Anthony Kealy

1
Developing Commissioning Policy

• Anthony Kealy
• Policy Directorate Commissioning Team

2
Issues

• Context of NHS reforms
• The current position
• Commissioning policy framework
• Update on key work streams
• Project plan
• Engagement and communication

3
Context of Reforms

• Health Reform in England update and next steps
• NHS System Rules for 2006/07
• Practice Based Commissioning Guidance
• Commissioning Policy Framework

• Dec 05
• Jan 06
• Jan 06
• Jul 06

4
Framework for the Reforms
Money following the patient, rewarding
incentivising providers (Transactional reforms)
More diverse providers with freedom to innovate
improve (Supply-side reforms)
Better care Better patient experience Better
value for money
More choice stronger voice for
patients (Demand-side reforms)
Framework of system management, regulation and
decision-making (System management reforms)
5
The Current Position

• Practice Based Commissioning rolling out
• Universal coverage of PBC by December 2006
• Payment by Results in place
• Review of specialised services commissioning
• Joint commissioning review

6
Commissioning Policy Framework

• A comprehensive policy framework and
  implementation guidance covering
• The range of commissioning functions
• Practice based commissioning
• Specialised services
• Joint commissioning
• Rules of engagement
• National / Regional infrastructure
• Potential role of private sector

7
Key Work Streams

• Three consultancy reports submitted
• Improving Purchasing of Clinical Services, Price
  Waterhouse Coopers
• National Settlement System Financial Resource
  Management System, Flute Consulting Ltd
• Creating a Market for Commissioning Services,
  McKinsey

8
Improving Purchasing of Clinical Services

• Regional Purchasing Centres, aligned with SHAs
• PCTs will hold a single contract with their PC
• Agreements and reconciliation arrangements
  between PCs to cover choice and specialist
  out-of-region commissioning
• PCs work through National Settlement System

9
NSS and FRMS

• NSS a single national payments engine
• Will aggregate all activity transactions and
  reimburse providers, operating on a weekly
  payment run
• Development / procurement now progressing
• FRMS tool to understand financial performance
  and model impact of commissioning decisions
• PCTs would choose accredited provider
• Work to be taken forward through commissioning
  project

10
Creating a Market for Commissioning Services

• Need for stronger technical commissioning skills
  eg financial discipline, negotiating,
  contracting, actuarial
• Could support payment/settlement, data analysis
  and disease management programmes
• A range of business models from full-service to
  individual service lines
• Action would be required to create a sustainable
  market
• Work to be taken forward through commissioning
  project

11
Commissioning Project Plan

• Define Commissioning and describe requirements
  for each of its component functions
• Develop guidance/rules on key policy elements
• Practice-based commissioning
• Specialised services commissioning
• Joint commissioning
• Identify case studies of innovative approaches
  and good practice
• Develop a framework of incentives, levers and
  sanctions for effective commissioning at all
  levels

12
Commissioning Project Plan

• Develop infrastructure to minimise bureaucracy
  and transaction costs, eg
• NSS and FRMS
• Regional purchasing centres?
• Develop/review model contracts and SLAs
• Identify information requirements
• Secure the range of skills and capabilities
  required for effective strategic commissioning
• Link to PCT Diagnostic and development programme
• Consider role of private sector

13
Engagement Communication

• DH project group, involving all key stakeholders
• NHS reference group
• Engagement with other forums (like this one)