Clinical Commissioning

Update April 2011

“liberating the NHS” a major policy shift introduced by coalition government

Significant change for NHS and local authorities

We will all be involved- whether we like it or not!

Clinical commissioning

Introduction

Major shift in government policy, transferring responsibility for commissioning care to GPs

Ongoing political disquiet- model likely to change to involve other parties- secondary care, other health professionals, patients

Improving care , saving money, transferring responsibility and /or blame?

Effective commissioning

Should be based on: Improving outcomes for patients; prioritises

demand over supply, innovative approaches to delivery of services

Patient empowerment; promotion of shared approaches to care, keeping patients fully informed, power to shape their own healthcare, and support to care for themselves

Effective commissioning

Evidence based practice ;draw on research expertise to use evidence to assess needs, design services and monitor outcome

Community mobilisation ; values of public service, harnessing the power of patients to determine their own health outcome- community engagement. Integrating with public health agenda, promoting wellbeing, preventing ill health

Effective commissioning

Ensuring the needs of the vulnerable, overlooked or ignored are addressed

Sustainability ; commitment to the sustainable use of resources – natural environment, NHS finances and the time and spirit of staff

commissioning consortia

Organisations that will take on the task of commissioning

Pathfinders ; current model to develop ways of making it work locally, shadowing PCT work

Will need to partner with clinicians and the public, true collaborative working

Major challenge for leadership- breaking down barriers between primary and secondary care

commissioning consortia

Breaking down barriers between health and social care and professionals and the public

Engagement across traditional boundaries Who will do it , and what support will they

get? Currently volunteers , locally elected by

peers

GPs in consortia

Do they have the requisite skills? Leadership Knowledge Vision Priorities and context Negotiation skills Managing change Respect

GP consortia

Health needs assessment Contracting skills Financial and budgetary understanding

……..ie a major undertaking!

What support is available?

New role of Associate Dean for commissioning in Surrey, Kent and Sussex

Taps in to deanery support, links to university

Planned commissioning development groups to tackle practical skills acquirement, understanding and knowledge, along the lines of the existing appraisal development workshops

What support is available?

National support through RCGP , LMC, BMA Planned diplomas , academic modules via

universities to develop commissioning skills , possible portfolio careers for GPs

GP Tutor network tasked with helping everyone to understand the process- protected learning time

Grass roots GPs

Why should I be interested? ALL GPs are involved in commissioning Every prescription and referral is a

commissioning act It will never work without the support and

understanding of grassroot GPs QOF will encourage you!

QOF and commissioning

Re allocated points for 2011-2012 96.5 points for quality and productivity

indicators Encouraging increasing efficiency in use of

NHS resources Cost effective prescribing Reducing emergency admissions and

hospital referrals by use of alternate pathways

QOF and commissioning

2011-12 indicator changes: http://www.bma.org.uk/images/summaryqof

guidance2011_v3_tcm41-204734.pdf

Local initiatives and the way forward

Case Scenarios

You are a newly qualified GP and have been asked to lead on delivery of the QP QOF in the practice- how will you do this , and what skills will you need?

Your practice has been approached by the consortium to be told you are an outlier- how will you manage this situation?

Your senior partner is refusing to change his/her prescribing or referral habit- and they use the Brompton as the local hospital is “not up to scratch” how will you address this?

NHS commissioning board NHS outcomes framework will set

expectations for performance- within resource parameters set by government

This board will manage GP contracts and set practice level budgets for the new CCGs

Board will monitor and hold CCGs to account

SHAs and PCTs will go – PCTs from april 2013

Structure

GP practices will have to belong to a CCG Part of GP budget likely to go to CCG for the

delivery of commissioning outcomes Current local example in funding practices

to participate in “high risk” patient reviews with CMHT and Social Services- and to actively review referral processes

Structure

Local authorities will form a new relationship with the NHS and CCGs

Public health will move to Las and be subject to new health improvement programmes

Healthcare providers will be subject to dual monitoring and licensing system

Monitor will become the new economic regulator

Structure

• Care Quality Commission will monitor delivery and infrastructure – all practices will have to be CQC registered

• Two key principles- putting patients first “no decision about me , without me”

• Proposed information revolution- allowing an extended range of informed choice

• Improving healthcare outcomes, Quality improvement programme supported by NICE

Structure

HealthWatch England collates national information, acts as consumer champion

Structure

1-Planning Assessing health needs Reviewing current provision Capacity planning Identifying gaps and priorities

So what is commissioning?

2- procurement Service design / redesign Defining contracts Procuring appropriate services Demand management

So what is commissioning?

3- monitoring Monitoring activity and quality Invoicing, data validation and payment User and local authority views , choice Feedback All clinically driven, with patient . Public and

LA input

So what is commissioning?

Significant unhappiness with The Health and Social Care Bill- RCGP , BMA etc

However , Bill now through The Lords- Royal Assent expected before Easter

More savings needed- if current target met in 2015 , a further £20 billion savings needed “ a decade of no money” Richard Douglas, DoH director of policy, strategy and finance

Where are we now?

Essential part of MRCGP- community orientation, teamwork, maintaining trust, safety and quality

We are all involved in micro-commissioning New skills of enquiry, analysis, collaboration

, negotiation and presentation needed for all

CPD needs to change to recognise the cultural shift

Your involvement

Five P model for cpd Personal needs – what do I need to further

my career? Practice needs- what do I need to learn to

help develop my practice? Patient needs- what do I need to learn to

provide good care for my patients?

Your involvement

Population needs- what do I need to learn to reflect the needs of my CCG population?

Political needs- what do I need to learn to reflect the needs of the NHS?

And maybe some of you will wish to become commissioners/ board members

Portfolio careers

Your involvement