":"That absolutely has to be"},{"startTime":645.03,"endTime":647.55,"body":"done as an integral part"},{"startTime":647.55,"endTime":649.716,"body":"in order to achieve any successes,"},{"startTime":649.716,"endTime":652.783,"body":"you know, for our patients and outcomes."},{"startTime":652.783,"endTime":655.17,"body":"- So I think it's a"},{"startTime":652.783,"endTime":655.17,"body":"really challenging time"},{"startTime":655.17,"endTime":656.79,"body":"to release planning guidance"},{"startTime":656.79,"endTime":659.95,"body":"and health policy at the moment as well."},{"startTime":660.84,"endTime":665.84,"body":"It's obviously have anticipated"},{"startTime":660.84,"endTime":665.84,"body":"to be an election year,"},{"startTime":667.47,"endTime":671.31,"body":"so there'll be political"},{"startTime":667.47,"endTime":671.31,"body":"pressure to promise everything"},{"startTime":671.31,"endTime":673.71,"body":"in terms of waiting lists reduction"},{"startTime":673.71,"endTime":676.38,"body":"and speed of access to primary care"},{"startTime":676.38,"endTime":677.97,"body":"and availability of services"},{"startTime":677.97,"endTime":679.62,"body":"and developments across all the business"},{"startTime":679.62,"endTime":683.01,"body":"and being friendly to business"},{"startTime":683.01,"endTime":685.92,"body":"and provision across different sectors."},{"startTime":685.92,"endTime":690.33,"body":"And then at the same time, a"},{"startTime":685.92,"endTime":690.33,"body":"financial growth trajectory."},{"startTime":690.33,"endTime":692.64,"body":"I think we've just passed 43% of GDP"},{"startTime":692.64,"endTime":697.413,"body":"being spent on health"},{"startTime":692.64,"endTime":697.413,"body":"this last, last year."},{"startTime":698.31,"endTime":703.138,"body":"And that's grown by"},{"startTime":698.31,"endTime":703.138,"body":"about sort of five or 6%"},{"startTime":703.138,"endTime":704.25,"body":"in the last three or four years."},{"startTime":704.25,"endTime":706.65,"body":"So you've got a sort of out of control"},{"startTime":706.65,"endTime":709.32,"body":"financial trajectory for the state overall"},{"startTime":709.32,"endTime":711.27,"body":"and then a political dynamic"},{"startTime":711.27,"endTime":715.857,"body":"that wants to promise everything"},{"startTime":711.27,"endTime":715.857,"body":"to the public this year."},{"startTime":715.857,"endTime":718.95,"body":"And that creates a real"},{"startTime":715.857,"endTime":718.95,"body":"challenge for people."},{"startTime":718.95,"endTime":721.77,"body":"And I think as Neil and"},{"startTime":718.95,"endTime":721.77,"body":"Zafran have described,"},{"startTime":721.77,"endTime":724.59,"body":"the art is in really understanding"},{"startTime":724.59,"endTime":727.83,"body":"what are the key priorities"},{"startTime":724.59,"endTime":727.83,"body":"that are going to give you value"},{"startTime":727.83,"endTime":729.69,"body":"and where do you really"},{"startTime":727.83,"endTime":729.69,"body":"want to focus your time"},{"startTime":729.69,"endTime":732.6,"body":"and your limited resources"},{"startTime":729.69,"endTime":732.6,"body":"to deliver the best,"},{"startTime":732.6,"endTime":735.24,"body":"the best care and deliver the"},{"startTime":732.6,"endTime":735.24,"body":"best organisational results"},{"startTime":735.24,"endTime":737.1,"body":"as you have to be really quite discerning"},{"startTime":737.1,"endTime":738.27,"body":"when you're looking at a document"},{"startTime":738.27,"endTime":741.87,"body":"that has hundreds of deliverables in it"},{"startTime":741.87,"endTime":743.312,"body":"and really understand the motivation"},{"startTime":743.312,"endTime":745.479,"body":"behind some of that thing."},{"startTime":746.34,"endTime":748.98,"body":"- So thinking about our audience"},{"startTime":748.98,"endTime":753.24,"body":"that are listening in"},{"startTime":748.98,"endTime":753.24,"body":"today and looking through,"},{"startTime":753.24,"endTime":755.46,"body":"we'll move on to the GP"},{"startTime":753.24,"endTime":755.46,"body":"contract in a minute, Neil,"},{"startTime":755.46,"endTime":757.71,"body":"and, you know, and the DES and everything,"},{"startTime":757.71,"endTime":761.04,"body":"but just thinking about staying"},{"startTime":757.71,"endTime":761.04,"body":"with the planning guidance."},{"startTime":761.04,"endTime":762.03,"body":"Reading through it,"},{"startTime":762.03,"endTime":765.87,"body":"there's only five references"},{"startTime":762.03,"endTime":765.87,"body":"to medicine within there."},{"startTime":765.87,"endTime":767.64,"body":"There are nine references to prevention,"},{"startTime":767.64,"endTime":769.8,"body":"so, you know, one balances out the other,"},{"startTime":769.8,"endTime":772.89,"body":"but there's only five"},{"startTime":769.8,"endTime":772.89,"body":"references to medicines as such."},{"startTime":772.89,"endTime":775.743,"body":"Obviously there is an"},{"startTime":772.89,"endTime":775.743,"body":"objective around medicines,"},{"startTime":776.94,"endTime":780.81,"body":"but there's 32 references"},{"startTime":776.94,"endTime":780.81,"body":"around productivity,"},{"startTime":780.81,"endTime":783.6,"body":"37 references around capacity,"},{"startTime":783.6,"endTime":786.27,"body":"recovery is mentioned 18 times,"},{"startTime":786.27,"endTime":788.25,"body":"and medicines is only mentioned five times"},{"startTime":788.25,"endTime":792.51,"body":"and every single mention is"},{"startTime":788.25,"endTime":792.51,"body":"talking about cost savings."},{"startTime":792.51,"endTime":794.97,"body":"Now obviously we're"},{"startTime":792.51,"endTime":794.97,"body":"recognising exactly that"},{"startTime":794.97,"endTime":797.92,"body":"around we're in a really"},{"startTime":794.97,"endTime":797.92,"body":"cash strapped environment"},{"startTime":799.59,"endTime":802.11,"body":"and a lot of money is spent on medicines,"},{"startTime":802.11,"endTime":805.23,"body":"but the fact that it's"},{"startTime":802.11,"endTime":805.23,"body":"only mentioned five times,"},{"startTime":805.23,"endTime":808.443,"body":"I'm curious what your views are on that."},{"startTime":809.88,"endTime":814.74,"body":"Is it that the value of medicines"},{"startTime":809.88,"endTime":814.74,"body":"in the NHS is undervalued"},{"startTime":814.74,"endTime":816.36,"body":"or is there another reason?"},{"startTime":816.36,"endTime":818.76,"body":"So what are your thoughts on that?"},{"startTime":818.76,"endTime":820.77,"body":"I'll come to you Zafran first."},{"startTime":820.77,"endTime":821.603,"body":"- Thank you for that, Karen."},{"startTime":821.603,"endTime":824.73,"body":"Yeah, so medicines are used in"},{"startTime":821.603,"endTime":824.73,"body":"almost all clinical pathways."},{"startTime":824.73,"endTime":825.63,"body":"We know that."},{"startTime":825.63,"endTime":828.48,"body":"And the spends of medicines,"},{"startTime":825.63,"endTime":828.48,"body":"I believe it consumes"},{"startTime":828.48,"endTime":832.05,"body":"the second largest share of"},{"startTime":828.48,"endTime":832.05,"body":"the NHS budget in England."},{"startTime":832.05,"endTime":833.13,"body":"So as I've alluded to,"},{"startTime":833.13,"endTime":836.1,"body":"even though it may have"},{"startTime":833.13,"endTime":836.1,"body":"been mentioned five times,"},{"startTime":836.1,"endTime":837.93,"body":"there will be pathways"},{"startTime":836.1,"endTime":837.93,"body":"in clinical services"},{"startTime":837.93,"endTime":839.73,"body":"that it will have an impact on."},{"startTime":839.73,"endTime":842.46,"body":"So it literally touches everything."},{"startTime":842.46,"endTime":844.59,"body":"So I don't think you need to overemphasise"},{"startTime":844.59,"endTime":846.03,"body":"that there's a use of medicines."},{"startTime":846.03,"endTime":846.87,"body":"It's a bit like, you know,"},{"startTime":846.87,"endTime":848.73,"body":"over instance the use of clinicians,"},{"startTime":848.73,"endTime":851.19,"body":"without them, we just can't"},{"startTime":848.73,"endTime":851.19,"body":"work, we can't operate."},{"startTime":851.19,"endTime":853.26,"body":"So there's always that"},{"startTime":851.19,"endTime":853.26,"body":"kind of core assumption."},{"startTime":853.26,"endTime":856.08,"body":"And then beyond that, this"},{"startTime":853.26,"endTime":856.08,"body":"national planning document,"},{"startTime":856.08,"endTime":857.52,"body":"you've also got the documents"},{"startTime":857.52,"endTime":858.84,"body":"that I've alluded to previously"},{"startTime":858.84,"endTime":861.51,"body":"around the national medicine"},{"startTime":858.84,"endTime":861.51,"body":"optimization opportunities,"},{"startTime":861.51,"endTime":864.45,"body":"which then goes into detail"},{"startTime":861.51,"endTime":864.45,"body":"for each of the ICBs."},{"startTime":864.45,"endTime":866.55,"body":"So I'm not too concerned about the fact"},{"startTime":866.55,"endTime":870.36,"body":"that there's not a huge"},{"startTime":866.55,"endTime":870.36,"body":"mention of medicines per se."},{"startTime":870.36,"endTime":872.7,"body":"I think that's already a"},{"startTime":870.36,"endTime":872.7,"body":"caveat and already given,"},{"startTime":872.7,"endTime":873.903,"body":"if that makes any sense."},{"startTime":875.251,"endTime":877.62,"body":"And I think when you"},{"startTime":875.251,"endTime":877.62,"body":"talk about cost savings"},{"startTime":877.62,"endTime":880.29,"body":"and efficiencies within our kind of system"},{"startTime":880.29,"endTime":881.52,"body":"and a lot of the national papers"},{"startTime":881.52,"endTime":884.22,"body":"that I've read and looked"},{"startTime":881.52,"endTime":884.22,"body":"at, it's around best value."},{"startTime":884.22,"endTime":886.77,"body":"So it's not just about cost"},{"startTime":884.22,"endTime":886.77,"body":"savings and efficiencies."},{"startTime":886.77,"endTime":888.93,"body":"it's also about how we do procurement."},{"startTime":888.93,"endTime":890.58,"body":"It's about how we do things and making,"},{"startTime":890.58,"endTime":892.29,"body":"doing it once, doing it right."},{"startTime":892.29,"endTime":893.613,"body":"It's also about being"},{"startTime":892.29,"endTime":893.613,"body":"mindful about the impact"},{"startTime":893.613,"endTime":897.09,"body":"that that may have in terms"},{"startTime":893.613,"endTime":897.09,"body":"of shaping other services."},{"startTime":897.09,"endTime":898.44,"body":"So it's being a bit more mindful"},{"startTime":898.44,"endTime":899.97,"body":"and having a more integrated approach."},{"startTime":899.97,"endTime":903.63,"body":"And it does talk about efficiency savings,"},{"startTime":903.63,"endTime":906.03,"body":"but it also talks about"},{"startTime":903.63,"endTime":906.03,"body":"clinical safety as well."},{"startTime":906.03,"endTime":909.57,"body":"So, you know, so for example,"},{"startTime":906.03,"endTime":909.57,"body":"polypharmacy is a huge area"},{"startTime":909.57,"endTime":912.27,"body":"and a lot of the time you may"},{"startTime":909.57,"endTime":912.27,"body":"be argued that de-prescribing"},{"startTime":912.27,"endTime":914.4,"body":"actually doesn't save you"},{"startTime":912.27,"endTime":914.4,"body":"a huge amount of money"},{"startTime":914.4,"endTime":916.17,"body":"because of the amount of"},{"startTime":914.4,"endTime":916.17,"body":"intervention required,"},{"startTime":916.17,"endTime":917.76,"body":"the clinical intervention required."},{"startTime":917.76,"endTime":918.96,"body":"You know, if you speak to clinicians"},{"startTime":918.96,"endTime":921.03,"body":"about when they're de-prescribing"},{"startTime":918.96,"endTime":921.03,"body":"someone, for example,"},{"startTime":921.03,"endTime":922.68,"body":"has been on long-term benzodiazepines,"},{"startTime":922.68,"endTime":924.84,"body":"you know, for the saving you get in money"},{"startTime":924.84,"endTime":927.75,"body":"for the reduction, for"},{"startTime":924.84,"endTime":927.75,"body":"the time put in, you know,"},{"startTime":927.75,"endTime":930.51,"body":"there's no value in terms"},{"startTime":927.75,"endTime":930.51,"body":"of cost efficiencies there,"},{"startTime":930.51,"endTime":931.74,"body":"in terms of medicines."},{"startTime":931.74,"endTime":933.99,"body":"But from a clinical and"},{"startTime":931.74,"endTime":933.99,"body":"holistic point of view,"},{"startTime":933.99,"endTime":935.1,"body":"is it the right thing to do?"},{"startTime":935.1,"endTime":936.12,"body":"Absolutely."},{"startTime":936.12,"endTime":939.69,"body":"So it's about patient care"},{"startTime":936.12,"endTime":939.69,"body":"and it's about shifting"},{"startTime":939.69,"endTime":942.42,"body":"and ensuring we maximise savings,"},{"startTime":942.42,"endTime":945.09,"body":"but without the detriment"},{"startTime":942.42,"endTime":945.09,"body":"to the patient itself."},{"startTime":945.09,"endTime":948.0,"body":"And that's very mindful about"},{"startTime":945.09,"endTime":948.0,"body":"how we and our approaches."},{"startTime":948.0,"endTime":951.48,"body":"So we don't do things just"},{"startTime":948.0,"endTime":951.48,"body":"because it will save us money"},{"startTime":951.48,"endTime":954.09,"body":"without understanding"},{"startTime":951.48,"endTime":954.09,"body":"what that impact could be"},{"startTime":954.09,"endTime":956.31,"body":"for our patients, for"},{"startTime":954.09,"endTime":956.31,"body":"our key stakeholders,"},{"startTime":956.31,"endTime":960.03,"body":"for our clinicians, for our"},{"startTime":956.31,"endTime":960.03,"body":"consultants, the wider impact."},{"startTime":960.03,"endTime":962.25,"body":"And sometimes there's"},{"startTime":960.03,"endTime":962.25,"body":"future planning as well"},{"startTime":962.25,"endTime":964.98,"body":"where you may be getting"},{"startTime":962.25,"endTime":964.98,"body":"things coming off patent"},{"startTime":964.98,"endTime":968.1,"body":"and there may be a long term"},{"startTime":964.98,"endTime":968.1,"body":"impact by doing something now"},{"startTime":968.1,"endTime":969.9,"body":"because we are not thinking ahead,"},{"startTime":969.9,"endTime":971.76,"body":"so that it has to be that"},{"startTime":969.9,"endTime":971.76,"body":"kind of regional brain"},{"startTime":971.76,"endTime":973.02,"body":"and regional thinking."},{"startTime":973.02,"endTime":974.88,"body":"So I'm not really too"},{"startTime":973.02,"endTime":974.88,"body":"concerned about the fact"},{"startTime":974.88,"endTime":976.53,"body":"that medicines aren't mentioned too much,"},{"startTime":976.53,"endTime":978.6,"body":"because we know that"},{"startTime":976.53,"endTime":978.6,"body":"they're high spend anyway"},{"startTime":978.6,"endTime":981.18,"body":"and we know they're part of"},{"startTime":978.6,"endTime":981.18,"body":"clinical pathways and services."},{"startTime":981.18,"endTime":983.7,"body":"And I'm not also too concerned, you know,"},{"startTime":983.7,"endTime":986.147,"body":"in terms of just about cost"},{"startTime":983.7,"endTime":986.147,"body":"saving because we get it,"},{"startTime":986.147,"endTime":988.74,"body":"'cause it's not just"},{"startTime":986.147,"endTime":988.74,"body":"about cost saving for us."},{"startTime":988.74,"endTime":990.93,"body":"So, so I think that's the difference."},{"startTime":990.93,"endTime":993.36,"body":"If the only thing that"},{"startTime":990.93,"endTime":993.36,"body":"we thought was important"},{"startTime":993.36,"endTime":995.4,"body":"was just saving money and not thinking"},{"startTime":995.4,"endTime":997.47,"body":"about the patient and the system,"},{"startTime":997.47,"endTime":999.78,"body":"then I think most of us probably"},{"startTime":997.47,"endTime":999.78,"body":"wouldn't work for the NHS."},{"startTime":999.78,"endTime":1001.94,"body":"That's not how it works"},{"startTime":999.78,"endTime":1001.94,"body":"really on the ground."},{"startTime":1001.94,"endTime":1003.11,"body":"And because we're all part"},{"startTime":1003.11,"endTime":1006.62,"body":"of this wonderful organisation and system"},{"startTime":1006.62,"endTime":1008.84,"body":"and it's part of the fabric"},{"startTime":1006.62,"endTime":1008.84,"body":"of our country to be honest."},{"startTime":1008.84,"endTime":1010.537,"body":"So we all want to make a difference"},{"startTime":1010.537,"endTime":1011.93,"body":"and we all want to try and leave it"},{"startTime":1011.93,"endTime":1013.76,"body":"in a better place than where we came."},{"startTime":1013.76,"endTime":1014.969,"body":"So as a result of that,"},{"startTime":1014.969,"endTime":1016.55,"body":"we're trying to do the best that we can,"},{"startTime":1016.55,"endTime":1018.74,"body":"and money is going to be"},{"startTime":1016.55,"endTime":1018.74,"body":"important 'cause money is tight."},{"startTime":1018.74,"endTime":1021.47,"body":"It's like being in a"},{"startTime":1018.74,"endTime":1021.47,"body":"very thrifty household"},{"startTime":1021.47,"endTime":1023.51,"body":"is how can we do things better"},{"startTime":1023.51,"endTime":1025.28,"body":"knowing that we haven't"},{"startTime":1023.51,"endTime":1025.28,"body":"got enough resource"},{"startTime":1025.28,"endTime":1026.84,"body":"or making that resource stretch"},{"startTime":1026.84,"endTime":1029.0,"body":"and that's what we're trying to do."},{"startTime":1029.0,"endTime":1031.04,"body":"So I hope that explains that a bit."},{"startTime":1031.04,"endTime":1032.29,"body":"- Absolutely. Absolutely."},{"startTime":1033.29,"endTime":1035.489,"body":"- Yeah, so you were nodding, Neil."},{"startTime":1035.489,"endTime":1039.14,"body":"- 'Cause it's a real interesting change"},{"startTime":1039.14,"endTime":1042.41,"body":"in how medicines optimization has morphed"},{"startTime":1042.41,"endTime":1044.62,"body":"over the 20 years I've"},{"startTime":1042.41,"endTime":1044.62,"body":"been involved in practise."},{"startTime":1044.62,"endTime":1048.29,"body":"And I think medicine"},{"startTime":1044.62,"endTime":1048.29,"body":"optimisation has such a,"},{"startTime":1048.29,"endTime":1051.2,"body":"we think of it as a scary"},{"startTime":1048.29,"endTime":1051.2,"body":"cost saving exercise,"},{"startTime":1051.2,"endTime":1053.87,"body":"but potential for pharmaceutical companies"},{"startTime":1053.87,"endTime":1057.74,"body":"to maximise their product share,"},{"startTime":1057.74,"endTime":1059.93,"body":"their market share with their products."},{"startTime":1059.93,"endTime":1063.023,"body":"There's a lot of opportunity"},{"startTime":1059.93,"endTime":1063.023,"body":"in that meds optimisation."},{"startTime":1064.34,"endTime":1066.68,"body":"It used to be that we'd get a diktat"},{"startTime":1066.68,"endTime":1069.65,"body":"that we'd change to the"},{"startTime":1066.68,"endTime":1069.65,"body":"cheapest generic that was around"},{"startTime":1069.65,"endTime":1074.0,"body":"without any sort of cost"},{"startTime":1069.65,"endTime":1074.0,"body":"analysis of what that means"},{"startTime":1074.0,"endTime":1077.0,"body":"to primary care in terms"},{"startTime":1074.0,"endTime":1077.0,"body":"of the cost to change,"},{"startTime":1077.0,"endTime":1079.4,"body":"the cost to change both in patient terms"},{"startTime":1079.4,"endTime":1081.47,"body":"and destabilising their care,"},{"startTime":1081.47,"endTime":1084.41,"body":"but also in practices in employment, staff"},{"startTime":1084.41,"endTime":1087.533,"body":"to do two or three different"},{"startTime":1084.41,"endTime":1087.533,"body":"follow up appointments."},{"startTime":1088.4,"endTime":1090.02,"body":"But I think now meds optimisation,"},{"startTime":1090.02,"endTime":1092.52,"body":"now we've got the"},{"startTime":1090.02,"endTime":1092.52,"body":"pharmacist teams involved"},{"startTime":1092.52,"endTime":1096.05,"body":"and it's much more successful"},{"startTime":1092.52,"endTime":1096.05,"body":"and it's much more focused"},{"startTime":1096.05,"endTime":1099.23,"body":"on system benefit and patient benefit"},{"startTime":1099.23,"endTime":1102.65,"body":"rather than being just"},{"startTime":1099.23,"endTime":1102.65,"body":"a true cost exercise,"},{"startTime":1102.65,"endTime":1106.28,"body":"a acquisition cost exercise,"},{"startTime":1102.65,"endTime":1106.28,"body":"which is, you know?"},{"startTime":1106.28,"endTime":1109.07,"body":"So there are opportunities"},{"startTime":1106.28,"endTime":1109.07,"body":"in medicine optimisation."},{"startTime":1109.07,"endTime":1110.36,"body":"The other point I wanted to raise"},{"startTime":1110.36,"endTime":1114.05,"body":"was about the interpretation"},{"startTime":1110.36,"endTime":1114.05,"body":"of the operational plan."},{"startTime":1114.05,"endTime":1117.02,"body":"One thing is a massive"},{"startTime":1114.05,"endTime":1117.02,"body":"opportunity is diagnostics."},{"startTime":1117.02,"endTime":1121.49,"body":"So there's a massive push"},{"startTime":1117.02,"endTime":1121.49,"body":"to get early diagnostics"},{"startTime":1121.49,"endTime":1126.44,"body":"done within six weeks, I"},{"startTime":1121.49,"endTime":1126.44,"body":"think, about 95% by next year."},{"startTime":1126.44,"endTime":1129.02,"body":"So there's a lot of point of care testing"},{"startTime":1129.02,"endTime":1132.26,"body":"that could be implemented."},{"startTime":1132.26,"endTime":1133.85,"body":"There's a lot of opportunity there"},{"startTime":1133.85,"endTime":1138.85,"body":"for companies to work with ICBs, PCMs"},{"startTime":1139.55,"endTime":1141.923,"body":"to try and take, achieve that target."},{"startTime":1143.09,"endTime":1144.89,"body":"So that's not something to be missed,"},{"startTime":1144.89,"endTime":1147.26,"body":"'cause that's a whole sort of new area"},{"startTime":1147.26,"endTime":1150.23,"body":"of near patient testing."},{"startTime":1150.23,"endTime":1151.88,"body":"- Yeah."},{"startTime":1150.23,"endTime":1151.88,"body":"- And if I could add to that."},{"startTime":1151.88,"endTime":1152.713,"body":"Sorry, Karen."},{"startTime":1152.713,"endTime":1154.28,"body":"I'm just going to say you're"},{"startTime":1152.713,"endTime":1154.28,"body":"absolutely right, Neil."},{"startTime":1154.28,"endTime":1156.32,"body":"And then you've also got the"},{"startTime":1154.28,"endTime":1156.32,"body":"health innovation networks,"},{"startTime":1156.32,"endTime":1158.63,"body":"which were previously the"},{"startTime":1156.32,"endTime":1158.63,"body":"academic health science networks"},{"startTime":1158.63,"endTime":1160.76,"body":"and the NHS mandate for them to go"},{"startTime":1160.76,"endTime":1163.88,"body":"and work with private"},{"startTime":1160.76,"endTime":1163.88,"body":"industry third party providers"},{"startTime":1163.88,"endTime":1167.12,"body":"to look at how they can"},{"startTime":1163.88,"endTime":1167.12,"body":"use innovation, med tech"},{"startTime":1167.12,"endTime":1171.41,"body":"to actually bring that into"},{"startTime":1167.12,"endTime":1171.41,"body":"the NHS at a pace and scale."},{"startTime":1171.41,"endTime":1173.87,"body":"So, you know, we're not saying, you know,"},{"startTime":1173.87,"endTime":1175.04,"body":"do a pilot here and that's it."},{"startTime":1175.04,"endTime":1177.2,"body":"We sort do a pilot here"},{"startTime":1175.04,"endTime":1177.2,"body":"and scale there up."},{"startTime":1177.2,"endTime":1179.0,"body":"So there is lots of opportunities"},{"startTime":1179.0,"endTime":1181.94,"body":"and I think the NHS has"},{"startTime":1179.0,"endTime":1181.94,"body":"recognised that we need"},{"startTime":1181.94,"endTime":1184.73,"body":"more the kind of the innovation"},{"startTime":1181.94,"endTime":1184.73,"body":"than critical thinking."},{"startTime":1184.73,"endTime":1186.2,"body":"So you're right, Neil, there is a lot more"},{"startTime":1186.2,"endTime":1188.57,"body":"kind of opportunity in"},{"startTime":1186.2,"endTime":1188.57,"body":"terms of working dynamics"},{"startTime":1188.57,"endTime":1191.633,"body":"and what that can look like"},{"startTime":1188.57,"endTime":1191.633,"body":"in the future and even now."},{"startTime":1193.37,"endTime":1194.203,"body":"- Brilliant."},{"startTime":1195.2,"endTime":1198.253,"body":"Have you got any thoughts around"},{"startTime":1195.2,"endTime":1198.253,"body":"that, Jack, before I move?"},{"startTime":1199.19,"endTime":1201.65,"body":"- I wasn't surprised that"},{"startTime":1199.19,"endTime":1201.65,"body":"it wasn't hugely mentioned"},{"startTime":1201.65,"endTime":1202.88,"body":"in the plan guides"},{"startTime":1202.88,"endTime":1206.78,"body":"and I think it's really"},{"startTime":1202.88,"endTime":1206.78,"body":"interesting factor of medicines"},{"startTime":1206.78,"endTime":1208.94,"body":"in terms of how it's sort"},{"startTime":1206.78,"endTime":1208.94,"body":"managed strategically."},{"startTime":1208.94,"endTime":1211.89,"body":"I think you rarely have discussions"},{"startTime":1212.78,"endTime":1215.33,"body":"about management medicines at board level"},{"startTime":1215.33,"endTime":1219.743,"body":"across any of the"},{"startTime":1215.33,"endTime":1219.743,"body":"organisations I've worked with."},{"startTime":1220.58,"endTime":1224.25,"body":"It's very much the domain in my experience"},{"startTime":1225.373,"endTime":1227.84,"body":"of the chief pharmacist"},{"startTime":1225.373,"endTime":1227.84,"body":"medicines optimisation,"},{"startTime":1227.84,"endTime":1230.507,"body":"the professional strand"},{"startTime":1227.84,"endTime":1230.507,"body":"that goes through that"},{"startTime":1230.507,"endTime":1233.543,"body":"and that is managed as a"},{"startTime":1230.507,"endTime":1233.543,"body":"function of all organisations."},{"startTime":1234.5,"endTime":1237.56,"body":"But rarely is the sort of"},{"startTime":1234.5,"endTime":1237.56,"body":"strategic direction of medicine"},{"startTime":1237.56,"endTime":1241.19,"body":"sort of debated at an"},{"startTime":1237.56,"endTime":1241.19,"body":"organisational level,"},{"startTime":1241.19,"endTime":1242.72,"body":"I think that's probably fair enough."},{"startTime":1242.72,"endTime":1244.7,"body":"I'm not saying that's right or wrong,"},{"startTime":1244.7,"endTime":1246.62,"body":"it's just a factor I think."},{"startTime":1246.62,"endTime":1251.083,"body":"I think there is in inevitably"},{"startTime":1246.62,"endTime":1251.083,"body":"a financial dimension to it"},{"startTime":1252.71,"endTime":1254.06,"body":"in organisations and systems"},{"startTime":1254.06,"endTime":1257.657,"body":"are put under a lot of"},{"startTime":1254.06,"endTime":1257.657,"body":"pressure to be, you know,"},{"startTime":1260.09,"endTime":1264.413,"body":"unit efficient essentially"},{"startTime":1260.09,"endTime":1264.413,"body":"for a pricing point of view."},{"startTime":1265.34,"endTime":1268.04,"body":"But we've also had to see in"},{"startTime":1265.34,"endTime":1268.04,"body":"recent years massive exposure"},{"startTime":1268.04,"endTime":1272.0,"body":"to national supply chain vulnerabilities"},{"startTime":1272.0,"endTime":1273.98,"body":"and international supply"},{"startTime":1272.0,"endTime":1273.98,"body":"chain vulnerabilities"},{"startTime":1273.98,"endTime":1278.63,"body":"that's really hit organisations"},{"startTime":1273.98,"endTime":1278.63,"body":"across the board quite hard."},{"startTime":1278.63,"endTime":1282.203,"body":"So mitigating those sorts of"},{"startTime":1278.63,"endTime":1282.203,"body":"pressures is really important."},{"startTime":1283.495,"endTime":1284.78,"body":"I think there's some"},{"startTime":1283.495,"endTime":1284.78,"body":"really interesting thinking"},{"startTime":1284.78,"endTime":1288.33,"body":"around the how we build"},{"startTime":1284.78,"endTime":1288.33,"body":"wider value propositions"},{"startTime":1289.871,"endTime":1292.52,"body":"for medicines and"},{"startTime":1289.871,"endTime":1292.52,"body":"devices across the board."},{"startTime":1292.52,"endTime":1297.11,"body":"So at the moment the debate"},{"startTime":1292.52,"endTime":1297.11,"body":"is too often overly simplistic"},{"startTime":1297.11,"endTime":1301.97,"body":"between, you know, this cost"},{"startTime":1297.11,"endTime":1301.97,"body":"is lower than that cost."},{"startTime":1301.97,"endTime":1304.91,"body":"Whereas actually we've been"},{"startTime":1301.97,"endTime":1304.91,"body":"able to do things differently"},{"startTime":1304.91,"endTime":1307.91,"body":"around actually that"},{"startTime":1304.91,"endTime":1307.91,"body":"yeah, that one requires"},{"startTime":1307.91,"endTime":1311.87,"body":"x less of district nurse time"},{"startTime":1307.91,"endTime":1311.87,"body":"to administer in the community"},{"startTime":1311.87,"endTime":1314.66,"body":"and therefore it releases"},{"startTime":1311.87,"endTime":1314.66,"body":"15% of workforce capacity"},{"startTime":1314.66,"endTime":1319.16,"body":"and therefore the economic"},{"startTime":1314.66,"endTime":1319.16,"body":"gain to the system is x and y"},{"startTime":1319.16,"endTime":1322.67,"body":"or on the surgical side there's, I think,"},{"startTime":1322.67,"endTime":1325.13,"body":"there's different sorts of"},{"startTime":1322.67,"endTime":1325.13,"body":"commercial partnerships."},{"startTime":1325.13,"endTime":1327.32,"body":"I think we can be exploring that."},{"startTime":1327.32,"endTime":1331.1,"body":"That perhaps offer exclusivity of product,"},{"startTime":1331.1,"endTime":1333.53,"body":"but then a different"},{"startTime":1331.1,"endTime":1333.53,"body":"partnership around training"},{"startTime":1333.53,"endTime":1337.343,"body":"or investment in facilities"},{"startTime":1333.53,"endTime":1337.343,"body":"or things like that."},{"startTime":1339.08,"endTime":1340.61,"body":"I think we need to slightly move away"},{"startTime":1340.61,"endTime":1344.06,"body":"from just competing on units of product"},{"startTime":1344.06,"endTime":1346.13,"body":"and then more about strategic partnerships"},{"startTime":1346.13,"endTime":1349.4,"body":"with organisations that"},{"startTime":1346.13,"endTime":1349.4,"body":"are bit more holistic"},{"startTime":1349.4,"endTime":1352.67,"body":"in terms of the knowledge"},{"startTime":1349.4,"endTime":1352.67,"body":"and impact on healthcare,"},{"startTime":1352.67,"endTime":1355.34,"body":"the healthcare business"},{"startTime":1352.67,"endTime":1355.34,"body":"overall if you like."},{"startTime":1355.34,"endTime":1356.173,"body":"- Yeah."},{"startTime":1357.8,"endTime":1359.45,"body":"Thank you."},{"startTime":1359.45,"endTime":1360.32,"body":"I'm just thinking, Zafran,"},{"startTime":1360.32,"endTime":1361.55,"body":"you've mentioned a couple of times,"},{"startTime":1361.55,"endTime":1363.59,"body":"if I come to you, Neil,"},{"startTime":1363.59,"endTime":1366.17,"body":"you've mentioned the medicines"},{"startTime":1363.59,"endTime":1366.17,"body":"optimisation opportunities,"},{"startTime":1366.17,"endTime":1368.99,"body":"the 16 national priorities."},{"startTime":1368.99,"endTime":1370.91,"body":"Could you talk a little bit about that,"},{"startTime":1370.91,"endTime":1373.25,"body":"because we are asked quite a lot"},{"startTime":1373.25,"endTime":1377.75,"body":"in terms of how policies"},{"startTime":1373.25,"endTime":1377.75,"body":"like that decided on."},{"startTime":1377.75,"endTime":1379.94,"body":"So how do you decide which"},{"startTime":1377.75,"endTime":1379.94,"body":"five you're going to implement"},{"startTime":1379.94,"endTime":1382.88,"body":"and how is that, yeah, how's it decided"},{"startTime":1382.88,"endTime":1385.13,"body":"and how's it communicated"},{"startTime":1382.88,"endTime":1385.13,"body":"down through the system?"},{"startTime":1385.13,"endTime":1388.173,"body":"So, you know, how's it come"},{"startTime":1385.13,"endTime":1388.173,"body":"from your levels, Zafran,"},{"startTime":1388.173,"endTime":1390.237,"body":"and what impact does it have on you, Neil?"},{"startTime":1390.237,"endTime":1392.289,"body":"What level of influence do you have?"},{"startTime":1392.289,"endTime":1393.92,"body":"I come to you Zafran."},{"startTime":1393.92,"endTime":1395.03,"body":"- Yeah, sure, no problem Karen."},{"startTime":1395.03,"endTime":1397.61,"body":"So obviously there's 16"},{"startTime":1395.03,"endTime":1397.61,"body":"areas of opportunity."},{"startTime":1397.61,"endTime":1400.04,"body":"They're listed out in"},{"startTime":1397.61,"endTime":1400.04,"body":"the national document."},{"startTime":1400.04,"endTime":1402.05,"body":"And then based on that, you then,"},{"startTime":1402.05,"endTime":1402.883,"body":"obviously we take that back"},{"startTime":1402.883,"endTime":1407.15,"body":"to your kind of SRO chief"},{"startTime":1402.883,"endTime":1407.15,"body":"pharmacist, you'd use data,"},{"startTime":1407.15,"endTime":1409.07,"body":"you'd use your prescribing advisors,"},{"startTime":1409.07,"endTime":1412.22,"body":"you'd use your clinical leads,"},{"startTime":1409.07,"endTime":1412.22,"body":"you'd need your lead GPs,"},{"startTime":1412.22,"endTime":1414.62,"body":"and you'd work through what"},{"startTime":1412.22,"endTime":1414.62,"body":"the key priorities are,"},{"startTime":1414.62,"endTime":1419.45,"body":"whether are maybe potential"},{"startTime":1414.62,"endTime":1419.45,"body":"savings over kind of key areas"},{"startTime":1419.45,"endTime":1422.15,"body":"or whether there's, for example,"},{"startTime":1422.15,"endTime":1424.31,"body":"something that has a real"},{"startTime":1422.15,"endTime":1424.31,"body":"clinical kind of area"},{"startTime":1424.31,"endTime":1426.59,"body":"that you think actually"},{"startTime":1424.31,"endTime":1426.59,"body":"that's a safety issue,"},{"startTime":1426.59,"endTime":1428.81,"body":"like for example, high opioid prescribing"},{"startTime":1428.81,"endTime":1430.22,"body":"and how we can tackle that."},{"startTime":1430.22,"endTime":1433.4,"body":"So nothing is really done in isolation."},{"startTime":1433.4,"endTime":1434.75,"body":"It's done through, you know,"},{"startTime":1434.75,"endTime":1436.52,"body":"that kind of collaborative working,"},{"startTime":1436.52,"endTime":1439.4,"body":"that kind of critical thinking"},{"startTime":1436.52,"endTime":1439.4,"body":"with key stakeholders."},{"startTime":1439.4,"endTime":1441.98,"body":"And then, nationally we've been planned,"},{"startTime":1441.98,"endTime":1444.47,"body":"we need to develop a plan"},{"startTime":1441.98,"endTime":1444.47,"body":"to deliver at least five"},{"startTime":1444.47,"endTime":1447.65,"body":"of those national medicine"},{"startTime":1444.47,"endTime":1447.65,"body":"optimisation opportunities."},{"startTime":1447.65,"endTime":1449.0,"body":"And we have to do that."},{"startTime":1449.0,"endTime":1451.907,"body":"So we have to, where it will"},{"startTime":1449.0,"endTime":1451.907,"body":"improve local population"},{"startTime":1451.907,"endTime":1454.97,"body":"and health outcomes and"},{"startTime":1451.907,"endTime":1454.97,"body":"we need to make sure"},{"startTime":1454.97,"endTime":1457.88,"body":"that these align to being,"},{"startTime":1454.97,"endTime":1457.88,"body":"you know, that they complement"},{"startTime":1457.88,"endTime":1460.37,"body":"the local medicines"},{"startTime":1457.88,"endTime":1460.37,"body":"optimisation priorities."},{"startTime":1460.37,"endTime":1461.48,"body":"So we don't want to do something"},{"startTime":1461.48,"endTime":1463.07,"body":"that actually has an a negative"},{"startTime":1463.07,"endTime":1465.86,"body":"or adverse impact on"},{"startTime":1463.07,"endTime":1465.86,"body":"what we're doing locally."},{"startTime":1465.86,"endTime":1469.07,"body":"So first of all there's a"},{"startTime":1465.86,"endTime":1469.07,"body":"whole issue around alignment"},{"startTime":1469.07,"endTime":1470.66,"body":"and then there's getting agreement."},{"startTime":1470.66,"endTime":1471.89,"body":"And then once that's agreement,"},{"startTime":1471.89,"endTime":1473.15,"body":"then it's making sure that we've got"},{"startTime":1473.15,"endTime":1477.17,"body":"the kind of the policy"},{"startTime":1473.15,"endTime":1477.17,"body":"decision making right."},{"startTime":1477.17,"endTime":1478.37,"body":"So obviously there'll be like an area"},{"startTime":1478.37,"endTime":1481.13,"body":"of prescribing committee"},{"startTime":1478.37,"endTime":1481.13,"body":"or where that will go"},{"startTime":1481.13,"endTime":1482.81,"body":"and be signed off and ratified,"},{"startTime":1482.81,"endTime":1484.85,"body":"and where you've looked at other services"},{"startTime":1484.85,"endTime":1488.24,"body":"like pharmacy, dentistry, and"},{"startTime":1484.85,"endTime":1488.24,"body":"optometry to make sure that,"},{"startTime":1488.24,"endTime":1489.38,"body":"you know, we're not doing something"},{"startTime":1489.38,"endTime":1491.42,"body":"that's going to impact"},{"startTime":1489.38,"endTime":1491.42,"body":"them and be harmful to them"},{"startTime":1491.42,"endTime":1494.27,"body":"in terms of those kind"},{"startTime":1491.42,"endTime":1494.27,"body":"of contractors as well."},{"startTime":1494.27,"endTime":1497.48,"body":"And then it's making sure"},{"startTime":1494.27,"endTime":1497.48,"body":"that there's co-production"},{"startTime":1497.48,"endTime":1498.743,"body":"wherever possible."},{"startTime":1500.66,"endTime":1502.91,"body":"And that's where you need the public"},{"startTime":1502.91,"endTime":1505.97,"body":"and the patient's voice as"},{"startTime":1502.91,"endTime":1505.97,"body":"well as the key stakeholders."},{"startTime":1505.97,"endTime":1509.15,"body":"And so then there's a bit about"},{"startTime":1505.97,"endTime":1509.15,"body":"around about the learning,"},{"startTime":1509.15,"endTime":1512.51,"body":"you know, like I said before"},{"startTime":1509.15,"endTime":1512.51,"body":"about our do once approach."},{"startTime":1512.51,"endTime":1514.49,"body":"And that's what Neil was alluding to,"},{"startTime":1514.49,"endTime":1517.01,"body":"we don't want to be doing stuff"},{"startTime":1514.49,"endTime":1517.01,"body":"just for the sake of doing it"},{"startTime":1517.01,"endTime":1519.11,"body":"and then having to do"},{"startTime":1517.01,"endTime":1519.11,"body":"unnecessary duplication"},{"startTime":1519.11,"endTime":1521.66,"body":"or having to add more"},{"startTime":1519.11,"endTime":1521.66,"body":"resource in downstream."},{"startTime":1521.66,"endTime":1523.7,"body":"So just because we might not be doing that"},{"startTime":1523.7,"endTime":1524.623,"body":"or somebody else is doing it"},{"startTime":1524.623,"endTime":1528.14,"body":"doesn't mean that's a good"},{"startTime":1524.623,"endTime":1528.14,"body":"use of anybody's resource."},{"startTime":1528.14,"endTime":1531.62,"body":"So that's kind of how we kind"},{"startTime":1528.14,"endTime":1531.62,"body":"of plan it and manage it."},{"startTime":1531.62,"endTime":1534.89,"body":"And yes, where there are kind"},{"startTime":1531.62,"endTime":1534.89,"body":"of key metrics like, you know,"},{"startTime":1534.89,"endTime":1537.68,"body":"as Jack's talked about,"},{"startTime":1534.89,"endTime":1537.68,"body":"right, in terms of,"},{"startTime":1537.68,"endTime":1539.48,"body":"for example, unit price and cost savings,"},{"startTime":1539.48,"endTime":1541.46,"body":"then obviously we'll attribute that,"},{"startTime":1541.46,"endTime":1543.14,"body":"but some of it might be run actually well."},{"startTime":1543.14,"endTime":1545.78,"body":"We want to reduce the"},{"startTime":1543.14,"endTime":1545.78,"body":"anti microbial resistance,"},{"startTime":1545.78,"endTime":1547.67,"body":"so we're looking at"},{"startTime":1545.78,"endTime":1547.67,"body":"anti-microbial prescribing"},{"startTime":1547.67,"endTime":1549.98,"body":"and reducing that down"},{"startTime":1547.67,"endTime":1549.98,"body":"to five day working."},{"startTime":1549.98,"endTime":1552.65,"body":"Or we might be high in opioid"},{"startTime":1549.98,"endTime":1552.65,"body":"prescribing in certain areas,"},{"startTime":1552.65,"endTime":1555.59,"body":"so we're look at new ways"},{"startTime":1552.65,"endTime":1555.59,"body":"of working, innovation,"},{"startTime":1555.59,"endTime":1557.39,"body":"bringing in technology, you know,"},{"startTime":1557.39,"endTime":1559.76,"body":"helping patients in different ways"},{"startTime":1559.76,"endTime":1562.67,"body":"and that holistic approach"},{"startTime":1559.76,"endTime":1562.67,"body":"to helping to reduce that."},{"startTime":1562.67,"endTime":1563.69,"body":"Or it might be, for example,"},{"startTime":1563.69,"endTime":1565.55,"body":"looking at antidepressant prescribing"},{"startTime":1565.55,"endTime":1569.99,"body":"and how we'd want to work with"},{"startTime":1565.55,"endTime":1569.99,"body":"wider holistic practitioners"},{"startTime":1569.99,"endTime":1572.18,"body":"where we might want to work"},{"startTime":1569.99,"endTime":1572.18,"body":"with social prescribers"},{"startTime":1572.18,"endTime":1574.25,"body":"within place and PCN practices"},{"startTime":1574.25,"endTime":1575.51,"body":"and what that would look like."},{"startTime":1575.51,"endTime":1576.77,"body":"But you can't do any of that."},{"startTime":1576.77,"endTime":1577.756,"body":"You can't forge it."},{"startTime":1577.756,"endTime":1579.35,"body":"It's just sat in a room"},{"startTime":1577.756,"endTime":1579.35,"body":"somewhere on your own."},{"startTime":1579.35,"endTime":1581.03,"body":"You've got to have people involved"},{"startTime":1581.03,"endTime":1582.383,"body":"and engaged at all levels."},{"startTime":1583.63,"endTime":1586.597,"body":"And the whole point of"},{"startTime":1583.63,"endTime":1586.597,"body":"co-creation or co-production"},{"startTime":1588.56,"endTime":1589.67,"body":"is that then you've got key people"},{"startTime":1589.67,"endTime":1591.14,"body":"who've got ownership of that."},{"startTime":1591.14,"endTime":1593.12,"body":"So it's a real kind of system change."},{"startTime":1593.12,"endTime":1594.95,"body":"That's how you would then get down"},{"startTime":1594.95,"endTime":1596.78,"body":"to those five kind of key priorities"},{"startTime":1596.78,"endTime":1598.88,"body":"that they then got very"},{"startTime":1596.78,"endTime":1598.88,"body":"clear for the year."},{"startTime":1598.88,"endTime":1600.92,"body":"So then people understand the why,"},{"startTime":1600.92,"endTime":1602.96,"body":"they understand the how"},{"startTime":1600.92,"endTime":1602.96,"body":"and the what as well,"},{"startTime":1602.96,"endTime":1603.793,"body":"because, you know, how we're going to do"},{"startTime":1603.793,"endTime":1605.18,"body":"and what that means for them."},{"startTime":1605.18,"endTime":1606.44,"body":"And then everyone's tackling it"},{"startTime":1606.44,"endTime":1608.42,"body":"from that kind of whole issue."},{"startTime":1608.42,"endTime":1611.06,"body":"So that's why planning now is a lot more,"},{"startTime":1611.06,"endTime":1612.38,"body":"you know, as Neil was saying before,"},{"startTime":1612.38,"endTime":1614.54,"body":"it's not just about a gung-ho approach"},{"startTime":1614.54,"endTime":1616.385,"body":"and going doing something,"},{"startTime":1614.54,"endTime":1616.385,"body":"there's got to be planning"},{"startTime":1616.385,"endTime":1618.23,"body":"and there's got to be some real engagement"},{"startTime":1618.23,"endTime":1619.58,"body":"and then there's got to"},{"startTime":1618.23,"endTime":1619.58,"body":"be some clear metrics."},{"startTime":1619.58,"endTime":1622.01,"body":"And for us, for those key"},{"startTime":1619.58,"endTime":1622.01,"body":"national five indicators"},{"startTime":1622.01,"endTime":1624.44,"body":"that we may take on, we've"},{"startTime":1622.01,"endTime":1624.44,"body":"then got to have a confirm"},{"startTime":1624.44,"endTime":1627.41,"body":"and challenge with the"},{"startTime":1624.44,"endTime":1627.41,"body":"regional kind of NHS England"},{"startTime":1627.41,"endTime":1629.54,"body":"to ensure that we are"},{"startTime":1627.41,"endTime":1629.54,"body":"doing that as a system."},{"startTime":1629.54,"endTime":1631.67,"body":"But there's also something"},{"startTime":1629.54,"endTime":1631.67,"body":"about shared learning"},{"startTime":1631.67,"endTime":1633.05,"body":"across a region."},{"startTime":1633.05,"endTime":1634.047,"body":"So what's our neighbours doing?"},{"startTime":1634.047,"endTime":1635.63,"body":"You know, what are they doing?"},{"startTime":1635.63,"endTime":1637.04,"body":"What's worked well, what hasn't?"},{"startTime":1637.04,"endTime":1638.93,"body":"So it's sharing that best practise."},{"startTime":1638.93,"endTime":1640.49,"body":"So it's been about more being more open"},{"startTime":1640.49,"endTime":1642.65,"body":"and transparent about why"},{"startTime":1640.49,"endTime":1642.65,"body":"you're doing what you're doing."},{"startTime":1642.65,"endTime":1643.88,"body":"There's no kind of, you know,"},{"startTime":1643.88,"endTime":1646.61,"body":"backdoor kind of jobs being"},{"startTime":1643.88,"endTime":1646.61,"body":"done or cloak and dagger."},{"startTime":1646.61,"endTime":1649.64,"body":"It has to be very open, and I"},{"startTime":1646.61,"endTime":1649.64,"body":"think as Neil was alluding to,"},{"startTime":1649.64,"endTime":1650.93,"body":"and we have to be very honest about that"},{"startTime":1650.93,"endTime":1653.69,"body":"and that's honestly open conversations."},{"startTime":1653.69,"endTime":1655.34,"body":"Hope that explains a bit of it."},{"startTime":1655.34,"endTime":1656.75,"body":"- Yeah, absolutely."},{"startTime":1656.75,"endTime":1660.252,"body":"I'll come to Neil 'cause"},{"startTime":1656.75,"endTime":1660.252,"body":"I mean that sounds ideal,"},{"startTime":1660.252,"endTime":1662.15,"body":"Zafran, if that's how it's being decided."},{"startTime":1662.15,"endTime":1663.68,"body":"Is that your experience, Neil?"},{"startTime":1663.68,"endTime":1665.66,"body":"- Yeah, well that's my experience anyway."},{"startTime":1665.66,"endTime":1667.19,"body":"That's what we are trying to do."},{"startTime":1667.19,"endTime":1668.743,"body":"So, you know, before we get shut down,"},{"startTime":1668.743,"endTime":1670.16,"body":"that is what we are trying to do."},{"startTime":1670.16,"endTime":1671.18,"body":"Absolutely."},{"startTime":1671.18,"endTime":1672.526,"body":"You know, that's the aspiration."},{"startTime":1672.526,"endTime":1673.89,"body":"- Yeah, absolutely."},{"startTime":1673.89,"endTime":1676.58,"body":"- I think that's the best practise"},{"startTime":1676.58,"endTime":1678.77,"body":"and I think that, you know,"},{"startTime":1676.58,"endTime":1678.77,"body":"you have to work as a team,"},{"startTime":1678.77,"endTime":1680.99,"body":"because the way that this is deployed"},{"startTime":1680.99,"endTime":1682.73,"body":"is through other parties."},{"startTime":1682.73,"endTime":1683.93,"body":"You have to get everyone on board"},{"startTime":1683.93,"endTime":1686.39,"body":"with why you're making that change."},{"startTime":1686.39,"endTime":1687.35,"body":"Why you're making a change?"},{"startTime":1687.35,"endTime":1690.71,"body":"It's just a cost saving and"},{"startTime":1687.35,"endTime":1690.71,"body":"that cost is never seen."},{"startTime":1690.71,"endTime":1693.56,"body":"The team that's doing the"},{"startTime":1690.71,"endTime":1693.56,"body":"used expending their resource"},{"startTime":1693.56,"endTime":1695.45,"body":"actually never see those cost savings."},{"startTime":1695.45,"endTime":1698.69,"body":"So that's one big mistake that people make"},{"startTime":1698.69,"endTime":1702.08,"body":"is that the actual prescribing budget"},{"startTime":1702.08,"endTime":1704.57,"body":"affects general practise"},{"startTime":1702.08,"endTime":1704.57,"body":"funding, which it doesn't."},{"startTime":1704.57,"endTime":1707.99,"body":"So if I prescribe"},{"startTime":1704.57,"endTime":1707.99,"body":"something very expensive,"},{"startTime":1707.99,"endTime":1710.45,"body":"it doesn't mean I have less money."},{"startTime":1710.45,"endTime":1712.76,"body":"If I prescribe something very cheap,"},{"startTime":1712.76,"endTime":1715.73,"body":"it doesn't mean I can save,"},{"startTime":1712.76,"endTime":1715.73,"body":"I get to keep that money."},{"startTime":1715.73,"endTime":1716.96,"body":"Nor does it mean that that money"},{"startTime":1716.96,"endTime":1719.21,"body":"actually comes back into primary care,"},{"startTime":1719.21,"endTime":1723.32,"body":"and so it is a really"},{"startTime":1719.21,"endTime":1723.32,"body":"hard thing to motivate."},{"startTime":1723.32,"endTime":1726.17,"body":"So previously it was just a dictation"},{"startTime":1726.17,"endTime":1727.22,"body":"that you wanted to change."},{"startTime":1727.22,"endTime":1728.63,"body":"You had a target to get everyone"},{"startTime":1728.63,"endTime":1731.96,"body":"onto certain particular medication."},{"startTime":1731.96,"endTime":1734.0,"body":"And it wasn't always scientifically clear"},{"startTime":1734.0,"endTime":1736.58,"body":"as to how they'd chosen that medication"},{"startTime":1736.58,"endTime":1738.08,"body":"for people to change to."},{"startTime":1738.08,"endTime":1739.85,"body":"And there wasn't a good economic argument"},{"startTime":1739.85,"endTime":1742.91,"body":"if people had a clinically safe control,"},{"startTime":1742.91,"endTime":1743.962,"body":"let's say the blood pressure,"},{"startTime":1743.962,"endTime":1747.14,"body":"why would you want to"},{"startTime":1743.962,"endTime":1747.14,"body":"destabilise that situation?"},{"startTime":1747.14,"endTime":1748.763,"body":"It's a long term treatment."},{"startTime":1750.08,"endTime":1751.4,"body":"But I don't think that's happened."},{"startTime":1751.4,"endTime":1753.38,"body":"We haven't had as many switches"},{"startTime":1753.38,"endTime":1755.42,"body":"over the past five or 10 years."},{"startTime":1755.42,"endTime":1757.55,"body":"We used to switch every year,"},{"startTime":1757.55,"endTime":1759.83,"body":"there'd be something else to change to"},{"startTime":1759.83,"endTime":1761.72,"body":"because it became off patent."},{"startTime":1761.72,"endTime":1765.23,"body":"Drugs are obviously terrible"},{"startTime":1761.72,"endTime":1765.23,"body":"until whilst they're on patent."},{"startTime":1765.23,"endTime":1768.013,"body":"And as soon as they're generic,"},{"startTime":1765.23,"endTime":1768.013,"body":"they're the best thing ever."},{"startTime":1768.899,"endTime":1772.52,"body":"And so we saw a massive"},{"startTime":1768.899,"endTime":1772.52,"body":"increase in particularly"},{"startTime":1772.52,"endTime":1776.93,"body":"to lipid management medication"},{"startTime":1772.52,"endTime":1776.93,"body":"or anti-platelet stuff."},{"startTime":1776.93,"endTime":1780.44,"body":"It was suddenly the best"},{"startTime":1776.93,"endTime":1780.44,"body":"thing ever once it was cheap."},{"startTime":1780.44,"endTime":1783.65,"body":"So, and that's probably down to"},{"startTime":1780.44,"endTime":1783.65,"body":"cost modelling and economics,"},{"startTime":1783.65,"endTime":1786.44,"body":"but I'm sure there's less subtle reasons"},{"startTime":1786.44,"endTime":1788.54,"body":"why that might happen."},{"startTime":1788.54,"endTime":1793.1,"body":"But yeah, I think working as a"},{"startTime":1788.54,"endTime":1793.1,"body":"team, this is a team project,"},{"startTime":1793.1,"endTime":1795.29,"body":"the NHS needs to work more together"},{"startTime":1795.29,"endTime":1798.56,"body":"so that the savings that"},{"startTime":1795.29,"endTime":1798.56,"body":"are released from this"},{"startTime":1798.56,"endTime":1801.23,"body":"come back into support practices,"},{"startTime":1801.23,"endTime":1804.023,"body":"support pharmacists, and"},{"startTime":1801.23,"endTime":1804.023,"body":"support the wider team."},{"startTime":1806.18,"endTime":1809.12,"body":"Medicines are a massive"},{"startTime":1806.18,"endTime":1809.12,"body":"cost, a massive part of it,"},{"startTime":1809.12,"endTime":1810.59,"body":"but they're a massive necessity as well."},{"startTime":1810.59,"endTime":1814.85,"body":"You know, there's not,"},{"startTime":1810.59,"endTime":1814.85,"body":"we take even for granted"},{"startTime":1814.85,"endTime":1816.929,"body":"that there's the solution"},{"startTime":1814.85,"endTime":1816.929,"body":"to somebody's problem"},{"startTime":1816.929,"endTime":1820.79,"body":"and often there is and"},{"startTime":1816.929,"endTime":1820.79,"body":"that is, as a result"},{"startTime":1820.79,"endTime":1824.33,"body":"of the money spent through"},{"startTime":1820.79,"endTime":1824.33,"body":"pharmaceutical research."},{"startTime":1824.33,"endTime":1829.33,"body":"So yeah, I don't think I have"},{"startTime":1824.33,"endTime":1829.33,"body":"anything much more about that."},{"startTime":1829.58,"endTime":1833.21,"body":"I mean, to make a difference to that,"},{"startTime":1833.21,"endTime":1837.407,"body":"you would need to have some"},{"startTime":1833.21,"endTime":1837.407,"body":"input into the advisory boards"},{"startTime":1837.407,"endTime":1842.407,"body":"for the prescribing guidelines and things,"},{"startTime":1842.75,"endTime":1844.723,"body":"but I'd imagine that that is,"},{"startTime":1844.723,"endTime":1847.31,"body":"Zafran knows better about"},{"startTime":1844.723,"endTime":1847.31,"body":"that, how they make the choice"},{"startTime":1847.31,"endTime":1851.54,"body":"about what is the optimum product range"},{"startTime":1851.54,"endTime":1853.82,"body":"to choose for certain things."},{"startTime":1853.82,"endTime":1854.653,"body":"- Yeah."},{"startTime":1855.83,"endTime":1858.907,"body":"Just, Jack, just, I don't want"},{"startTime":1855.83,"endTime":1858.907,"body":"to not include you in that."},{"startTime":1858.907,"endTime":1863.337,"body":"I know you were saying that"},{"startTime":1858.907,"endTime":1863.337,"body":"obviously these sorts of,"},{"startTime":1863.337,"endTime":1865.34,"body":"you know, the discussions"},{"startTime":1863.337,"endTime":1865.34,"body":"around medicines,"},{"startTime":1865.34,"endTime":1868.518,"body":"things fall to the likes"},{"startTime":1865.34,"endTime":1868.518,"body":"of Zafran and Neil."},{"startTime":1868.518,"endTime":1871.22,"body":"Do medicines conversations"},{"startTime":1868.518,"endTime":1871.22,"body":"cross your desk?"},{"startTime":1871.22,"endTime":1873.14,"body":"Is that something you ever talk about?"},{"startTime":1873.14,"endTime":1874.94,"body":"- Yeah, I think it."},{"startTime":1874.94,"endTime":1877.22,"body":"So in terms of how the"},{"startTime":1874.94,"endTime":1877.22,"body":"business cycle works,"},{"startTime":1877.22,"endTime":1882.02,"body":"so I would normally work"},{"startTime":1877.22,"endTime":1882.02,"body":"with our chief pharmacist"},{"startTime":1882.02,"endTime":1885.38,"body":"in terms of setting the annual plan."},{"startTime":1885.38,"endTime":1887.9,"body":"So, yeah, look at the budgets,"},{"startTime":1887.9,"endTime":1892.07,"body":"look at the areas where"},{"startTime":1887.9,"endTime":1892.07,"body":"we gain efficiencies,"},{"startTime":1892.07,"endTime":1893.72,"body":"the new investment areas we need to make"},{"startTime":1893.72,"endTime":1896.18,"body":"if there are technology"},{"startTime":1893.72,"endTime":1896.18,"body":"appraisals coming down"},{"startTime":1896.18,"endTime":1897.29,"body":"or other stuff."},{"startTime":1897.29,"endTime":1902.29,"body":"So there's definitely that"},{"startTime":1897.29,"endTime":1902.29,"body":"initial business planning bit."},{"startTime":1903.29,"endTime":1905.03,"body":"I think we do get involved,"},{"startTime":1905.03,"endTime":1906.8,"body":"so certainly I get involved"},{"startTime":1905.03,"endTime":1906.8,"body":"with our pharmacists"},{"startTime":1906.8,"endTime":1909.38,"body":"on some of the elements"},{"startTime":1906.8,"endTime":1909.38,"body":"that Neil talks about,"},{"startTime":1909.38,"endTime":1911.69,"body":"which I think are really"},{"startTime":1909.38,"endTime":1911.69,"body":"important around how you develop"},{"startTime":1911.69,"endTime":1915.5,"body":"a better model to drive efficiency"},{"startTime":1915.5,"endTime":1918.41,"body":"and improvement in practise"},{"startTime":1915.5,"endTime":1918.41,"body":"that gets a share of benefit"},{"startTime":1918.41,"endTime":1921.05,"body":"back into the teams that are doing it."},{"startTime":1921.05,"endTime":1922.13,"body":"I think that's really important,"},{"startTime":1922.13,"endTime":1924.53,"body":"because otherwise you are just"},{"startTime":1922.13,"endTime":1924.53,"body":"bludgeoning people every year"},{"startTime":1924.53,"endTime":1927.89,"body":"to say, oh, spend less,"},{"startTime":1924.53,"endTime":1927.89,"body":"be more productive,"},{"startTime":1927.89,"endTime":1930.213,"body":"do more work, be, you"},{"startTime":1927.89,"endTime":1930.213,"body":"know, for less resource"},{"startTime":1930.213,"endTime":1931.85,"body":"and so and so on and so on."},{"startTime":1931.85,"endTime":1935.45,"body":"So that's how we develop"},{"startTime":1931.85,"endTime":1935.45,"body":"that model of gain share"},{"startTime":1935.45,"endTime":1938.27,"body":"is something that we would definitely"},{"startTime":1938.27,"endTime":1942.2,"body":"be sort of worked on"},{"startTime":1938.27,"endTime":1942.2,"body":"throughout the organisation."},{"startTime":1942.2,"endTime":1945.83,"body":"And then there'll only be really specific"},{"startTime":1945.83,"endTime":1947.66,"body":"high risk or high gain areas"},{"startTime":1947.66,"endTime":1951.32,"body":"would normally be more"},{"startTime":1947.66,"endTime":1951.32,"body":"addressed at a board level."},{"startTime":1951.32,"endTime":1955.67,"body":"So recently some of the"},{"startTime":1951.32,"endTime":1955.67,"body":"biosimilar switching"},{"startTime":1955.67,"endTime":1960.67,"body":"in more in acute care has been"},{"startTime":1955.67,"endTime":1960.67,"body":"very, very, very high value"},{"startTime":1962.69,"endTime":1965.12,"body":"clinically contentious in some areas,"},{"startTime":1965.12,"endTime":1967.763,"body":"legally contentious in some areas."},{"startTime":1968.93,"endTime":1970.16,"body":"And there's quite variability"},{"startTime":1970.16,"endTime":1972.38,"body":"in pace of uptake across"},{"startTime":1970.16,"endTime":1972.38,"body":"hospitals, you know,"},{"startTime":1972.38,"endTime":1974.93,"body":"even within a relatively small geography,"},{"startTime":1974.93,"endTime":1976.32,"body":"so those sorts of things"},{"startTime":1977.6,"endTime":1980.33,"body":"would sort of make it to board level"},{"startTime":1980.33,"endTime":1982.1,"body":"and we'd have debate about that"},{"startTime":1982.1,"endTime":1985.91,"body":"or intervene with different"},{"startTime":1982.1,"endTime":1985.91,"body":"trusts and so on and so on."},{"startTime":1985.91,"endTime":1988.04,"body":"Or need to bring different"},{"startTime":1985.91,"endTime":1988.04,"body":"clinical teams together"},{"startTime":1988.04,"endTime":1991.79,"body":"to debate the merits of things like that."},{"startTime":1991.79,"endTime":1995.12,"body":"So when it gets to a"},{"startTime":1991.79,"endTime":1995.12,"body":"certain threshold really,"},{"startTime":1995.12,"endTime":1999.429,"body":"and it's one particular"},{"startTime":1995.12,"endTime":1999.429,"body":"problem, diabetic technology"},{"startTime":1999.429,"endTime":2002.08,"body":"and new monitoring and"},{"startTime":1999.429,"endTime":2002.08,"body":"stuff coming through."},{"startTime":2002.08,"endTime":2006.07,"body":"There again is a massive investment area."},{"startTime":2006.07,"endTime":2009.28,"body":"And again it's an area where"},{"startTime":2006.07,"endTime":2009.28,"body":"the centre may make a decision"},{"startTime":2009.28,"endTime":2011.65,"body":"to say, oh, everybody"},{"startTime":2009.28,"endTime":2011.65,"body":"should be entitled to this."},{"startTime":2011.65,"endTime":2013.63,"body":"And then quietly they'll say to you,"},{"startTime":2013.63,"endTime":2015.04,"body":"well there's no much"},{"startTime":2013.63,"endTime":2015.04,"body":"money to pay for that."},{"startTime":2015.04,"endTime":2016.42,"body":"So, yeah, be prepared to absorb"},{"startTime":2016.42,"endTime":2019.897,"body":"that massive cost pressure in that year."},{"startTime":2019.897,"endTime":2022.18,"body":"And then you have to find"},{"startTime":2019.897,"endTime":2022.18,"body":"a way of doing that within"},{"startTime":2022.18,"endTime":2023.98,"body":"and which means other stuff will lose out."},{"startTime":2023.98,"endTime":2027.16,"body":"So in some of those really"},{"startTime":2023.98,"endTime":2027.16,"body":"big trade off conversations,"},{"startTime":2027.16,"endTime":2030.76,"body":"does it sort of get to"},{"startTime":2027.16,"endTime":2030.76,"body":"organisational level, I think?"},{"startTime":2030.76,"endTime":2031.63,"body":"- Okay."},{"startTime":2031.63,"endTime":2033.7,"body":"That's really interesting."},{"startTime":2033.7,"endTime":2034.81,"body":"Okay, let's-"},{"startTime":2033.7,"endTime":2034.81,"body":"- I was also going to say,"},{"startTime":2034.81,"endTime":2037.75,"body":"sorry Karen, I was also"},{"startTime":2034.81,"endTime":2037.75,"body":"going to say apologies."},{"startTime":2037.75,"endTime":2038.95,"body":"I was also going to say there's something"},{"startTime":2038.95,"endTime":2040.93,"body":"around population health"},{"startTime":2038.95,"endTime":2040.93,"body":"management as well,"},{"startTime":2040.93,"endTime":2042.22,"body":"health inequalities."},{"startTime":2042.22,"endTime":2044.52,"body":"So there's always, I"},{"startTime":2042.22,"endTime":2044.52,"body":"mean, look at prescribing"},{"startTime":2045.56,"endTime":2047.02,"body":"you look at what's not being prescribed"},{"startTime":2047.02,"endTime":2048.28,"body":"or what's not being picked up."},{"startTime":2048.28,"endTime":2051.28,"body":"So for example, for us there's"},{"startTime":2048.28,"endTime":2051.28,"body":"hypertension case finding"},{"startTime":2051.28,"endTime":2054.01,"body":"and a lot of that kind of"},{"startTime":2051.28,"endTime":2054.01,"body":"work, you can't do on your own."},{"startTime":2054.01,"endTime":2056.08,"body":"So you've got the public"},{"startTime":2054.01,"endTime":2056.08,"body":"health consultants,"},{"startTime":2056.08,"endTime":2058.6,"body":"the experts, you know,"},{"startTime":2056.08,"endTime":2058.6,"body":"you've got data analysts,"},{"startTime":2058.6,"endTime":2060.28,"body":"you've got all that in integral"},{"startTime":2060.28,"endTime":2061.93,"body":"telling you where the issues are,"},{"startTime":2061.93,"endTime":2063.58,"body":"but then you are also going"},{"startTime":2061.93,"endTime":2063.58,"body":"to need private providers,"},{"startTime":2063.58,"endTime":2065.98,"body":"third party providers, PCNs, place,"},{"startTime":2065.98,"endTime":2068.53,"body":"practices to work together,"},{"startTime":2065.98,"endTime":2068.53,"body":"the voluntary sector,"},{"startTime":2068.53,"endTime":2070.72,"body":"local authorities to help"},{"startTime":2068.53,"endTime":2070.72,"body":"you to identify those"},{"startTime":2070.72,"endTime":2072.07,"body":"and treat those patients."},{"startTime":2072.07,"endTime":2075.97,"body":"So there is something about,"},{"startTime":2072.07,"endTime":2075.97,"body":"yes, prescribing is important,"},{"startTime":2075.97,"endTime":2077.68,"body":"but, and there is a, you know,"},{"startTime":2077.68,"endTime":2079.63,"body":"always people talk about de-prescribing,"},{"startTime":2079.63,"endTime":2081.7,"body":"but there's lots of areas"},{"startTime":2079.63,"endTime":2081.7,"body":"as Neil's alluded to"},{"startTime":2081.7,"endTime":2083.83,"body":"that actually we need to upskill"},{"startTime":2083.83,"endTime":2087.1,"body":"to be more around secondary"},{"startTime":2083.83,"endTime":2087.1,"body":"prevention as well"},{"startTime":2087.1,"endTime":2088.93,"body":"and also initial diagnosis."},{"startTime":2088.93,"endTime":2090.25,"body":"So wasting a lot more of that work"},{"startTime":2090.25,"endTime":2091.42,"body":"coming through as well now."},{"startTime":2091.42,"endTime":2093.22,"body":"- Yeah, and that's a"},{"startTime":2091.42,"endTime":2093.22,"body":"really important thing"},{"startTime":2093.22,"endTime":2097.21,"body":"because that's an open market really"},{"startTime":2097.21,"endTime":2100.03,"body":"in sort of third parties being involved"},{"startTime":2100.03,"endTime":2103.21,"body":"in providing for detection services"},{"startTime":2103.21,"endTime":2105.85,"body":"or looking at providing focused"},{"startTime":2105.85,"endTime":2108.55,"body":"long-term condition management."},{"startTime":2108.55,"endTime":2111.79,"body":"There's a whole lot of"},{"startTime":2108.55,"endTime":2111.79,"body":"non-pharmaceuticals,"},{"startTime":2111.79,"endTime":2113.995,"body":"but they're actually a service"},{"startTime":2113.995,"endTime":2114.987,"body":"that teams would be able to provide."},{"startTime":2114.987,"endTime":2117.43,"body":"It's a business opportunity, isn't it?"},{"startTime":2117.43,"endTime":2119.02,"body":"- Yeah, and not only that."},{"startTime":2119.02,"endTime":2121.06,"body":"If you think about that on a wider scale,"},{"startTime":2121.06,"endTime":2123.94,"body":"a lot of that kind of case"},{"startTime":2121.06,"endTime":2123.94,"body":"finding stuff, et cetera,"},{"startTime":2123.94,"endTime":2125.92,"body":"might be coming through"},{"startTime":2123.94,"endTime":2125.92,"body":"pharmacies, for example,"},{"startTime":2125.92,"endTime":2127.84,"body":"where they're helping"},{"startTime":2125.92,"endTime":2127.84,"body":"to find those patients."},{"startTime":2127.84,"endTime":2129.36,"body":"Well, well how could they do it?"},{"startTime":2129.36,"endTime":2131.83,"body":"Or 'cause they've also"},{"startTime":2129.36,"endTime":2131.83,"body":"got issues with resources,"},{"startTime":2131.83,"endTime":2133.36,"body":"how could they use different technology?"},{"startTime":2133.36,"endTime":2135.16,"body":"What could that look like?"},{"startTime":2135.16,"endTime":2136.21,"body":"So some of this work,"},{"startTime":2136.21,"endTime":2138.43,"body":"I mean a lot of this work"},{"startTime":2136.21,"endTime":2138.43,"body":"is actually quite exciting,"},{"startTime":2138.43,"endTime":2141.13,"body":"because it's about health"},{"startTime":2138.43,"endTime":2141.13,"body":"innovation, it's about, you know,"},{"startTime":2141.13,"endTime":2142.96,"body":"using different things, different models."},{"startTime":2142.96,"endTime":2146.02,"body":"It's about trying and"},{"startTime":2142.96,"endTime":2146.02,"body":"testing and not being afraid"},{"startTime":2146.02,"endTime":2147.757,"body":"of trying something and then not working."},{"startTime":2147.757,"endTime":2149.65,"body":"But as long as you learn"},{"startTime":2147.757,"endTime":2149.65,"body":"something from that"},{"startTime":2149.65,"endTime":2151.72,"body":"and you share that across the system,"},{"startTime":2151.72,"endTime":2154.24,"body":"and you do start getting some wonderful"},{"startTime":2154.24,"endTime":2156.085,"body":"pockets of experience of how that works."},{"startTime":2156.085,"endTime":2157.278,"body":"I'm very good to that"},{"startTime":2157.278,"endTime":2159.069,"body":"being adaptive."},{"startTime":2157.278,"endTime":2159.069,"body":"- Now that's something."},{"startTime":2159.069,"endTime":2160.45,"body":"I'm sorry."},{"startTime":2160.45,"endTime":2161.53,"body":"You hit the nail on the head there,"},{"startTime":2161.53,"endTime":2164.29,"body":"trying and accepting failing,"},{"startTime":2164.29,"endTime":2166.96,"body":"because that's something"},{"startTime":2164.29,"endTime":2166.96,"body":"that in clinical world,"},{"startTime":2166.96,"endTime":2170.86,"body":"that's a big no, isn't it,"},{"startTime":2166.96,"endTime":2170.86,"body":"trying and accepting failing?"},{"startTime":2170.86,"endTime":2174.34,"body":"So it's a whole mind shift"},{"startTime":2170.86,"endTime":2174.34,"body":"to entrepreneurialism"},{"startTime":2174.34,"endTime":2177.16,"body":"and actually looking at opportunities."},{"startTime":2177.16,"endTime":2179.53,"body":"And making a change if it doesn't work,"},{"startTime":2179.53,"endTime":2181.75,"body":"you know, switch to a"},{"startTime":2179.53,"endTime":2181.75,"body":"different opportunity."},{"startTime":2181.75,"endTime":2185.17,"body":"But there are a lot of"},{"startTime":2181.75,"endTime":2185.17,"body":"opportunities in that market."},{"startTime":2185.17,"endTime":2189.25,"body":"- Yeah, there's lots of"},{"startTime":2185.17,"endTime":2189.25,"body":"areas of work that suffer."},{"startTime":2189.25,"endTime":2192.64,"body":"Just mentioned that aren't overtly badged"},{"startTime":2192.64,"endTime":2195.28,"body":"as medicine strategically"},{"startTime":2192.64,"endTime":2195.28,"body":"or in documents you read,"},{"startTime":2195.28,"endTime":2197.17,"body":"but actually are quite, you know,"},{"startTime":2197.17,"endTime":2199.9,"body":"the medication interventions"},{"startTime":2197.17,"endTime":2199.9,"body":"are quite critical"},{"startTime":2199.9,"endTime":2201.61,"body":"in the preventative agenda, Karen,"},{"startTime":2201.61,"endTime":2203.471,"body":"that you've absolutely"},{"startTime":2201.61,"endTime":2203.471,"body":"mentioned across the board"},{"startTime":2203.471,"endTime":2206.44,"body":"that has to be highly, highly targeted."},{"startTime":2206.44,"endTime":2209.59,"body":"A real focus on detection, a"},{"startTime":2206.44,"endTime":2209.59,"body":"real focus on some of the data"},{"startTime":2209.59,"endTime":2212.34,"body":"and intelligence infrastructure"},{"startTime":2209.59,"endTime":2212.34,"body":"that goes around there."},{"startTime":2213.73,"endTime":2218.5,"body":"But they are often"},{"startTime":2213.73,"endTime":2218.5,"body":"medication based solutions,"},{"startTime":2218.5,"endTime":2220.48,"body":"and in fact I think"},{"startTime":2218.5,"endTime":2220.48,"body":"that's the health service"},{"startTime":2220.48,"endTime":2222.43,"body":"I think has got to really target its role"},{"startTime":2222.43,"endTime":2224.77,"body":"much more specifically"},{"startTime":2222.43,"endTime":2224.77,"body":"on some of those things."},{"startTime":2224.77,"endTime":2229.66,"body":"So I think my personal view is"},{"startTime":2224.77,"endTime":2229.66,"body":"that we are a bit too woolly"},{"startTime":2231.373,"endTime":2233.68,"body":"in terms of that we want to do prevention"},{"startTime":2233.68,"endTime":2235.81,"body":"or address health inequality."},{"startTime":2235.81,"endTime":2237.883,"body":"And when you look at health inequality,"},{"startTime":2240.271,"endTime":2242.59,"body":"so I'm sitting in Ashford hospital,"},{"startTime":2242.59,"endTime":2243.88,"body":"which is under Heathrow Airport."},{"startTime":2243.88,"endTime":2247.78,"body":"And if I drive 20 minutes that"},{"startTime":2243.88,"endTime":2247.78,"body":"way, by the time I got there,"},{"startTime":2247.78,"endTime":2249.88,"body":"the life expectancy would've gone up"},{"startTime":2249.88,"endTime":2251.47,"body":"for every one and a half minutes,"},{"startTime":2251.47,"endTime":2252.76,"body":"I've been in the car by a year."},{"startTime":2252.76,"endTime":2255.1,"body":"The people live that far down the road"},{"startTime":2255.1,"endTime":2259.093,"body":"live 14 years longer than"},{"startTime":2255.1,"endTime":2259.093,"body":"the people in this community."},{"startTime":2261.94,"endTime":2264.47,"body":"I could throw the entire health spend"},{"startTime":2265.63,"endTime":2268.57,"body":"at that problem in this area"},{"startTime":2265.63,"endTime":2268.57,"body":"and I wouldn't make a dent in it"},{"startTime":2268.57,"endTime":2272.2,"body":"because the driver of that"},{"startTime":2268.57,"endTime":2272.2,"body":"is the economic prosperity"},{"startTime":2272.2,"endTime":2274.45,"body":"of the area around Heathrow Airport"},{"startTime":2274.45,"endTime":2279.403,"body":"compared to a leafy"},{"startTime":2274.45,"endTime":2279.403,"body":"affluent town down the road."},{"startTime":2280.66,"endTime":2282.37,"body":"So if we we're talking"},{"startTime":2282.37,"endTime":2283.78,"body":"about intervening health inequalities,"},{"startTime":2283.78,"endTime":2285.19,"body":"we have to be really specific"},{"startTime":2285.19,"endTime":2288.97,"body":"in terms of the samples of the"},{"startTime":2285.19,"endTime":2288.97,"body":"communities want to influence"},{"startTime":2288.97,"endTime":2291.82,"body":"and what are the factors"},{"startTime":2288.97,"endTime":2291.82,"body":"we're trying to move,"},{"startTime":2291.82,"endTime":2295.24,"body":"because at the end of the day,"},{"startTime":2291.82,"endTime":2295.24,"body":"most of your health outcome"},{"startTime":2295.24,"endTime":2297.31,"body":"is not determined by your healthcare."},{"startTime":2297.31,"endTime":2299.05,"body":"It's determined by your standard of living"},{"startTime":2299.05,"endTime":2300.22,"body":"and equality of your housing"},{"startTime":2300.22,"endTime":2301.45,"body":"and the quality of your education"},{"startTime":2301.45,"endTime":2302.98,"body":"and the amount you take home every month"},{"startTime":2302.98,"endTime":2304.42,"body":"and all the rest of it."},{"startTime":2304.42,"endTime":2306.97,"body":"So we have to be really quite"},{"startTime":2304.42,"endTime":2306.97,"body":"specific and quite targeted"},{"startTime":2306.97,"endTime":2309.16,"body":"in how we build those interventions"},{"startTime":2309.16,"endTime":2311.11,"body":"from a health inequality point of view."},{"startTime":2312.294,"endTime":2313.66,"body":"- Absolutely. Okay."},{"startTime":2312.294,"endTime":2313.66,"body":"- And I'll say-"},{"startTime":2313.66,"endTime":2314.493,"body":"Sorry."},{"startTime":2313.66,"endTime":2314.493,"body":"- Yeah."},{"startTime":2314.493,"endTime":2316.46,"body":"So, Zafran, again."},{"startTime":2314.493,"endTime":2316.46,"body":"- Sorry. Thanks Karen."},{"startTime":2316.46,"endTime":2318.52,"body":"And I would say that's where"},{"startTime":2316.46,"endTime":2318.52,"body":"population health management"},{"startTime":2318.52,"endTime":2319.913,"body":"really helps you do that,"},{"startTime":2319.913,"endTime":2321.37,"body":"'cause you've got data set upon data set"},{"startTime":2321.37,"endTime":2322.6,"body":"that allows you to look at it."},{"startTime":2322.6,"endTime":2324.43,"body":"So for example, one"},{"startTime":2322.6,"endTime":2324.43,"body":"area of learning for us"},{"startTime":2324.43,"endTime":2326.11,"body":"has been that there's an assumption"},{"startTime":2326.11,"endTime":2327.91,"body":"that because you're in"},{"startTime":2326.11,"endTime":2327.91,"body":"very deprived areas,"},{"startTime":2327.91,"endTime":2329.92,"body":"you don't have high opioid"},{"startTime":2327.91,"endTime":2329.92,"body":"prescribing, you know,"},{"startTime":2329.92,"endTime":2332.71,"body":"deprivation, lack of"},{"startTime":2329.92,"endTime":2332.71,"body":"opportunity, et cetera,"},{"startTime":2332.71,"endTime":2335.11,"body":"but then you get pockets"},{"startTime":2332.71,"endTime":2335.11,"body":"of high opioid use"},{"startTime":2335.11,"endTime":2336.43,"body":"in very affluent areas as well."},{"startTime":2336.43,"endTime":2337.68,"body":"So what's going on there?"},{"startTime":2339.737,"endTime":2342.25,"body":"So the data allows you"},{"startTime":2339.737,"endTime":2342.25,"body":"to map out the areas"},{"startTime":2342.25,"endTime":2344.98,"body":"that you need to work in"},{"startTime":2342.25,"endTime":2344.98,"body":"and sometimes the areas"},{"startTime":2344.98,"endTime":2347.08,"body":"that you think there's"},{"startTime":2344.98,"endTime":2347.08,"body":"an assumption generally"},{"startTime":2347.08,"endTime":2349.96,"body":"that would be aren't the only areas."},{"startTime":2349.96,"endTime":2353.05,"body":"So data's really important"},{"startTime":2349.96,"endTime":2353.05,"body":"and really powerful."},{"startTime":2353.05,"endTime":2354.58,"body":"And the reason why I've"},{"startTime":2353.05,"endTime":2354.58,"body":"interjected with Jack,"},{"startTime":2354.58,"endTime":2358.39,"body":"so my apologies, is not"},{"startTime":2354.58,"endTime":2358.39,"body":"everyone's got a handle on data."},{"startTime":2358.39,"endTime":2360.64,"body":"We haven't all got a handle on data."},{"startTime":2360.64,"endTime":2363.07,"body":"So the reality of it is there's"},{"startTime":2360.64,"endTime":2363.07,"body":"some real opportunity there"},{"startTime":2363.07,"endTime":2366.16,"body":"around how data is"},{"startTime":2363.07,"endTime":2366.16,"body":"really captured, managed,"},{"startTime":2366.16,"endTime":2368.83,"body":"and what that may look"},{"startTime":2366.16,"endTime":2368.83,"body":"like across a landscape"},{"startTime":2368.83,"endTime":2370.36,"body":"because that's really powerful."},{"startTime":2370.36,"endTime":2371.193,"body":"- Completely agree with that."},{"startTime":2371.193,"endTime":2373.67,"body":"The variability in the"},{"startTime":2371.193,"endTime":2373.67,"body":"intelligence landscape"},{"startTime":2374.81,"endTime":2377.113,"body":"is, you know, is massive, massive really."},{"startTime":2377.98,"endTime":2379.27,"body":"And, again, that's an area I think"},{"startTime":2379.27,"endTime":2382.33,"body":"where in terms of working with industry"},{"startTime":2382.33,"endTime":2384.07,"body":"and areas of mutual benefit"},{"startTime":2384.07,"endTime":2386.8,"body":"where actually you can"},{"startTime":2384.07,"endTime":2386.8,"body":"sometimes access expertise"},{"startTime":2386.8,"endTime":2389.26,"body":"and infrastructure that is a lot better"},{"startTime":2389.26,"endTime":2392.01,"body":"than the public sector can access"},{"startTime":2392.01,"endTime":2394.569,"body":"and there's just an opportunity there."},{"startTime":2394.569,"endTime":2395.41,"body":"Go ahead."},{"startTime":2395.41,"endTime":2396.25,"body":"- Just getting a bit excited."},{"startTime":2396.25,"endTime":2400.72,"body":"And above my station there,"},{"startTime":2396.25,"endTime":2400.72,"body":"I was just going to say,"},{"startTime":2400.72,"endTime":2402.43,"body":"you all heard of the ARSS funding."},{"startTime":2402.43,"endTime":2403.69,"body":"Well, as part of the ARSS funding,"},{"startTime":2403.69,"endTime":2406.81,"body":"now you can actually"},{"startTime":2403.69,"endTime":2406.81,"body":"fund for data analysts."},{"startTime":2406.81,"endTime":2409.15,"body":"So again, where would they come from?"},{"startTime":2409.15,"endTime":2410.89,"body":"Where would they have the expertise from?"},{"startTime":2410.89,"endTime":2411.73,"body":"Who could bring them in?"},{"startTime":2411.73,"endTime":2414.67,"body":"How could they co-create,"},{"startTime":2411.73,"endTime":2414.67,"body":"co-locate, co-production?"},{"startTime":2414.67,"endTime":2416.77,"body":"What could that look like?"},{"startTime":2416.77,"endTime":2419.08,"body":"So there's a real kind of opportunity"},{"startTime":2419.08,"endTime":2422.23,"body":"as PCNs really develop"},{"startTime":2419.08,"endTime":2422.23,"body":"around their resourcing"},{"startTime":2422.23,"endTime":2423.34,"body":"and what they've got."},{"startTime":2423.34,"endTime":2424.36,"body":"There's also opportunity for them"},{"startTime":2424.36,"endTime":2426.13,"body":"to actually then take and shape"},{"startTime":2426.13,"endTime":2427.63,"body":"that kind of working as well."},{"startTime":2427.63,"endTime":2428.95,"body":"So there's lots of opportunities out there"},{"startTime":2428.95,"endTime":2430.51,"body":"that people probably don't think about"},{"startTime":2430.51,"endTime":2431.59,"body":"when they think about journeying"},{"startTime":2431.59,"endTime":2433.87,"body":"data, population health management,"},{"startTime":2433.87,"endTime":2436.69,"body":"the public health policy, you"},{"startTime":2433.87,"endTime":2436.69,"body":"know, et cetera, et cetera."},{"startTime":2436.69,"endTime":2437.523,"body":"It's huge."},{"startTime":2440.62,"endTime":2441.88,"body":"- That is really interesting, Jack,"},{"startTime":2441.88,"endTime":2443.65,"body":"when you're talking"},{"startTime":2441.88,"endTime":2443.65,"body":"about health inequalities"},{"startTime":2443.65,"endTime":2445.93,"body":"and it's conversations we have quite a lot"},{"startTime":2445.93,"endTime":2447.19,"body":"and it's quite interesting"},{"startTime":2447.19,"endTime":2450.76,"body":"'cause when objectives are"},{"startTime":2447.19,"endTime":2450.76,"body":"set around certain areas,"},{"startTime":2450.76,"endTime":2452.44,"body":"they're really specific,"},{"startTime":2452.44,"endTime":2454.81,"body":"and then in others it says things"},{"startTime":2454.81,"endTime":2456.55,"body":"like address health inequalities"},{"startTime":2456.55,"endTime":2459.55,"body":"and deliver the Core20PLUS5 approach."},{"startTime":2459.55,"endTime":2461.854,"body":"So I'd be really interested."},{"startTime":2461.854,"endTime":2463.78,"body":"Have any of you got any examples"},{"startTime":2463.78,"endTime":2467.44,"body":"of initiatives within your"},{"startTime":2463.78,"endTime":2467.44,"body":"area where you are delivering,"},{"startTime":2467.44,"endTime":2472.44,"body":"you know, \"delivering the"},{"startTime":2467.44,"endTime":2472.44,"body":"Core20PLUS5 approach\"?"},{"startTime":2473.08,"endTime":2474.73,"body":"- Yeah, Karen, we've got an example"},{"startTime":2474.73,"endTime":2477.603,"body":"from our PCN well up north."},{"startTime":2479.099,"endTime":2481.66,"body":"Obviously Northumberland's"},{"startTime":2479.099,"endTime":2481.66,"body":"a very rural sort of area,"},{"startTime":2481.66,"endTime":2484.066,"body":"a lot of farmers and we"},{"startTime":2481.66,"endTime":2484.066,"body":"know that they're ones"},{"startTime":2484.066,"endTime":2487.66,"body":"that don't access services very often."},{"startTime":2487.66,"endTime":2489.34,"body":"And so we've got a local initiative"},{"startTime":2489.34,"endTime":2491.62,"body":"run through our staff funding"},{"startTime":2491.62,"endTime":2494.735,"body":"that is based in the livestock markets"},{"startTime":2494.735,"endTime":2497.068,"body":"and does outreach work there"},{"startTime":2498.638,"endTime":2500.183,"body":"and does CBD assessments like"},{"startTime":2498.638,"endTime":2500.183,"body":"an NHS health tech type offer."},{"startTime":2504.142,"endTime":2505.6,"body":"And that's had a great uptake"},{"startTime":2505.6,"endTime":2508.243,"body":"and been really welcome by the community."},{"startTime":2509.38,"endTime":2510.7,"body":"- Brilliant."},{"startTime":2510.7,"endTime":2511.75,"body":"Anybody else got any?"},{"startTime":2512.759,"endTime":2515.11,"body":"- Yeah, essentially I think"},{"startTime":2512.759,"endTime":2515.11,"body":"this is one of the areas"},{"startTime":2515.11,"endTime":2517.27,"body":"where we really leverage our partnerships"},{"startTime":2517.27,"endTime":2519.703,"body":"across the different organisations."},{"startTime":2521.83,"endTime":2524.62,"body":"There's two sorts of types"},{"startTime":2521.83,"endTime":2524.62,"body":"of project we would have,"},{"startTime":2524.62,"endTime":2527.71,"body":"We would have, well ones that"},{"startTime":2524.62,"endTime":2527.71,"body":"are highly medical in nature."},{"startTime":2527.71,"endTime":2531.13,"body":"So we have ones that"},{"startTime":2527.71,"endTime":2531.13,"body":"are quite zoomed in on."},{"startTime":2531.13,"endTime":2533.65,"body":"Actually, we know there's"},{"startTime":2531.13,"endTime":2533.65,"body":"a real higher prevalence"},{"startTime":2533.65,"endTime":2536.86,"body":"of CBD or AF or hypertension in that area."},{"startTime":2536.86,"endTime":2538.61,"body":"And we need to really focus in"},{"startTime":2539.56,"endTime":2542.2,"body":"on equalising that"},{"startTime":2539.56,"endTime":2542.2,"body":"particular health outcome"},{"startTime":2542.2,"endTime":2544.66,"body":"and getting people detected"},{"startTime":2542.2,"endTime":2544.66,"body":"onto the right treatment,"},{"startTime":2544.66,"endTime":2547.52,"body":"'cause we know that'll"},{"startTime":2544.66,"endTime":2547.52,"body":"save x number of lives"},{"startTime":2548.47,"endTime":2549.64,"body":"over the next five years."},{"startTime":2549.64,"endTime":2551.65,"body":"And so there's areas of communities"},{"startTime":2551.65,"endTime":2554.35,"body":"that we've been able to"},{"startTime":2551.65,"endTime":2554.35,"body":"use data intelligence"},{"startTime":2554.35,"endTime":2555.85,"body":"to target very much like that."},{"startTime":2557.02,"endTime":2557.853,"body":"The ones that I think of"},{"startTime":2557.853,"endTime":2560.89,"body":"were almost a little more"},{"startTime":2557.853,"endTime":2560.89,"body":"interested in some ways"},{"startTime":2560.89,"endTime":2564.79,"body":"are where we've tried to"},{"startTime":2560.89,"endTime":2564.79,"body":"use NHS capital development"},{"startTime":2564.79,"endTime":2565.78,"body":"quite differently."},{"startTime":2565.78,"endTime":2569.39,"body":"So one of our areas, we"},{"startTime":2565.78,"endTime":2569.39,"body":"are looking at building"},{"startTime":2570.758,"endTime":2573.04,"body":"a new health centre and, you know,"},{"startTime":2573.04,"endTime":2577.555,"body":"getting rid of some of our"},{"startTime":2573.04,"endTime":2577.555,"body":"old falling down GP practices"},{"startTime":2577.555,"endTime":2581.08,"body":"and using that to build a new facility,"},{"startTime":2581.08,"endTime":2585.26,"body":"but in a place that then has a"},{"startTime":2581.08,"endTime":2585.26,"body":"leisure centre attached to it"},{"startTime":2586.236,"endTime":2588.02,"body":"and creates footfall for business"},{"startTime":2589.108,"endTime":2592.72,"body":"and regenerates a high street"},{"startTime":2589.108,"endTime":2592.72,"body":"that then regenerates an area"},{"startTime":2592.72,"endTime":2595.69,"body":"and creates more wealth in"},{"startTime":2592.72,"endTime":2595.69,"body":"that area that over time"},{"startTime":2595.69,"endTime":2598.84,"body":"will equalise outcomes for a community."},{"startTime":2598.84,"endTime":2601.66,"body":"And we have quite close partnerships"},{"startTime":2601.66,"endTime":2603.763,"body":"with our boroughs or council authorities"},{"startTime":2603.763,"endTime":2605.35,"body":"that are part of our alliance"},{"startTime":2605.35,"endTime":2606.76,"body":"that now enables us to do that."},{"startTime":2606.76,"endTime":2609.88,"body":"So, and I almost think that's probably"},{"startTime":2609.88,"endTime":2611.93,"body":"where the gain is on health inequalities."},{"startTime":2612.88,"endTime":2615.2,"body":"That's about regenerating towns really"},{"startTime":2616.242,"endTime":2618.58,"body":"is where the gain is in that, I think."},{"startTime":2618.58,"endTime":2620.32,"body":"As I say, the health sector's role"},{"startTime":2620.32,"endTime":2622.6,"body":"is probably really a lot smaller"},{"startTime":2622.6,"endTime":2625.03,"body":"and in focusing on those areas"},{"startTime":2625.03,"endTime":2628.27,"body":"where you've got health access inequality"},{"startTime":2628.27,"endTime":2632.05,"body":"more than a health outcome"},{"startTime":2628.27,"endTime":2632.05,"body":"inequality if you like."},{"startTime":2632.05,"endTime":2634.99,"body":"So yeah, we have two"},{"startTime":2632.05,"endTime":2634.99,"body":"strands of projects on that"},{"startTime":2634.99,"endTime":2637.84,"body":"and they both quite measurable"},{"startTime":2634.99,"endTime":2637.84,"body":"in their results really."},{"startTime":2637.84,"endTime":2638.74,"body":"- Yeah. Brilliant."},{"startTime":2640.03,"endTime":2641.47,"body":"Okay."},{"startTime":2640.03,"endTime":2641.47,"body":"- Sorry."},{"startTime":2641.47,"endTime":2642.73,"body":"So I was going to say, so we had one"},{"startTime":2642.73,"endTime":2646.33,"body":"with the hypertension case"},{"startTime":2642.73,"endTime":2646.33,"body":"finding where we wanted to work"},{"startTime":2646.33,"endTime":2648.94,"body":"within a quite a deprived inner city area"},{"startTime":2648.94,"endTime":2651.34,"body":"and it was working with"},{"startTime":2648.94,"endTime":2651.34,"body":"the GPs and pharmacies"},{"startTime":2651.34,"endTime":2654.52,"body":"and we realised that they"},{"startTime":2651.34,"endTime":2654.52,"body":"were as most of primary carers"},{"startTime":2654.52,"endTime":2657.82,"body":"really up to the hill"},{"startTime":2654.52,"endTime":2657.82,"body":"in terms of resourcing."},{"startTime":2657.82,"endTime":2660.22,"body":"So they came across"},{"startTime":2657.82,"endTime":2660.22,"body":"with a really great idea"},{"startTime":2660.22,"endTime":2662.92,"body":"of using the voluntary"},{"startTime":2660.22,"endTime":2662.92,"body":"sector by training them up"},{"startTime":2662.92,"endTime":2665.71,"body":"and mobilising them to"},{"startTime":2662.92,"endTime":2665.71,"body":"go out to communities"},{"startTime":2665.71,"endTime":2668.62,"body":"and to actually help find"},{"startTime":2665.71,"endTime":2668.62,"body":"those hypertension cases,"},{"startTime":2668.62,"endTime":2669.76,"body":"those patients."},{"startTime":2669.76,"endTime":2672.79,"body":"And so that was a very part"},{"startTime":2669.76,"endTime":2672.79,"body":"but exceptionally successful"},{"startTime":2672.79,"endTime":2674.08,"body":"and that's now been rolled out."},{"startTime":2674.08,"endTime":2677.26,"body":"So there is, you know, when"},{"startTime":2674.08,"endTime":2677.26,"body":"you turn things on its head"},{"startTime":2677.26,"endTime":2679.06,"body":"and you get partnerships involved"},{"startTime":2679.06,"endTime":2681.07,"body":"and you get different"},{"startTime":2679.06,"endTime":2681.07,"body":"ideas and creativity,"},{"startTime":2681.07,"endTime":2683.11,"body":"it's amazing what you"},{"startTime":2681.07,"endTime":2683.11,"body":"can actually achieve."},{"startTime":2683.11,"endTime":2685.9,"body":"And so then we've actually"},{"startTime":2683.11,"endTime":2685.9,"body":"trained an army of people"},{"startTime":2685.9,"endTime":2687.487,"body":"to become, you know, volunteers to go out"},{"startTime":2687.487,"endTime":2690.13,"body":"and to scope and to find those patients."},{"startTime":2690.13,"endTime":2692.59,"body":"So then the community"},{"startTime":2690.13,"endTime":2692.59,"body":"almost takes ownership"},{"startTime":2692.59,"endTime":2695.08,"body":"for those health inequalities"},{"startTime":2692.59,"endTime":2695.08,"body":"and then tries to move forward"},{"startTime":2695.08,"endTime":2696.49,"body":"as to how they can do that better."},{"startTime":2696.49,"endTime":2699.49,"body":"And that's then has a"},{"startTime":2696.49,"endTime":2699.49,"body":"spinoff of walking groups,"},{"startTime":2699.49,"endTime":2702.19,"body":"people going for, you know,"},{"startTime":2699.49,"endTime":2702.19,"body":"cups of teas, you know,"},{"startTime":2702.19,"endTime":2706.09,"body":"there's people now looking"},{"startTime":2702.19,"endTime":2706.09,"body":"to how they can lose weight."},{"startTime":2706.09,"endTime":2709.03,"body":"There's a whole campaign around,"},{"startTime":2706.09,"endTime":2709.03,"body":"you know, staying healthy"},{"startTime":2709.03,"endTime":2710.98,"body":"and that's been taken over"},{"startTime":2709.03,"endTime":2710.98,"body":"by the voluntary sector."},{"startTime":2710.98,"endTime":2712.99,"body":"We said it has an impacted"},{"startTime":2710.98,"endTime":2712.99,"body":"local communities."},{"startTime":2712.99,"endTime":2714.91,"body":"So I think yeah, there's"},{"startTime":2712.99,"endTime":2714.91,"body":"different ways of working,"},{"startTime":2714.91,"endTime":2716.995,"body":"but it could definitely have an impact."},{"startTime":2716.995,"endTime":2719.68,"body":"- I think we're pursuing a lot"},{"startTime":2716.995,"endTime":2719.68,"body":"more devolution as well now."},{"startTime":2719.68,"endTime":2722.35,"body":"Now, Karen, I think that's so increasingly"},{"startTime":2722.35,"endTime":2725.26,"body":"we're looking at an area"},{"startTime":2722.35,"endTime":2725.26,"body":"and thinking actually,"},{"startTime":2725.26,"endTime":2727.033,"body":"or what do we do in that town?"},{"startTime":2727.869,"endTime":2730.33,"body":"What what's the population"},{"startTime":2727.869,"endTime":2730.33,"body":"profile of that town?"},{"startTime":2730.33,"endTime":2733.18,"body":"What's the need in a given area?"},{"startTime":2733.18,"endTime":2735.223,"body":"And then we're devolving, you know,"},{"startTime":2735.223,"endTime":2737.74,"body":"with the budgetary"},{"startTime":2735.223,"endTime":2737.74,"body":"aspects, team composition,"},{"startTime":2737.74,"endTime":2742.06,"body":"what whatever it is and lead"},{"startTime":2737.74,"endTime":2742.06,"body":"clinical leaders in that town"},{"startTime":2742.06,"endTime":2744.4,"body":"then shape the team"},{"startTime":2742.06,"endTime":2744.4,"body":"for that neighbourhood."},{"startTime":2744.4,"endTime":2746.83,"body":"And it allows you to"},{"startTime":2744.4,"endTime":2746.83,"body":"be much more targeted."},{"startTime":2746.83,"endTime":2748.12,"body":"So if you've got a higher"},{"startTime":2746.83,"endTime":2748.12,"body":"prevalence of mental health,"},{"startTime":2748.12,"endTime":2750.61,"body":"then you need mental health practitioners"},{"startTime":2750.61,"endTime":2753.673,"body":"rather than heart failure"},{"startTime":2750.61,"endTime":2753.673,"body":"specialist, nurses."},{"startTime":2754.776,"endTime":2757.09,"body":"You're able to to modify that team"},{"startTime":2757.09,"endTime":2759.64,"body":"and tailor a professional skill mix"},{"startTime":2759.64,"endTime":2762.547,"body":"that's a lot more specific to a community."},{"startTime":2762.547,"endTime":2763.81,"body":"And I think increasingly"},{"startTime":2763.81,"endTime":2765.88,"body":"those sort of neighbourhood footprints"},{"startTime":2765.88,"endTime":2767.62,"body":"are going to be the building block"},{"startTime":2767.62,"endTime":2771.73,"body":"that we do our first sort of"},{"startTime":2767.62,"endTime":2771.73,"body":"round of planning on really?"},{"startTime":2771.73,"endTime":2774.893,"body":"- Yeah, there's a large"},{"startTime":2771.73,"endTime":2774.893,"body":"drive to, oh yeah, sorry."},{"startTime":2774.893,"endTime":2778.753,"body":"- If I could just be"},{"startTime":2774.893,"endTime":2778.753,"body":"controversially commercial."},{"startTime":2779.92,"endTime":2782.62,"body":"There's a lot of opportunity"},{"startTime":2779.92,"endTime":2782.62,"body":"to help for inequalities"},{"startTime":2782.62,"endTime":2784.42,"body":"and in terms of marketing."},{"startTime":2784.42,"endTime":2789.42,"body":"Brand awareness, brands could"},{"startTime":2784.42,"endTime":2789.42,"body":"support these initiatives."},{"startTime":2790.57,"endTime":2793.33,"body":"There's potential for"},{"startTime":2790.57,"endTime":2793.33,"body":"health service awards."},{"startTime":2793.33,"endTime":2795.94,"body":"there's all sorts of things"},{"startTime":2793.33,"endTime":2795.94,"body":"that marketing opportunities"},{"startTime":2795.94,"endTime":2799.3,"body":"with health inequalities because"},{"startTime":2795.94,"endTime":2799.3,"body":"it's such a well loved area"},{"startTime":2799.3,"endTime":2801.4,"body":"and there's such a priority, you know,"},{"startTime":2801.4,"endTime":2804.217,"body":"and need to really think, well it's not,"},{"startTime":2804.217,"endTime":2805.69,"body":"not direct marketing, but there's a lot"},{"startTime":2805.69,"endTime":2809.173,"body":"of reputational gain from"},{"startTime":2805.69,"endTime":2809.173,"body":"helping these projects."},{"startTime":2810.25,"endTime":2812.62,"body":"That's just my little"},{"startTime":2810.25,"endTime":2812.62,"body":"commercial thing there."},{"startTime":2812.62,"endTime":2815.05,"body":"- I like that, Commercially controversial."},{"startTime":2815.05,"endTime":2815.883,"body":"Carry on."},{"startTime":2815.883,"endTime":2817.123,"body":"That's what we like to hear."},{"startTime":2818.26,"endTime":2819.4,"body":"Well, we'll stay with you Neil."},{"startTime":2819.4,"endTime":2820.78,"body":"Let's go onto the GP."},{"startTime":2820.78,"endTime":2823.09,"body":"We've got about 15 minutes left."},{"startTime":2823.09,"endTime":2827.05,"body":"Let's go onto the GP contract"},{"startTime":2823.09,"endTime":2827.05,"body":"and the network contract DES."},{"startTime":2827.05,"endTime":2832.05,"body":"So obviously we know, I mean,"},{"startTime":2827.05,"endTime":2832.05,"body":"BMA's publishing figures"},{"startTime":2832.3,"endTime":2837.22,"body":"around 2/3 of GP practices"},{"startTime":2832.3,"endTime":2837.22,"body":"are expressing concern"},{"startTime":2837.22,"endTime":2840.34,"body":"about financial stability and longevity."},{"startTime":2840.34,"endTime":2842.89,"body":"It'd be really interesting to hear"},{"startTime":2842.89,"endTime":2845.29,"body":"what it's like out there"},{"startTime":2842.89,"endTime":2845.29,"body":"in terms of, you know,"},{"startTime":2845.29,"endTime":2847.873,"body":"you've obviously had the 2% pay."},{"startTime":2850.15,"endTime":2850.983,"body":"- Yeah."},{"startTime":2854.959,"endTime":2857.11,"body":"- And there's different elements"},{"startTime":2857.11,"endTime":2858.79,"body":"that have come across in the PCN DES"},{"startTime":2858.79,"endTime":2862.51,"body":"in terms of some of the QOF indicators"},{"startTime":2862.51,"endTime":2865.99,"body":"being financially"},{"startTime":2862.51,"endTime":2865.99,"body":"protected and IIF reducing,"},{"startTime":2865.99,"endTime":2869.14,"body":"you know, what's that looking"},{"startTime":2865.99,"endTime":2869.14,"body":"like in general practice."},{"startTime":2869.14,"endTime":2871.06,"body":"- It's looking terrible"},{"startTime":2869.14,"endTime":2871.06,"body":"really, to be honest, Karen."},{"startTime":2871.06,"endTime":2873.73,"body":"I don't want to deal with doom and gloom"},{"startTime":2873.73,"endTime":2875.32,"body":"because this is opportunity."},{"startTime":2875.32,"endTime":2878.383,"body":"So yeah, there's blood on the"},{"startTime":2875.32,"endTime":2878.383,"body":"streets, it's an opportunity."},{"startTime":2880.741,"endTime":2885.13,"body":"And the, the actual funding has"},{"startTime":2880.741,"endTime":2885.13,"body":"gone from per capita patient"},{"startTime":2885.13,"endTime":2890.13,"body":"was what, 152 in 2016"},{"startTime":2885.13,"endTime":2890.13,"body":"pounds per year per patient"},{"startTime":2890.89,"endTime":2895.89,"body":"to 164 pounds per"},{"startTime":2890.89,"endTime":2895.89,"body":"patient per year in 2022."},{"startTime":2896.32,"endTime":2900.91,"body":"So there's not a lot of"},{"startTime":2896.32,"endTime":2900.91,"body":"increase for such a long time,"},{"startTime":2900.91,"endTime":2904.06,"body":"and we all know inflationary"},{"startTime":2900.91,"endTime":2904.06,"body":"costs, staff costs,"},{"startTime":2904.06,"endTime":2906.56,"body":"staff pressures are a real big concern"},{"startTime":2907.54,"endTime":2912.16,"body":"both in terms of the"},{"startTime":2907.54,"endTime":2912.16,"body":"unaffordability of pay increases,"},{"startTime":2912.16,"endTime":2914.51,"body":"you know, that aren't"},{"startTime":2912.16,"endTime":2914.51,"body":"reflected in the contract"},{"startTime":2916.3,"endTime":2919.13,"body":"and also the workload, I"},{"startTime":2916.3,"endTime":2919.13,"body":"supposed it's maxed out"},{"startTime":2919.99,"endTime":2921.82,"body":"the headlines are a lot"},{"startTime":2919.99,"endTime":2921.82,"body":"of funding is coming"},{"startTime":2921.82,"endTime":2923.83,"body":"to primary care, but it's maybe coming"},{"startTime":2923.83,"endTime":2925.693,"body":"to the PCN DES and the ARRS,"},{"startTime":2926.59,"endTime":2929.5,"body":"but nothing's come into"},{"startTime":2926.59,"endTime":2929.5,"body":"practices whatsoever."},{"startTime":2929.5,"endTime":2932.74,"body":"And even stuff that the digital,"},{"startTime":2929.5,"endTime":2932.74,"body":"the digital monies has gone"},{"startTime":2932.74,"endTime":2935.5,"body":"to commissioning support units"},{"startTime":2935.5,"endTime":2937.78,"body":"rather than coming into practices."},{"startTime":2937.78,"endTime":2939.97,"body":"So yeah, there's a lot of concern."},{"startTime":2939.97,"endTime":2944.97,"body":"I think something like"},{"startTime":2939.97,"endTime":2944.97,"body":"3,500 GPs left last year"},{"startTime":2945.52,"endTime":2949.66,"body":"and I think, what was it,"},{"startTime":2949.66,"endTime":2954.4,"body":"one in five practices"},{"startTime":2949.66,"endTime":2954.4,"body":"closed since 2013, sorry."},{"startTime":2954.4,"endTime":2956.5,"body":"And new GPs, they're leaving"},{"startTime":2956.5,"endTime":2960.22,"body":"and one in four is leaving at the moment."},{"startTime":2960.22,"endTime":2962.29,"body":"Younger GPs plan to leave."},{"startTime":2962.29,"endTime":2964.51,"body":"And a lot of the GPs, a lot of doctors"},{"startTime":2964.51,"endTime":2966.52,"body":"aren't planning to be"},{"startTime":2964.51,"endTime":2966.52,"body":"in clinical training,"},{"startTime":2966.52,"endTime":2969.61,"body":"clinical practise, they're"},{"startTime":2966.52,"endTime":2969.61,"body":"leading to other sectors."},{"startTime":2969.61,"endTime":2971.83,"body":"So I mean that's an"},{"startTime":2969.61,"endTime":2971.83,"body":"opportunity for other sectors"},{"startTime":2971.83,"endTime":2974.92,"body":"that they've got some healthcare workforce"},{"startTime":2974.92,"endTime":2978.07,"body":"for health tech companies,"},{"startTime":2974.92,"endTime":2978.07,"body":"pharmaceutical companies,"},{"startTime":2978.07,"endTime":2979.72,"body":"but it's a difficult"},{"startTime":2978.07,"endTime":2979.72,"body":"time, challenging time,"},{"startTime":2979.72,"endTime":2981.82,"body":"but that focuses people's investment."},{"startTime":2981.82,"endTime":2984.04,"body":"So, and looking for solutions."},{"startTime":2984.04,"endTime":2988.6,"body":"So I think primary care is"},{"startTime":2984.04,"endTime":2988.6,"body":"looking for more solutions"},{"startTime":2988.6,"endTime":2993.6,"body":"and willing to explore the"},{"startTime":2988.6,"endTime":2993.6,"body":"edges of reasonableness."},{"startTime":2993.61,"endTime":2997.81,"body":"So yeah, what I mean by that, the edges."},{"startTime":2997.81,"endTime":3001.05,"body":"So I think you have to explore"},{"startTime":2997.81,"endTime":3001.05,"body":"the edges of what you can do"},{"startTime":3001.05,"endTime":3003.27,"body":"because we've got a contract"},{"startTime":3003.27,"endTime":3005.58,"body":"and we can't over deliver"},{"startTime":3003.27,"endTime":3005.58,"body":"that contract anymore."},{"startTime":3005.58,"endTime":3008.19,"body":"We have to really stick"},{"startTime":3005.58,"endTime":3008.19,"body":"within our contract."},{"startTime":3008.19,"endTime":3011.64,"body":"We've seen workload coming"},{"startTime":3008.19,"endTime":3011.64,"body":"from secondary care,"},{"startTime":3011.64,"endTime":3014.31,"body":"which doesn't come with"},{"startTime":3011.64,"endTime":3014.31,"body":"any resource to deliver it."},{"startTime":3014.31,"endTime":3016.02,"body":"And so there's been a big appetite"},{"startTime":3016.02,"endTime":3018.183,"body":"to push back on that workload."},{"startTime":3019.89,"endTime":3023.94,"body":"But the opportunity there"},{"startTime":3019.89,"endTime":3023.94,"body":"in terms of new IT systems,"},{"startTime":3023.94,"endTime":3028.94,"body":"new solutions, I'm looking at"},{"startTime":3023.94,"endTime":3028.94,"body":"robotic processes quite often."},{"startTime":3029.04,"endTime":3033.09,"body":"I'm looking at AI triage type systems,"},{"startTime":3033.09,"endTime":3036.42,"body":"anything that will help"},{"startTime":3033.09,"endTime":3036.42,"body":"us be more productive,"},{"startTime":3036.42,"endTime":3041.42,"body":"more efficient and automate"},{"startTime":3036.42,"endTime":3041.42,"body":"some of these repetitive tasks"},{"startTime":3043.32,"endTime":3045.123,"body":"that don't need human intervention."},{"startTime":3046.44,"endTime":3047.573,"body":"So yeah, there's a lot of opportunities"},{"startTime":3047.573,"endTime":3050.94,"body":"and, it is a difficult time, and I think"},{"startTime":3050.94,"endTime":3052.855,"body":"there's kind of message-"},{"startTime":3050.94,"endTime":3052.855,"body":"- There is a lot of change isn't there?"},{"startTime":3052.855,"endTime":3056.055,"body":"There's a lot of change in"},{"startTime":3052.855,"endTime":3056.055,"body":"primary care in the way-"},{"startTime":3056.055,"endTime":3057.3,"body":"Change in terms of the staff."},{"startTime":3057.3,"endTime":3061.17,"body":"The staff mix is very different"},{"startTime":3057.3,"endTime":3061.17,"body":"than it was 10 years ago."},{"startTime":3061.17,"endTime":3064.41,"body":"And that's a benefit,"},{"startTime":3061.17,"endTime":3064.41,"body":"that's a real big benefit."},{"startTime":3064.41,"endTime":3065.61,"body":"We've got bigger teams now."},{"startTime":3065.61,"endTime":3067.47,"body":"I think that's really important."},{"startTime":3067.47,"endTime":3069.27,"body":"- Yeah, it's interesting."},{"startTime":3069.27,"endTime":3072.27,"body":"I know NHSE sent a letter"},{"startTime":3069.27,"endTime":3072.27,"body":"out to all practices"},{"startTime":3072.27,"endTime":3074.34,"body":"at the end of April talking about the fact"},{"startTime":3074.34,"endTime":3075.987,"body":"there's been an additional 57"},{"startTime":3075.987,"endTime":3079.23,"body":"and a half million appointments"},{"startTime":3075.987,"endTime":3079.23,"body":"since pre-pandemic,"},{"startTime":3079.23,"endTime":3081.45,"body":"which is huge."},{"startTime":3081.45,"endTime":3084.12,"body":"But obviously with 3,500 GPs leaving,"},{"startTime":3084.12,"endTime":3087.72,"body":"that's not GP appointments, is it?"},{"startTime":3087.72,"endTime":3089.37,"body":"It's patient facing appointments."},{"startTime":3091.29,"endTime":3093.6,"body":"- It's quite hard to,"},{"startTime":3091.29,"endTime":3093.6,"body":"unless you really dig."},{"startTime":3093.6,"endTime":3097.35,"body":"The data is captured through GPAD,"},{"startTime":3097.35,"endTime":3101.82,"body":"so it's GP activity data and that."},{"startTime":3101.82,"endTime":3104.22,"body":"Because a lot of work"},{"startTime":3101.82,"endTime":3104.22,"body":"was previously hidden,"},{"startTime":3104.22,"endTime":3106.538,"body":"it's hard to know what the increase is."},{"startTime":3106.538,"endTime":3107.371,"body":"- Okay."},{"startTime":3110.19,"endTime":3112.74,"body":"Oh, we've just lost you there, Neil."},{"startTime":3112.74,"endTime":3115.26,"body":"- Schedule activity, that was a contact,"},{"startTime":3115.26,"endTime":3117.51,"body":"but it wasn't a consultation."},{"startTime":3117.51,"endTime":3118.343,"body":"Yeah, sorry."},{"startTime":3120.66,"endTime":3123.48,"body":"Previously we didn't"},{"startTime":3120.66,"endTime":3123.48,"body":"schedule all activity,"},{"startTime":3123.48,"endTime":3125.07,"body":"but now all activity's on there,"},{"startTime":3125.07,"endTime":3128.55,"body":"so that some of it might be"},{"startTime":3125.07,"endTime":3128.55,"body":"that there's better recording"},{"startTime":3128.55,"endTime":3130.353,"body":"of the information."},{"startTime":3131.85,"endTime":3134.16,"body":"But yeah, like I say,"},{"startTime":3131.85,"endTime":3134.16,"body":"it's a massive increase."},{"startTime":3134.16,"endTime":3135.81,"body":"- Yeah."},{"startTime":3135.81,"endTime":3140.81,"body":"So from your perspective,"},{"startTime":3135.81,"endTime":3140.81,"body":"Jack, with the PCN DES,"},{"startTime":3140.94,"endTime":3142.47,"body":"what's happening in primary care,"},{"startTime":3142.47,"endTime":3146.4,"body":"the changing way that"},{"startTime":3142.47,"endTime":3146.4,"body":"primary care is now operating"},{"startTime":3146.4,"endTime":3149.76,"body":"and the pressures that they're under,"},{"startTime":3149.76,"endTime":3152.58,"body":"what sort of things are"},{"startTime":3149.76,"endTime":3152.58,"body":"happening in your area"},{"startTime":3152.58,"endTime":3156.18,"body":"or that you're aware of nationally"},{"startTime":3152.58,"endTime":3156.18,"body":"to support primary care?"},{"startTime":3156.18,"endTime":3157.013,"body":"- Yeah."},{"startTime":3158.94,"endTime":3160.71,"body":"It feels like a particularly"},{"startTime":3158.94,"endTime":3160.71,"body":"unique ground, this one,"},{"startTime":3160.71,"endTime":3165.71,"body":"'cause also I haven't been in"},{"startTime":3160.71,"endTime":3165.71,"body":"just as an absolute experience"},{"startTime":3166.02,"endTime":3167.823,"body":"of some of my colleagues."},{"startTime":3169.169,"endTime":3171.66,"body":"But every contracting round of it,"},{"startTime":3171.66,"endTime":3174.24,"body":"no one's ever happy with"},{"startTime":3171.66,"endTime":3174.24,"body":"the contracting round."},{"startTime":3174.24,"endTime":3175.53,"body":"I can't remember a time when anyone said,"},{"startTime":3175.53,"endTime":3176.73,"body":"oh yes, it's a great contract."},{"startTime":3176.73,"endTime":3177.563,"body":"I can't remember it."},{"startTime":3177.563,"endTime":3179.85,"body":"I can't wait for it to come down."},{"startTime":3179.85,"endTime":3182.25,"body":"But this one was quite unique"},{"startTime":3182.25,"endTime":3185.7,"body":"in that I had GP board"},{"startTime":3182.25,"endTime":3185.7,"body":"members bring me up to,"},{"startTime":3185.7,"endTime":3188.07,"body":"I want to bring something"},{"startTime":3185.7,"endTime":3188.07,"body":"to board this next month"},{"startTime":3188.07,"endTime":3190.59,"body":"about how bad the GP contract is"},{"startTime":3190.59,"endTime":3193.26,"body":"and how out outraged the profession is"},{"startTime":3193.26,"endTime":3194.093,"body":"and the impacts this is going to have."},{"startTime":3194.093,"endTime":3198.01,"body":"And we need to plan for"},{"startTime":3194.093,"endTime":3198.01,"body":"the consequences of this"},{"startTime":3199.089,"endTime":3199.922,"body":"through the year."},{"startTime":3199.922,"endTime":3202.86,"body":"And that was quite a"},{"startTime":3199.922,"endTime":3202.86,"body":"step change of reaction"},{"startTime":3202.86,"endTime":3204.6,"body":"to what we would normally see."},{"startTime":3204.6,"endTime":3207.48,"body":"Even in a contracting round,"},{"startTime":3207.48,"endTime":3209.193,"body":"when people are quite dissatisfied."},{"startTime":3210.51,"endTime":3214.623,"body":"I think it is a change in"},{"startTime":3210.51,"endTime":3214.623,"body":"landscape primary care."},{"startTime":3218.58,"endTime":3219.54,"body":"It's the variability"},{"startTime":3219.54,"endTime":3222.12,"body":"that makes it really, really challenging,"},{"startTime":3222.12,"endTime":3224.32,"body":"'cause I have some of"},{"startTime":3222.12,"endTime":3224.32,"body":"the most inspirational"},{"startTime":3225.27,"endTime":3228.03,"body":"top quality colleagues"},{"startTime":3225.27,"endTime":3228.03,"body":"that I've ever worked with"},{"startTime":3228.03,"endTime":3232.2,"body":"would be GPs who run excellent practices."},{"startTime":3232.2,"endTime":3234.84,"body":"But I could take a sample"},{"startTime":3232.2,"endTime":3234.84,"body":"of any 50 practices"},{"startTime":3234.84,"endTime":3237.389,"body":"and I'll see a threefold variation"},{"startTime":3237.389,"endTime":3239.1,"body":"in any metric of your choice,"},{"startTime":3239.1,"endTime":3243.24,"body":"a business metric, a"},{"startTime":3239.1,"endTime":3243.24,"body":"quality metric or whatever."},{"startTime":3243.24,"endTime":3245.79,"body":"And in some areas, it's impossible"},{"startTime":3245.79,"endTime":3249.63,"body":"to provide modern, good"},{"startTime":3245.79,"endTime":3249.63,"body":"standard of healthcare"},{"startTime":3249.63,"endTime":3252.896,"body":"if you are in a converted bungalow"},{"startTime":3252.896,"endTime":3254.7,"body":"or a Portakabin in a park,"},{"startTime":3254.7,"endTime":3257.46,"body":"and it's just you and no clinical backup,"},{"startTime":3257.46,"endTime":3261.45,"body":"or you simply can't"},{"startTime":3257.46,"endTime":3261.45,"body":"provide modern healthcare"},{"startTime":3261.45,"endTime":3263.493,"body":"like that any anymore."},{"startTime":3264.39,"endTime":3267.39,"body":"So I think strategically"},{"startTime":3264.39,"endTime":3267.39,"body":"in the next few years,"},{"startTime":3267.39,"endTime":3270.36,"body":"there will be a shift to"},{"startTime":3267.39,"endTime":3270.36,"body":"greater collaboration."},{"startTime":3270.36,"endTime":3273.31,"body":"I think you will see smaller practices"},{"startTime":3275.132,"endTime":3279.48,"body":"either giving up contracts or"},{"startTime":3275.132,"endTime":3279.48,"body":"people are choosing to retire"},{"startTime":3279.48,"endTime":3281.43,"body":"who are single hands in practice"},{"startTime":3281.43,"endTime":3284.73,"body":"and therefore a natural"},{"startTime":3281.43,"endTime":3284.73,"body":"sort of consolidation"},{"startTime":3284.73,"endTime":3287.1,"body":"of the primary care market."},{"startTime":3287.1,"endTime":3290.4,"body":"And then I do think the partnership model,"},{"startTime":3290.4,"endTime":3293.7,"body":"I think is one that you're"},{"startTime":3290.4,"endTime":3293.7,"body":"seeing less and less GPs"},{"startTime":3293.7,"endTime":3294.87,"body":"choosing to be partners."},{"startTime":3294.87,"endTime":3296.94,"body":"And it's more and more difficult"},{"startTime":3294.87,"endTime":3296.94,"body":"to recruit good partners."},{"startTime":3296.94,"endTime":3299.37,"body":"And I think newly qualified doctors"},{"startTime":3299.37,"endTime":3304.29,"body":"want more portfolio careers"},{"startTime":3299.37,"endTime":3304.29,"body":"across primary care."},{"startTime":3304.29,"endTime":3306.45,"body":"So I do think you will get to a point"},{"startTime":3306.45,"endTime":3307.53,"body":"in the next sort of 10 years"},{"startTime":3307.53,"endTime":3310.53,"body":"where there are more"},{"startTime":3307.53,"endTime":3310.53,"body":"primary care organisations,"},{"startTime":3310.53,"endTime":3312.87,"body":"whether they are limited companies"},{"startTime":3312.87,"endTime":3316.44,"body":"or whether they are NHS trusts"},{"startTime":3316.44,"endTime":3318.3,"body":"that develop a primary care arm."},{"startTime":3318.3,"endTime":3319.503,"body":"And there's a lot of models out there"},{"startTime":3319.503,"endTime":3323.97,"body":"that do this very well"},{"startTime":3319.503,"endTime":3323.97,"body":"and do this at a scale."},{"startTime":3323.97,"endTime":3326.7,"body":"And I think that'll become"},{"startTime":3323.97,"endTime":3326.7,"body":"more and more prevalent"},{"startTime":3326.7,"endTime":3328.8,"body":"and it'll become more and more"},{"startTime":3328.8,"endTime":3331.35,"body":"sort of an employed arm"},{"startTime":3328.8,"endTime":3331.35,"body":"of the health service"},{"startTime":3331.35,"endTime":3333.48,"body":"rather than the partnership"},{"startTime":3331.35,"endTime":3333.48,"body":"model that we have."},{"startTime":3333.48,"endTime":3336.49,"body":"I think that's probably the"},{"startTime":3333.48,"endTime":3336.49,"body":"10 year sort of trajectory"},{"startTime":3337.415,"endTime":3338.76,"body":"that you can see a little bit."},{"startTime":3338.76,"endTime":3340.83,"body":"And I know some of my GP colleagues"},{"startTime":3340.83,"endTime":3343.77,"body":"would find that incredibly depressing."},{"startTime":3343.77,"endTime":3348.757,"body":"others would see that as"},{"startTime":3343.77,"endTime":3348.757,"body":"the natural next step."},{"startTime":3349.89,"endTime":3351.87,"body":"So I do think it's a"},{"startTime":3349.89,"endTime":3351.87,"body":"really challenging time."},{"startTime":3351.87,"endTime":3355.8,"body":"I think the PCN contract"},{"startTime":3351.87,"endTime":3355.8,"body":"and this sort of central,"},{"startTime":3355.8,"endTime":3358.2,"body":"I think any time where"},{"startTime":3355.8,"endTime":3358.2,"body":"you are forcing people"},{"startTime":3358.2,"endTime":3361.23,"body":"to collaborate through a commercial lever,"},{"startTime":3361.23,"endTime":3363.96,"body":"I think is never some sort."},{"startTime":3363.96,"endTime":3366.75,"body":"So it works in areas where"},{"startTime":3363.96,"endTime":3366.75,"body":"people want to collaborate"},{"startTime":3366.75,"endTime":3368.1,"body":"and they're a good mix of people"},{"startTime":3368.1,"endTime":3369.93,"body":"and they get along quite well."},{"startTime":3369.93,"endTime":3370.89,"body":"But if you're in an area"},{"startTime":3370.89,"endTime":3372.78,"body":"where you don't get on with"},{"startTime":3370.89,"endTime":3372.78,"body":"the practises down the road"},{"startTime":3372.78,"endTime":3374.46,"body":"and somebody's leveraged"},{"startTime":3372.78,"endTime":3374.46,"body":"a contract over you"},{"startTime":3374.46,"endTime":3376.59,"body":"that forces you to work together,"},{"startTime":3376.59,"endTime":3379.86,"body":"that's not a recipe for high"},{"startTime":3376.59,"endTime":3379.86,"body":"quality service delivery."},{"startTime":3379.86,"endTime":3382.473,"body":"So I don't like it as a principle."},{"startTime":3383.346,"endTime":3384.453,"body":"It's my personal view."},{"startTime":3387.0,"endTime":3391.113,"body":"- Yeah, that's just totally correct, Jack."},{"startTime":3392.34,"endTime":3393.51,"body":"That's really is what happening."},{"startTime":3393.51,"endTime":3395.85,"body":"And I think what's going"},{"startTime":3393.51,"endTime":3395.85,"body":"to happen further along"},{"startTime":3395.85,"endTime":3398.31,"body":"is a private, like a two tier system"},{"startTime":3398.31,"endTime":3401.88,"body":"of private general practice staff by GPs"},{"startTime":3401.88,"endTime":3405.72,"body":"and a second NHS service"},{"startTime":3401.88,"endTime":3405.72,"body":"that's GP supervised"},{"startTime":3405.72,"endTime":3409.833,"body":"rather than being patient facing."},{"startTime":3411.03,"endTime":3412.65,"body":"- Yeah, I would also, sorry."},{"startTime":3412.65,"endTime":3414.0,"body":"I was going to say I would"},{"startTime":3412.65,"endTime":3414.0,"body":"also add to that, Neil."},{"startTime":3414.0,"endTime":3417.15,"body":"You're probably going to get"},{"startTime":3414.0,"endTime":3417.15,"body":"other providers, for example,"},{"startTime":3417.15,"endTime":3419.55,"body":"community pharmacy now looking"},{"startTime":3417.15,"endTime":3419.55,"body":"at point of care testing,"},{"startTime":3419.55,"endTime":3423.84,"body":"so co-creating with clinicians."},{"startTime":3423.84,"endTime":3426.93,"body":"So you've actually got a"},{"startTime":3423.84,"endTime":3426.93,"body":"whole different kind of way"},{"startTime":3426.93,"endTime":3428.793,"body":"of how people are delivering healthcare"},{"startTime":3428.793,"endTime":3430.8,"body":"that that may come about."},{"startTime":3430.8,"endTime":3432.93,"body":"However, I am rose tinted."},{"startTime":3432.93,"endTime":3435.81,"body":"I think there is something"},{"startTime":3432.93,"endTime":3435.81,"body":"about, you know, what GPs bring,"},{"startTime":3435.81,"endTime":3438.66,"body":"what primary care brings that"},{"startTime":3435.81,"endTime":3438.66,"body":"other parties can't bring"},{"startTime":3438.66,"endTime":3441.3,"body":"to the table and their"},{"startTime":3438.66,"endTime":3441.3,"body":"ethos and their working"},{"startTime":3441.3,"endTime":3443.04,"body":"and their hardship and their commitment."},{"startTime":3443.04,"endTime":3445.263,"body":"You, you're not going to get"},{"startTime":3443.04,"endTime":3445.263,"body":"that at any kind of piece at,"},{"startTime":3445.263,"endTime":3446.79,"body":"that kind of value."},{"startTime":3446.79,"endTime":3449.91,"body":"So whatever happens, it has to appreciate"},{"startTime":3449.91,"endTime":3453.66,"body":"that that once that is taken"},{"startTime":3449.91,"endTime":3453.66,"body":"away, then what you will get"},{"startTime":3453.66,"endTime":3455.73,"body":"will not be as good as what it used to be."},{"startTime":3455.73,"endTime":3457.23,"body":"And that's been really honest"},{"startTime":3457.23,"endTime":3459.24,"body":"because there's a huge"},{"startTime":3457.23,"endTime":3459.24,"body":"amount of goodwill out there."},{"startTime":3459.24,"endTime":3461.19,"body":"I mean I've, you know, I've got to declare"},{"startTime":3461.19,"endTime":3463.44,"body":"I've got friends and"},{"startTime":3461.19,"endTime":3463.44,"body":"family who are doctors."},{"startTime":3463.44,"endTime":3464.76,"body":"I've got nurses in the family."},{"startTime":3464.76,"endTime":3465.81,"body":"I've got, you know, opticians."},{"startTime":3465.81,"endTime":3467.31,"body":"I get it, you know?"},{"startTime":3467.31,"endTime":3468.72,"body":"I've got people in admin, you know,"},{"startTime":3468.72,"endTime":3471.0,"body":"and it makes you appreciate"},{"startTime":3471.0,"endTime":3472.527,"body":"the good amount of goodwill out there."},{"startTime":3472.527,"endTime":3475.62,"body":"And so if you try to build"},{"startTime":3472.527,"endTime":3475.62,"body":"everything on a commercial model,"},{"startTime":3475.62,"endTime":3476.94,"body":"which I know Jack was saying, you know,"},{"startTime":3476.94,"endTime":3478.5,"body":"you can't really force"},{"startTime":3476.94,"endTime":3478.5,"body":"people to work together"},{"startTime":3478.5,"endTime":3481.11,"body":"and you lose that goodwill"},{"startTime":3478.5,"endTime":3481.11,"body":"through either, you know,"},{"startTime":3481.11,"endTime":3484.23,"body":"bad practise or actually"},{"startTime":3481.11,"endTime":3484.23,"body":"not very good intentions."},{"startTime":3484.23,"endTime":3486.63,"body":"Once it's gone, it's"},{"startTime":3484.23,"endTime":3486.63,"body":"really hard to replenish."},{"startTime":3486.63,"endTime":3487.86,"body":"And I think we've got to be really careful"},{"startTime":3487.86,"endTime":3488.94,"body":"about that as well."},{"startTime":3488.94,"endTime":3490.92,"body":"You know, so the workforce issue"},{"startTime":3490.92,"endTime":3492.72,"body":"is really, really important."},{"startTime":3492.72,"endTime":3493.59,"body":"That has got, you know,"},{"startTime":3493.59,"endTime":3495.69,"body":"we've got to make sure that these people,"},{"startTime":3495.69,"endTime":3497.52,"body":"and that's why everything"},{"startTime":3495.69,"endTime":3497.52,"body":"that we try to do,"},{"startTime":3497.52,"endTime":3499.683,"body":"we try to co-create, is"},{"startTime":3497.52,"endTime":3499.683,"body":"really important and powerful"},{"startTime":3499.683,"endTime":3502.26,"body":"that that decision making is there."},{"startTime":3502.26,"endTime":3503.49,"body":"And we're looking for opportunities"},{"startTime":3503.49,"endTime":3506.04,"body":"and we are being honest and"},{"startTime":3503.49,"endTime":3506.04,"body":"transparent about doing that"},{"startTime":3506.04,"endTime":3508.53,"body":"because we want to hold onto"},{"startTime":3506.04,"endTime":3508.53,"body":"the people that we've got."},{"startTime":3508.53,"endTime":3509.79,"body":"That's really important."},{"startTime":3509.79,"endTime":3512.16,"body":"So the heart of everything"},{"startTime":3509.79,"endTime":3512.16,"body":"is the workforce."},{"startTime":3512.16,"endTime":3514.5,"body":"Without them, we can't deliver anything."},{"startTime":3514.5,"endTime":3515.82,"body":"- Yeah."},{"startTime":3515.82,"endTime":3517.05,"body":"We've got two minutes left."},{"startTime":3517.05,"endTime":3518.79,"body":"I'm going to throw one question out there"},{"startTime":3518.79,"endTime":3520.3,"body":"that the audience have asked"},{"startTime":3521.28,"endTime":3525.24,"body":"and just ask for kind of"},{"startTime":3521.28,"endTime":3525.24,"body":"a one or two line answer"},{"startTime":3525.24,"endTime":3527.22,"body":"from each of you to see your views on it."},{"startTime":3527.22,"endTime":3531.15,"body":"So, 'cause quite a few people"},{"startTime":3527.22,"endTime":3531.15,"body":"have asked about funding."},{"startTime":3531.15,"endTime":3533.64,"body":"So obviously with ICS formation"},{"startTime":3533.64,"endTime":3537.45,"body":"and consolidation of"},{"startTime":3533.64,"endTime":3537.45,"body":"organisations and budgets."},{"startTime":3537.45,"endTime":3541.11,"body":"One question we had was, \"Is"},{"startTime":3537.45,"endTime":3541.11,"body":"there really just one budget?\""},{"startTime":3541.11,"endTime":3544.41,"body":"and what's being seen quite a"},{"startTime":3541.11,"endTime":3544.41,"body":"lot is that what potentially"},{"startTime":3544.41,"endTime":3546.66,"body":"should be happening with budgets flowing"},{"startTime":3546.66,"endTime":3549.15,"body":"through the system into the right place"},{"startTime":3549.15,"endTime":3552.81,"body":"or for the patient isn't"},{"startTime":3549.15,"endTime":3552.81,"body":"necessarily happening."},{"startTime":3552.81,"endTime":3556.65,"body":"So kind of in one or two"},{"startTime":3552.81,"endTime":3556.65,"body":"sentences for each of you,"},{"startTime":3556.65,"endTime":3557.97,"body":"what are your views on that?"},{"startTime":3557.97,"endTime":3561.24,"body":"Are you seeing the"},{"startTime":3557.97,"endTime":3561.24,"body":"benefits and the difference"},{"startTime":3561.24,"endTime":3564.42,"body":"with the way budgets should"},{"startTime":3561.24,"endTime":3564.42,"body":"be working within ICSs?"},{"startTime":3564.42,"endTime":3567.66,"body":"So, Neil, come to you first."},{"startTime":3567.66,"endTime":3569.323,"body":"Have you noticed a difference?"},{"startTime":3569.323,"endTime":3571.77,"body":"- No, I have not seen one budget."},{"startTime":3571.77,"endTime":3575.553,"body":"We have a very small budget"},{"startTime":3571.77,"endTime":3575.553,"body":"and I don't see how that,"},{"startTime":3577.65,"endTime":3579.33,"body":"the money doesn't follow a patient,"},{"startTime":3579.33,"endTime":3581.49,"body":"it doesn't follow their condition."},{"startTime":3581.49,"endTime":3584.1,"body":"It is predetermined."},{"startTime":3584.1,"endTime":3585.78,"body":"That's all for me."},{"startTime":3585.78,"endTime":3587.22,"body":"- Okay."},{"startTime":3585.78,"endTime":3587.22,"body":"- My view."},{"startTime":3587.22,"endTime":3588.053,"body":"- Jack."},{"startTime":3588.96,"endTime":3590.01,"body":"- No, no, no."},{"startTime":3590.01,"endTime":3594.45,"body":"I've managed health economy"},{"startTime":3590.01,"endTime":3594.45,"body":"budget for a number of years."},{"startTime":3594.45,"endTime":3596.94,"body":"I've never seen it go in any direction"},{"startTime":3596.94,"endTime":3599.79,"body":"other than become more fragmented"},{"startTime":3599.79,"endTime":3602.1,"body":"and often decrease in value."},{"startTime":3602.1,"endTime":3604.247,"body":"And it's the fragmentation"},{"startTime":3602.1,"endTime":3604.247,"body":"that kills it, to be honest."},{"startTime":3604.247,"endTime":3607.11,"body":"'cause you get a budget for mental health"},{"startTime":3607.11,"endTime":3608.787,"body":"and you get a budget for"},{"startTime":3607.11,"endTime":3608.787,"body":"this and a budget for that"},{"startTime":3608.787,"endTime":3610.47,"body":"and a capital budget,"},{"startTime":3610.47,"endTime":3613.29,"body":"and actually it completely"},{"startTime":3610.47,"endTime":3613.29,"body":"constrains your ability"},{"startTime":3613.29,"endTime":3617.85,"body":"to plan strategically and"},{"startTime":3613.29,"endTime":3617.85,"body":"use resource in totality."},{"startTime":3617.85,"endTime":3619.2,"body":"And that so it's fragmentation,"},{"startTime":3619.2,"endTime":3621.3,"body":"that's a real challenge"},{"startTime":3619.2,"endTime":3621.3,"body":"from a funding point view."},{"startTime":3622.604,"endTime":3624.003,"body":"- Zafran."},{"startTime":3624.003,"endTime":3625.8,"body":"- So I have come across where, I mean,"},{"startTime":3625.8,"endTime":3627.21,"body":"so the prescribing budget normally"},{"startTime":3627.21,"endTime":3628.83,"body":"is not within scope anyway."},{"startTime":3628.83,"endTime":3630.81,"body":"The financial envelope is really tight."},{"startTime":3630.81,"endTime":3632.94,"body":"If you look at economy, cost of inflation,"},{"startTime":3632.94,"endTime":3634.89,"body":"cost of medicines,"},{"startTime":3632.94,"endTime":3634.89,"body":"that's always far higher"},{"startTime":3634.89,"endTime":3637.65,"body":"than what they're giving you,"},{"startTime":3634.89,"endTime":3637.65,"body":"you know, a 2%, 3% growth."},{"startTime":3637.65,"endTime":3640.4,"body":"And actually you need a 10%"},{"startTime":3637.65,"endTime":3640.4,"body":"growth to keep line with that."},{"startTime":3640.4,"endTime":3642.78,"body":"It means that we are already, you know,"},{"startTime":3642.78,"endTime":3645.87,"body":"starting off the blocks, well"},{"startTime":3642.78,"endTime":3645.87,"body":"behind the first few runners."},{"startTime":3645.87,"endTime":3647.46,"body":"So it's a race that, you know,"},{"startTime":3647.46,"endTime":3649.2,"body":"you'd always try to play catch up."},{"startTime":3649.2,"endTime":3651.93,"body":"In terms of budgets and"},{"startTime":3649.2,"endTime":3651.93,"body":"central procurement,"},{"startTime":3651.93,"endTime":3654.3,"body":"that was quite interesting"},{"startTime":3651.93,"endTime":3654.3,"body":"'cause there was this idea about,"},{"startTime":3654.3,"endTime":3656.43,"body":"you know, making savings strategically"},{"startTime":3656.43,"endTime":3659.67,"body":"and disseminate that down to ICBs"},{"startTime":3659.67,"endTime":3661.02,"body":"and then using that pot of money"},{"startTime":3661.02,"endTime":3663.9,"body":"to then go out and test"},{"startTime":3661.02,"endTime":3663.9,"body":"and trace, you know,"},{"startTime":3663.9,"endTime":3666.6,"body":"and treat and prevent patients."},{"startTime":3666.6,"endTime":3667.47,"body":"Did that really work?"},{"startTime":3667.47,"endTime":3669.09,"body":"I think it could have"},{"startTime":3667.47,"endTime":3669.09,"body":"been done a lot better."},{"startTime":3669.09,"endTime":3672.42,"body":"So I think there is some"},{"startTime":3669.09,"endTime":3672.42,"body":"degree of it can work,"},{"startTime":3672.42,"endTime":3675.09,"body":"but then that resource needs"},{"startTime":3672.42,"endTime":3675.09,"body":"to follow all the way through."},{"startTime":3675.09,"endTime":3677.37,"body":"And sometimes you don't see"},{"startTime":3675.09,"endTime":3677.37,"body":"that, that's the problem."},{"startTime":3677.37,"endTime":3679.83,"body":"- Yeah. Thank you."},{"startTime":3679.83,"endTime":3680.76,"body":"Perfect."},{"startTime":3680.76,"endTime":3684.42,"body":"So we're out of time, unfortunately,"},{"startTime":3680.76,"endTime":3684.42,"body":"but thank you so much."},{"startTime":3684.42,"endTime":3688.407,"body":"I'd really like to thank"},{"startTime":3684.42,"endTime":3688.407,"body":"all of you for joining us"},{"startTime":3688.407,"endTime":3690.54,"body":"and for the invaluable"},{"startTime":3688.407,"endTime":3690.54,"body":"insights you've shared."},{"startTime":3690.54,"endTime":3693.93,"body":"So as we bring the webinar to a close,"},{"startTime":3693.93,"endTime":3696.27,"body":"just remains for me to remind everybody"},{"startTime":3696.27,"endTime":3697.41,"body":"that we're here to help,"},{"startTime":3697.41,"endTime":3700.437,"body":"should you wish to delve deeper"},{"startTime":3697.41,"endTime":3700.437,"body":"into what the changes are"},{"startTime":3700.437,"endTime":3703.2,"body":"and the challenges facing primary care"},{"startTime":3703.2,"endTime":3704.433,"body":"mean for your business."},{"startTime":3705.27,"endTime":3707.13,"body":"So thank you once again for joining"},{"startTime":3707.13,"endTime":3709.92,"body":"and we look forward to seeing"},{"startTime":3707.13,"endTime":3709.92,"body":"you at our next webinar."},{"startTime":3709.92,"endTime":3711.36,"body":"And please sign up to the newsletter"},{"startTime":3711.36,"endTime":3713.31,"body":"and then you'll see what's coming next."},{"startTime":3714.63,"endTime":3716.22,"body":"- [Presenter] Thank you for watching."},{"startTime":3716.22,"endTime":3719.43,"body":"If you'd like to find out more"},{"startTime":3716.22,"endTime":3719.43,"body":"about our work with the NHS"},{"startTime":3719.43,"endTime":3722.31,"body":"or how we could support"},{"startTime":3719.43,"endTime":3722.31,"body":"your market access goals,"},{"startTime":3722.31,"endTime":3727.26,"body":"please email info@mtechaccess.co.uk"},{"startTime":3727.26,"endTime":3731.433,"body":"or visit our website at mtechaccess.co.uk."}]}