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Commissioning Community Services – The challenge. Michael Sobanja 23 March 2006. Payment systems PBR – Contracts – C4H. Supply side reform Plurality Foundation Trusts Competition. User side reform Commissioning PBC Clinician engagement Patient choice. Regulation

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slide3

Payment systems

PBR – Contracts – C4H

Supply

side reform

Plurality

Foundation

Trusts

Competition

User

side reform

Commissioning

PBC

Clinician

engagement

Patient choice

Regulation

Monitor NSFs – NICE-HCC

three broad phases to nhs reform
Three broad phases to NHS Reform

Central

Direction

National

Standards

Financial

Investment

&

Support

“Constructive

Discomfort”

slide5
"District nurses, health visitors and other staff delivering clinical services will continue to be employed by their PCT unless and until the PCT decides otherwise.“
  • 25 October 2005
what is commissioning
What is commissioning?
  • Commissioning is the process which determines how the health and the healthcare budget is used.
    • Meeting the needs and/or wants of local people?
    • At and affordable level?
    • From whom?
    • What's the evidence base?
    • Integrated access to health and social care services
levels of commissioning
Levels of Commissioning

National

Regional

PCT Associations

PCT/LA

Practice

Neighbourhood

Locality

Cluster

who commissions primary care
Who commissions Primary care?

PCT

10

20

30

COMMISSIONING

PBC

the real challenge
The real challenge?
  • To commission excellent services in the community that are built around the patient and to
  • develop and deliver effective community based approaches to keeping people healthy
the dilemmas of commissioning
THE DILEMMAS OF COMMISSIONING
  • Trying to improve the experience and health of the individual patient without micro-managing the providers
  • The trade-off between the interests of individuals and those of the wider community
  • Balancing national priorities with local aspirations and flexibility
  • Investment in health improvement (long term payback) versus investment in health services (immediate gratification)
commissioning
COMMISSIONING

Different components:

  • Equity
        • fair distribution of evidence-based benefits
  • Responsiveness
        • emotional consequences of decisions
  • Efficiency
        • economic considerations including cost-effectiveness
slide13
Different groups will tend to prioritise these components as follows:
  • Commissioners
        • equity, efficiency, responsiveness
  • Patients
        • responsiveness, equity, efficiency
  • Providers
        • efficiency, responsiveness, equity
effective commissioning
EFFECTIVE COMMISSIONING
  • A clinical and managerial dialogue informed by patient and user views
  • Creating better patient/user services, pathways and experiences
  • A focus on improving process and outcomes - changing the fundamentals of the system
  • A focus on the key problems facing the health community
  • A focus on health economies rather than individual organisation
a new range of services
A new range of services
  • Traditional primary care services, such as district nursing, midwifery, health visiting, physiotherapy and podiatry
  • Diagnostics and specialist outpatient services previously delivered in hospital
  • Expanded walk-in services that include diagnostic tests, screening, clinical advice, basic prescriptions and health promotion
  • Additional services, such as sexual health services, treatment for drug and substance abuse, care for asylum seekers, prison healthcare, care for ethnic minority groups, services for care homes
  • Inpatient services at a community hospital or nursing home
  • Mental health services including community psychiatric nursing and counselling
  • Complementary medicine?
  • Local health information and advocacy
  • Pharmacy, dentistry and optometry
slide20
Supermarket chain Sainsbury's has announcedplans to open general practitioner services in itsbranches across the country.
slide21

Foundation

trusts

Private

Companies

Not for Profit

companies

Mutuals

GP GMS/PMS

Partnerships

Clinician

Chambers

Voluntary

Sector

Pharmacos

slide23

Cardiac

Surgery

Direct Access

Services

Surgical

Wards

Cardiology

A & E

Emergency

Medicine

Primary & Community

‘Continuing Care’

Paediatric

Diabetes

Specialist

Nurses &

Doctors

Medical Wards

Wards

Diabetes Specialist

Services

Clinical

Psychology

Receptionists

and

Support

Workers

Rheumatology

Diabetes

Specialist

Nurses

Supporting

Specialist Services

Services for

Young People

Nephrology

On Call

Service

Vascular &

Orthopaedic

Surgery

Diabetes

Specialist Team

Web Based

Services

Obstetrics

Joint Diabetes

Antenatal

Service

High Risk

Foot-care

Team

Diabetologists

NHS Direct

Orthotists &

Footwear

Specialists

Ophthalmology

Laser & Cataract

Services

Eye

Screening

Hospital

Dietetics

Components of

an Integrated

Diabetes

Care

Service

Community

Dietetics

Optometrists

Community

Podiatry

Pharmacies

Specialist

Vitreo-

Retinal

Services

Primary Care

Diabetes

Teams

Primary Care

Diabetes

Teams

Primary Care

Diabetes

Teams

Primary Care

Diabetes

Teams

Primary Care

Diabetes

Teams

Primary Care

Diabetes

Teams

Community

Nurses

Nursing

Homes

Call Centres

information services of the national health system four elements
Information Services of the National Health System - Four Elements

Where can I go?

  • CONTEXT – Health Services Providers
    • common descriptions and details of services and providers within the health system, their configurations and locations
  • INTENT – Standards for Health Services
    • Using clinical knowledge and adopting standards of care across the health system e.g. National electronic Library for Health
  • ACTIONS - Personal Health Management
    • electronic records, e- bookings, referrals, investigations, and prescriptions
  • OUTCOMES - Measuring Performance of Health Services
    • consistent support of the clinical audit of individual care

What will they (we) do?

What did they (we) decide?

Did it do any good?

information for commissioning
Information for Commissioning
  • Understanding need and demand
  • Comparative performance
  • Capacity generation – generating a market?
  • Understanding the true cost base
  • Giving patients useful information
slide27

JOINED UP THINKING !

PCS Web - a groundbreaking new e-record system that gives everyone in the primary care team instant, online access to patients' records - is being piloted in two PCTs in England from next month.

For the first time in the UK, health visitors and district nurses will have their own tailored e-nursing care records, based on the internationally recognised Omaha classification system.

Staff will be able to draw up nursing care plans and make detailed assessments of social aspects such as patients’ living conditions, hygiene needs and ability to care for themselves; areas that a traditional GP system does not cover, but that are essential for other staff to plan care and measure outcomes.

proposals are in hand to expand health services in the home
Proposals are in hand to expand health services in the home.

'I don't like it. They're queuing for

surgery on the kitchen table.

key challenges what do you think
Key Challenges – what do you think
  • How do we specify community health services – particularly the “ethos”?
  • Who do we see as the possible providers?
  • How do we measure the volume of services?
  • What is the outcome?
  • How can we increase investment?
  • How do promote inter-practice collaboration?
  • How do we tie it together with Local Auhtority services?
  • What part should Non Execs play in commissioning?