SERVICE REDESIGN AND COMMISSIONING

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SERVICE REDESIGN AND COMMISSIONING

• Heather Wicks
• Head of Non Elective Care Commissioning
• Oxfordshire PCT
• and
• Professional Advisor in Orthoptics to DH

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Session objectives

• Discuss what commissioning will look like in the
  near future and who the key players will be
• Consider how providers can engage most
  effectively with commissioners

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What is commissioning?

• the means by which we secure the best value for
  patients and taxpayers. By best value we mean
• The best possible health outcomes (incl. Reduced
  health inequalities)
• The best possible healthcare
• With the resources made available by the tax
  payer
• DH 2006 1

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Alternatively

• Commissioning
• the set of linked activities required to assess
  the health care needs of a population, specify
  the services required to meet those needs within
  a strategic framework, secure those services and
  monitor and evaluate the outcome
• Woodin (forthcoming)2

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Some other confusing terms!

• Procurement
• Process of identifying a provider by competitive
  tendering,quotation or other process
• Purchasing
• Buying services in response to demand or use
• Contracting
• The technical process of selecting a provider,
  negotiating terms and managing the contract
  arising from this (payment, monitoring,
  variations)

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Continuum of commissioning

• Level of commissioning
• Smith et al 3
• individual...practitioner.practice.localit
  y.community.region.nation

PCO/PCT commissioning
Multi-practice or locality commissioning
Patient choice
National commissioning
Single practice based commissioning
Joint commissioning
Lead PCT/LHB commissioning
micro meso macro
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The Commissioning Cycle
Assess health needs
monitor contract
Decide priorities
Award contract
Review current service provision
Procure provider
Develop new service model
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What is Commissioning?

• What should we be providing in the future?
• What are we currently providing?
• Are there any gaps between the two?
• How should we fill the gaps?
• What should we provide?
• Who should provide it?
• How well can they provide it?
• Are they providing it to our satisfaction?

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Provider identification

• Possible models
• preferred provider
• range of possible providers
• service specification with tendering

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Why should AHPs be interested in commissioning?

• Value added by being involved in national
  modernisation agenda
• Consequences of involvement and understanding
• Consequences of not being involved!

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How AHPs can influence and add value to
commissioning

• Commissioners key issues
• Commissioners language
• Pitfalls to avoid
• Provider perspective

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Stages in the commissioning cyclehealth needs
analysis

• Why does your local area really need your
  service?
• What is particular about the population now and
  in the future?
• What would happen if your service was
  decommissioned?
• Use historical and predictive demographic and
  other data public health good sources

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Stages in the commissioning cycledecide
priorities

• Use national and local strategic plans to develop
  your proposal
• National key policies eg 18/52 wait target,
  improving access, reducing inequality, links
  between social,education and health care
• Ensure full backing of your organisation before
  approaching commissioners

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Stages in the commissioning cycledecide
priorities

• Contextualise these
• ISIP
• LDP
• Local business/PBC consortia plans and priorities
• Show how your service can assist in achievement
  of local commissioners priorities and wishes

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Stages in the commissioning cyclecurrent
service provision

• Analyse your current service for successes and
  challenges
• Use process mapping for specific areas
• Collect evidence of clinical and cost
  effectiveness
• Evidence can be user (patient and healthcare
  professional) feedback, professional consensus as
  well as scientifically based
• Consider quality service improvements that can be
  made regardless of any commissioning challenge

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Stages in the commissioning cycledevelop
evidence based service model

• Components of a service model
• Model 3 tier, pathway, multiprof.
• Geographical spread
• Specification detail about how each tier
  provided in local context
• Contract document sealing expectations of each
  party

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Stages in the commissioning cycledevelop
evidence based service model

• Ensure your proposal illustrates
• Awareness of national and local priorities
• Exactly what it is that you will provide can
  they read what it says on the tin?
• What are the benefits that will be realised by
  your service for patients, users
  GPs/carers/education staff etc, strategic context
  and financial

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Stages in the commissioning cycledevelop
evidence based service model

• How you plan to work with local commissioners
  (esp. PBC commissioners) to both implement and
  monitor the service
• What your key performance indicators (KPIs) will
  be for process and outcomes
• How you will ensure all CG components addressed
  as well as activity quality and quantity

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Stages in the commissioning cyclenext steps

• Evaluation of tenders/potential providers
• Clinical governance
• Activity
• Variation and penalties
• Ongoing evaluation of service and relationship

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Current challenges for commissioners

• Expert clinical advice
• PCT and Practice Based Commissioners aligning
  priorities within local priorities frameworks
• LINks
• Information

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Contact details

• Heather Wicks
• Head of Non Elective Care Commissioning
• Oxfordshire PCT
• 01865 226546
• Heather.wicks_at_oxfordshirepct.nhs.uk

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References

• 1 Health reform in England update and
  commissioning framework
• DH 2006
• 2 Healthcare commissioning and contracting
• Woodin in Walshe K and Smith J (eds) Healthcare
  Management, Open University Press
• 3 Commissioning in the reformed NHS policy into
  practice
• NHS Alliance March 2006
• ISBN 0 7044 2582 3
• Wade E, Smith J, Peck E, Freeman T
• 4 PBC practical implementation
• DH November 2006
• 5 PBC early wins and top tips
• DH February 2006
• 6 Commissioning Toolkit for Community Based Eye
  Care SErvices
• DH January 2007

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Thank you for your attention