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PCT Commissioning, Business Models & Pathology. Dr Rick Jones Leeds Teaching Hospitals Trust. A Patient-led NHS requires:. Informed Patients: responsibility choice tax payers Effective Commissioners: responding to Patients understanding the evidence base managing demand

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pct commissioning business models pathology

PCT Commissioning,Business Models & Pathology

Dr Rick Jones

Leeds Teaching Hospitals Trust

a patient led nhs requires
A Patient-led NHS requires:
  • Informed Patients:
    • responsibility
    • choice
    • tax payers
  • Effective Commissioners:
    • responding to Patients
    • understanding the evidence base
    • managing demand
  • Responsive providers:
    • liberated from central control
    • competing to improve
    • managing costs
commissioning
Commissioning

‘the means by which we secure the best value for patients and taxpayers. By ‘best value’ we mean:

  • The best possible health outcomes
  • The best possible healthcare
  • With the resources made available by the tax payer’

DH 2006

commissioning4
Commissioning

The term “commissioning” is interpreted in different ways by different people. It is often used to denote “contracting” but in reality refers to a much broader process encompassing planning, procurement / contracting and performance management underpinned by partnerships.

Keith Douglas,

Director of Planning and Service Redesign, Eastleigh and Test Valley South Primary Care Trust and New Forest Primary Care Trust

commissioning5
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, 2007

the commissioning cycle
The Commissioning Cycle

Assess health needs

monitor contract

Decide priorities

Award contract

Review current service provision

Procure provider

Develop new service model

what people want
What people want
  • Local services there when you need them
  • Emergency care when you need it
  • No waiting
  • The best patient experience
  • To have a say, to have a choice
  • More emphasis on prevention
  • Health and social care working together
  • Improved health
where does pathology fit in 18 weeks
Where does Pathology fit in?18 Weeks

Tertiary

18 weeks

A&E

Diag

(IP)

OP

GP

OP

OP

IP

Diag

(OP)

OP

Assess

Other

1st OutpatientAppointment

Diagnostic

phase

Decision to treat

Treatment/Discharge

Follow-up

Data flows

Choose

and

Book

Future

Care

Activity

Outpatients

(Care

Activity)

Elective

Admission

List

Admitted

Patient

Care

A & E

delivery of 18 weeks diagnostics
NOW:

Clarify commissioning objectives

Patient pathway

Measurement

Identify best practice

Redesign patient flow and scheduling

Plan demand & capacity

Procure capacity

2008:

No waiting

Improved productivity

Appropriate access points

Demand & capacity in balance

Clinical futures & commissioning aligned

Delivery of 18 weeks: Diagnostics
pathways
Pathways

Pathways need to be focussed on the needs / demands of the population and on resources available: one of the really difficult tasks for commissioning to address is what should and should not be delivered as clearly not everything can be afforded…

Keith Douglas,

Director of Planning and Service Redesign, Eastleigh and Test Valley South Primary Care Trust and New Forest Primary Care Trust

how should pathology engage
How should pathology engage?
  • Who to approach?
  • By what route?
  • What type of services to present?
  • Reactive or pro-active engagement?

First know your customer and your product(s)

from craftsmen to service providers
From Craftsmen to Service Providers
  • Our society has become what it is today through the forces of
    • Specialization
    • Standardization
    • Scalability
  • It is now almost exclusively “service” oriented
    • Transportation
    • Telecommunication
    • Retail
    • Healthcare
    • Financial services

The IT industry which has many parallels to Pathology – high tech, rapidly developing, knowledge-based, ill understood by majority of users

tidal wave of business shift
Classic 1900’s Companies

Control Delivery

Control Services

Control Information

Have expensive acquisition processes and static relationships

Managed pricing and expectations

Information Age 21st Century

Consumer is empowered by information access

Businesses win by being open

Businesses win by leveraging new mechanisms to drive their own costs down.

Dramatic lower overall cost potential, higher level of services.

Tidal Wave of Business Shift
traditional pathology organisation

Pathology

Haem

ClinBiochem

Histo

Micro

Immuno

Genetics

Traditional Pathology Organisation

Local Trust

GPs

Other TrustsScreening

service based organisational framework

Operations Management Capability

Relationship

Management

Product

Management

DeliveryManagement

Quality

Assurance

Cust

1

Service A

Process

X

Service A

Outcome

Cust

2

Service B

Process

Y

Service B

Outcome

Cust

3

Service C

Process

Z

Service C

Outcome

Operations Execution Capability

Product

Development

Process

Engineering

Measurement

Sales

Service-based Organisational Framework
what exactly is a service

+

+

=

Technology, Products & Platforms

People

Process

Service

  • Intangible
  • Non-persistent
  • Described in Benefit or Customer Terms
  • An Action, not a Thing
What exactly is a service?
a service
A Service

“Giving assistance or advantage to another”

These are NOT services

what is pathology
What is pathology?
  • Laboratory Processing
  • Near Patient Testing
  • Clinical Advisory Service
  • Screening Services
  • Chronic Disease Management
  • Direct Clinical Service to Patients
  • Training and Education
  • Research and Development
  • Clinical Audit
  • Policy support
  • ………………………….plus other services
what are the key features of good commissioning
What are the key features of good commissioning?
  • Not just the responsibility of one organisation - input from wide range of people with different skills
  • Strong local partnerships, e.g.
    • PCT, local authority
    • Network
    • local users
  • Different types of commissioning, e.g.
    • PCT commissioning
    • Joint commissioning
    • Practice based commissioning
    • Network commissioning
    • Specialist commissioning
slide20
Supply chain management: The commissioner needs to understand the supplier and aim for mutual success on behalf of local people... understanding the cost base and the problems… the provider needs to understand the commissioners problems, aspirations, targets.

This requires honest and open lines of communication, using the right medium for the right message. Only with this can commissioners and providers deliver in partnership for communities.

Martin Barkley, Chief Executive, Hampshire Partnership NHS Trust

knowing your place in the service fulfilment chain
Knowing your place in the Service Fulfilment Chain

D =Patient

There are many providers and customers in a service fulfilment chain, but…

D

C =Clinician

A & B =Pathology

C

B = Provider

C = Customer

C = Provider

D = Customer

B

A = Provider

B = Customer

A

….. services must be expressed in terms of the

ultimate end customer,

examples of pbc service redesign
Examples of PBC Service Redesign
  • Chronic obstructive pulmonary disease
  • Long-term conditions
  • Ophthalmology
  • Heart failure
    • BNP in community
    • In-house ECHO
  • Urology
    • Haematuria protocol for diagnostic tests
    • H.pylori
slide23
Knowledge: Commissioners need to know national policy, guidance, standards, targets. They need: a passion (or at least an interest) in the services being commissioned, to understand local needs and priorities, to be able to speak and commit on behalf of the organisation and know the service being commissioned.

Martin Barkley, Chief Executive, Hampshire Partnership NHS Trust

pathology commissioning
Pathology Commissioning
  • Direct Access
  • Provider / Provider
  • Clinical contract with Trust
  • Specialist commissioning

Do commissioners know what to commission?

continuum of commissioning
Continuum of commissioning

Level of commissioning

Smith et al 3

individual……...practitioner……….practice……….locality……….community…….region……….nation

Multi-practice or locality commissioning

PCO/PCT commissioning

Patient choice

National commissioning

Single practice based commissioning

Joint commissioning

Lead PCT/LHB commissioning

micromesomacro

what shas will want
What SHAs will want
  • Strategic Planning (major investment / configuration / workforce)
  • Support for research, innovation and education / training
  • Help in creating new health system
  • System management with regulators
  • Performance management of PCTs / market
  • Possibly some tertiary level via PCT groups & networks
commissioning specialist services
Commissioning Specialist Services

Example: Haemoglobinopathy screening

  • Universal neonatal screening
    • NHS roll out programme, funded until March 2007
  • Universal antenatal screening funded study for 2 years to screen women in Leeds / Bradford

Post 2007: PCT sign up?

what pcts will want
What PCTs will want
  • Strategic Commissioning - not short term fixes
  • Programmes to improve the health of the community
  • Reduction in inequalities - standard packages
  • Assurance of safe, high quality services
  • Managed contracts on behalf of Practices
  • Performance within budgets
  • Transparency on costs
  • Verification of secondary care requirements - checklists
  • Public engagement - informed choices
  • May need some community services
commissioning cancer services
Commissioning Cancer Services

Example – leukaemia

  • Panels of cell markers
  • Commissioning only from laboratories who meet current guidelines
  • Audit of current activity / practice
  • Need sufficient activity / expertise
north bradford pct service improvement pyramid
North Bradford PCT Service Improvement Pyramid

Corporate bodies

Practice based commissioning

PCT +

PCT managed

Groups of practices

Practice managed

Service delivery informed by patients

performance improvement model
Performance Improvement Model

Mission

Performance Packages

Vision

Incentive Scheme

Patient Experience

Culture

PBC

PMS

Practice Manager leads

Support

Advisory Groups

PLT/PBE

Unit of Service

Delivery

Education

Pursuing Perfection

Specialist Groups

Practice Review Meetings

Collaboratives

Optimising Hospital Utilisation

Patient/Consumer Involvement

Clinical leads

Information

what gps want from pathology
What GPs Want From Pathology
  • Benchmarking data (test rates)
  • Integration of pathology into care pathway
  • Standardised guidance, up-to-date
  • Best practice guidelines
  • Reduction in inappropriate testing
  • Electronic requesting / reporting
  • Automatic prompts
  • Governance role of laboratories
  • Standardisation across the patch
  • POCT where appropriate

VALUE ADDED PARTNERSHIP

what patients will want
What patients will want
  • Convenient and accessible services
  • To know why tests are being done
  • Tests are safe and kept to a minimum
  • Results in the shortest possible time
  • Reliable results
  • Information on meaning and implications of results
putting it all together
Putting it all together

Strategic commissioning objectives

  • Long-term conditions
  • Diagnostics
  • Elective care
  • Urgent care

Enabling projects

how should pathology engage42
How should pathology engage?
  • Who to approach?
    • Trusts
    • PCTs
    • SHAs
    • GPs
  • By what route?
    • Some direct – POCT, INR, DMARDS
    • Some indirect – clinical bundles, composite services
  • What type of services to present?
    • Coherent - results & evidence & support
    • Complete – clinical answers not widgets
  • Reactive or pro-active engagement?
    • Pro-active – now or never
service orientated organisation
Service Orientated Organisation

ServiceSupport

Users

Production & Back Office

Clinically

Orientated

Service

Delivery

Patient

Centric

Approach

Acute

Trusts

&

PCTs

Logistics

BusinessSupport

High Volume Core Lab

Specialist

Functions

e.g. Molecular

Cytological

ScreeningDrugs

Regional

National

Research / Training / Devel

Quality Assurance / Audit

Knowledge Management

remember
Remember

“ A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty”

Sir Winston Churchill

conclusion

Conclusion

Price & Jones The challenges in commissioning laboratory medicine (pathology) services.

Journal of Management & Marketing in Healthcare. VOL. 1 NO. 2. PP 1–13. Jan 2008