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The Department is transforming the commissioning health and care services in the NHS to drive unprecedented improvements in patient outcomes. We worked with commissioners and their partners to develop a vision for world class commissioning and a set of 11 organisational competencies. Delivery of this vision will take place within an assurance system. This will improve performance and development, and reward commissioners as they move from their current position towards world class standards.
Practice-based commissioning (PBC) is a policy intended to give more decision-making power over NHS resources to general practitioners (GPs), and allow them to design and deliver completely new services or commission others to do so. It has a number of underlying policy objectives including delivering more cost effective and convenient forms of treatment outside hospital. Practice-based commissioning is a key strand of recent NHS reform policy in England alongside Payment by Results, patient choice and enhanced competition between providers. This briefing looks at the development of PBC in England, examines the pace of implementation and offers some analysis of the impact – current and future – on NHS services.
(Published November 2007, 10 pages)
The NHS Institute for Innovation & Improvement has now launched the new Commissioner Module for the No Delays Achiever. The new functionality is designed to support commissioners in working with their providers to achieve 18 week patient pathways. If you are a commissioner you can now compare multiple provider data to help you work with your providers in identifying and tackling variation and delay. As ever, the library of service improvement tools, techniques and case studies can also help commissioners find the most effective ways of working with their healthcare partners. Other improvements in response to user feedback include clearer organisation of graphs, a new ‘getting started’ section, an enhanced feedback function, and improved overall design.
www.nodelaysachiever.nhs.uk
For a full outline of modifications:
www.nodelaysachiever.nhs.uk/news
The NHS Institute’s No Delays Priority Programme is establishing two communities of practice as part of the evolution of its existing commissioning network to examine and tackle current commissioning challenges. Each Community will consist of around 15 members, meeting initially in London and Coventry. Places are limited, so apply soon.
This report sets out to determine whether practice based commissioning (PBC) is working from a financial management perspective. As well as key findings, the report explores the barriers to effective implementation of PBC, and includes case study examples of solutions and notable practice, recommendations and prospects for the future.
(Published November 2007, 76 pages)
In 2002 the Department of Health announced a fundamental change to the way in which NHS hospitals in England are paid for the work they do. Under this new system – Payment by Results (PbR) – hospitals are reimbursed for the activity they carry out using a tariff of fixed prices that reflect national average costs. The government is currently considering whether and how the system can be improved and extended to more services in the future. This briefing explains how Payment by Results works, examines the evidence on whether the system has achieved, or is likely to achieve, the policy aims set for it, and describes the government’s current proposals for the future of PbR.
(Published October 2007, 8 pages)
The King’s Fund has released a ground-breaking software tool that helps PCTs use routine data to predict the risk of emergency re-admission to hospital. Many PCTs in England have found PARR very useful in their attempts to reduce emergency hospital admissions and allocate resources more effectively.
Treatment Centres (TCs) offer safe, fast, pre-booked day and short-stay surgery and diagnostic procedures in areas that have traditionally had the longest waiting times, such as ophthalmology and orthopaedics. TCs will play an important part in modernising the NHS and delivering a patient-centred health service. Whether NHS-run or managed by companies in the independent sector, the additional capacity TCs provide will be crucial in bringing down waiting times and giving patients more choice about when and where they are treated.
Services for people with learning disabilities and challenging behaviour/mental health needs is an updated version of the guidance originally produced by Professor Mansell and his project team in 1993. This good practice guidance sets out the actions that should be taken in order to effectively meet the needs of people with challenging behaviour. The guidance contained in this document supports the agenda set out in 'Valuing People' (2001) and the focus on personalisation and prevention in social care.
(Published November 2007, 43 pages)
Best practice guidance to improve oral health in disabled children and adults. This document builds on the principles within Choosing Better Oral Health and uses the evidence-based approach within Delivering Better Oral Health as a guide to assist all who provide and commission dental services for people with disabilities.
(Published November 2007, 53 pages)
Diabetes has come a long way since the publication of the National Service Framework (NSF). Self management is now recognised as the key to improved health outcomes, but people with diabetes also need the active support of organised, proactive and expert health, community and social services.
This small booklet aims to address this issue by providing details of the improved pathways that can be designed for people with diabetes, the governance issues that can be addressed by PCTs and the money the can be saved by acute trusts and commissioners, if the expertise of consultant diabetologists and the teams they work with is used to the full.
(Published September 2007, 26 pages)
This updated guidance is intended for everyone involved in managing, commissioning or delivering NHS stop smoking services. It has been developed by means of a collaboration with representatives from SHAs, PCTs, the Information Centre and academics from the field of smoking cessation.
(Published October 2007, 26 pages)
This practical guide will support commissioning managers by creating a structured approach to commissioning planned care pathways that will meet 18 weeks and build towards a sustainable pathway-based commissioning approach.
(Published September 2007, 54 pages)
Good practice guidance on the commissioning of specialist adult learning disability health services for adults, in particular to assist in responding to shortcomings identified in these services in recent Healthcare Commission reports including those into abuse in Cornwall and Merton and Sutton.
(Published October 2007, 21 pages)
The NHS Operating Framework for 2008/2009 expects PCTs to take ambitious steps toward providing care as close to the patient's home as possible. NHS organisations need to focus their efforts on those areas most likely to bring significant benefits and to apply effective approaches to ensure that the change delivers.
Prioritise Opportunities: User Guide
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Toolkits
Delivering an 18 week patient pathway from GP referral to the start of treatment by the end of 2008 is a key objective for the NHS. This website is dedicated to supporting the Service and provides access to: information to help you implement the changes, details of initiatives around the NHS that are already achieving improvements in the patient's journey, case studies to allow you to share best practice, and programme resources, including presentations and reports.
PCTs have an increasing role to play in commissioning a wide range of community based services for patients with chronic eye conditions. In the National Eye Care Services Steering Group's first report it has made recommendations for PCTs in commissioning services for glaucoma, cataract services, low vision services and age-related macular degeneration (ARMD). A new step by step guide has been produced to support Commissioners.
(Published October 2007, 64 pages)
The North West Commissioning Roadmap website is aimed at commissioners of adult health and wellbeing services in local authorities and PCTs in the North West.
It is a way of sharing practice around the region by offering advice, case studies, summaries of national guidance, comprehensive resources sections with links to other websites, and regional contact details.
The Government's response to Facing the Future: a review of the role of health visitors. It includes recommendations on the workforce and sets out the government plans for taking forward the relevant recommendations.
(Published October 2007, 22 pages)
There is variation in clinical practice in the NHS and in the treatments that patients receive. Some of this may be appropriate but patients may also receive treatments which are not very effective or for which there is no evidence. The HLG found that there is much work already being undertaken by a range of organisations and some good examples in local organisations. It also found that there is no ‘single bullet’ to address the issue of clinical effectiveness. This is a complex issue. Staff in the NHS need to be empowered locally to take ownership of the agenda and promote clinically effective practice.
(Published October 2007, 56 pages)
Who Pays? Establishing the responsible commissioner sets out a framework for establishing responsibility for commissioning an individual's care within the NHS, i.e. determining who pays for a patient’s care. The legal framework relating to secondary care commissioning responsibilities for Primary Care Trusts(PCTs) is set out in regulations 3(7) to (10) of the National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Regulations 2002 (S.I. 2002/2375) as amended by S.I. 2002/2548, 2003/1497, 2006/359 and 2007/559 (“the Functions Regulations”). This document is intended to provide guidance on the application of that legal framework to particular situations.
(Published September 2007, 32 pages)
Two new tools to help diabetes networks develop and improve their services have been released by the National Diabetes Support Team (NDST). Developing a Diabetes Service: Using the Diabetes Commissioning Toolkit provides a systematic approach for everyone involved in diabetes networks on how to use the Diabetes Commissioning Toolkit. The second document is a supplement to the NDST's popular Beyond Boundaries Network Guide. Workforce Planning and Design offers step by step guidance for diabetes networks on workforce development.
(Published September 2007)
Lesbian, gay, bisexual and trans (LGBT) people experience a number of health inequalities which are often unrecognised in health and social care settings. These briefings are intended to show that LGBT people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group.
The briefings provide easy-to-read guidance for health and social care commissioners, service planners and frontline staff. They aim to inform the delivery of appropriate services and to support health and social care professionals in their everyday work with LGBT people by providing fundamental awareness and evidence of LGBT needs in relation to health.
(Published September 2007, 13 Briefings)
The most comprehensive assessment to date of the unprecedented levels of funding invested by the government in the NHS over the past five years is published today by the King’s Fund.
Five years on from his seminal report for the Treasury which paved the way for the 50 per cent real terms increases in NHS spending since 2002, Sir Derek Wanless’ latest review for the King’s Fund examines how the extra money has been spent; what the NHS has achieved; whether the pace and direction of government reform has delivered value for money; and considers what lessons can be learned for the future.
(Published September 2007, 321 pages)
Practice based commissioning (PBC) is an England-only initiative and is about engaging primary care professionals in the commissioning of services for patients within their health locality. Through PBC, front line clinicians are being provided with the resources and support to become more involved in commissioning decisions. This section of the website supports pharmacists in the implementation of practice based commissioning by providing access to a range of news, tools and guidance.
This case study describes how two of the government's key initiatives have been brought together to drive the integration agenda in Oxfordshire. Practice-based commissioning is being used in one English county to integrate health and social care practice, and so promote independent living in the community.
Journal of Integrated Care 2007; 15 (4): 13-19
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NHS organisations have a great opportunity when transferring assets to social enterprises – particularly with the scope afforded by NHS Estate code, the guidance on managing their estate for disposals other than sales at open market value. Jane Donnison explains.
Please note access to the Health service journal requires self registration
Community Matron Interventions
Probabilistic sensitivity analysis: an audit of current practice and a review of its use and value in decision making (HTA Project)
Dental Commissioning and Contract Monitoring: NEW! 17/9/07 Performance Management Tools Launched
Commissioning guides: a resource for healthcare commissioning (leaflet)
PBC offers an opportunity for GP practices, Primary Care Trusts and local people to work together developing more appropriate pathway-based care and more efficient services. The report 'Practice Based Commissioning & Patient & Public Involvement: The New Frontier' explores this area.
However despite a general feeling that users should be involved, views of local communities are rarely taken on board with PBC.
Surveys carried out by NHS Alliance and Developing Patient Pathways suggest that some practices a experiencing barriers to involving patients in the early phases of PBC, despite adequate mechanisms.
(Published July 2007, 26 pages)
Enhanced services are services not provided through essential or additional services, or essential and additional services delivered to a higher specified standard. They were negotiated into the GMS contract as a key tool to help PCTs reduce demand on secondary care. Their main purposes are to expand the range of local services to meet local need, improve convenience and choice, and ensure value for money. They were designed to provide a major opportunity to expand and develop primary care, and give practices greater flexibility and the ability to control their workload.
(Updated August 2007)
The Primary Medical Services (Directed Enhanced Services) (England) Directions 2007
(Updated August 2007)
The aim of this fact sheet is to help those affected by Payment by Results (PbR) understand how it works and ensure that the system operates in the best possible way for people in need of stroke care. This fact sheet begins by explaining the PbR tariff and looks at the key issues for stroke and TIA services. PbR is a way of paying for services commissioned on behalf of NHS patients provided by NHS Trusts, NHS Foundation Trusts (FTs), Independent Sector Extended Choice Network providers and PCTs. There is a national price list for all activity within the scope of PbR – this is the “national tariff”. Providers are paid according to the amount of activity they do, multiplied by the relevant tariff price. Activity x Price = Income
(Published July 2007, 13 Pages)
Following the announcement of capital funds to assist the campus reprovision programme, a letter has now been sent to PCT Commissioners informing them of the bidding process to apply for this year’s capital funding for reproviding campus learning disability services in the community.
(Published August 2007)
NHS Comparators (NHSNet Site) is a national resource, initially focused on supporting Practice Based Commissioning. It supports comparisons at GP practice, Primary Care Trust, Strategic Health Authority and national levels, enabling users to investigate aspects of local commissioning activity, costs and outcomes. It is designed to supplement information available by local systems, not to replace local systems. The initial releases have limited functionality and a modest range of comparators but this will increase quite quickly over time.
This article describes people-based commissioning, to be distinguished from the more technical and short-term approach characterised as pocket book commissioning, and argues that people-based commissioning should be the preferred approach, which needs to address public health and mental health needs of the community.
Quality in Primary Care 2007; 15 (4) p. 235-239
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Not for profit and for profit sectors are currently working both alongside and in competition with NHS provider organisations. How all parts of the service system interconnect will in future be crucial for service users and carers.
Mental Health Review Journal, 2007; 12 (2) p. 25-29
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As the primary care landscape changes following recent proposals for expansion and greater services, astute individuals and teams are taking the opportunity to expand their horizons. One such individual is Dr Peter Godbehere, who, together with several other local practices, formed a private business providing additional health services.
Management in Practice, 2007; 8 p. 26-27
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The objective was to investigate the cost effectiveness of screening for Chlamydia trachomatis compared with a policy of no organised screening in the United Kingdom.
BMJ , 2007; 335, (7614) p. 291-294
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This article describes the products and services of the Greater Manchester commissioning business service and other such agencies which support PCTs and practice-based commissioners. Providing such support as needs analysis, commissioning strategy, service and pathway redesign, market management and contracting, performance reporting and contract management.
HSJ, 2007: 117 (6072) p. 22-25
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A survey of Primary Care Trusts (PCTs) was carried out to determine their readiness to engage patients and the public in healthcare commissioning. One third (51 out of 152 PCTs) responded. By virtue of their interest in the survey, these are likely to be among the better end of the patient and public involvement spectrum. While some PCTs have embarked on ambitious programmes to engage patients and the public in commissioning, many are not ready for the new challenges that confront them.
It is crucial that PCTs effectively involve patients and the public in their commissioning processes. A commissioning strategy without the input of the community is not worth the paper it is written on. But if they are to prioritise this as they must, PCT staff need help: they need budgets, leadership, techniques and technology.
(Published June 2007, 25 pages)
The report outlines examples of good practice in provision of health care services to offenders in prison and the community. The examples have been drawn from surveys, internet search and individual submissions. From all of the documents and sources reviewed, over 400 were selected as potential examples of good practice. The examples have been distilled from that selection and form the results of the survey.
(Published July 2007, 81 pages)
Recent years have seen great changes in the accountability of different parts of the NHS as alternative providers have become an increasingly visible part of the healthcare landscape. This latest report from Durham University is therefore very timely in its analysis of the wide variety of organisations characterised as social enterprises and their approaches to involving staff, public and patients.
(Published July 2007, 63 pages)
This report sets out our findings on: the extent and nature of the voluntary sector's delivery of public services; the locally perceived impact of government efforts to build capacity; the current state of commissioning; and procurement practice. The report is primarily for managers in local councils who are responsible for commissioning services, but it will also be of interest to voluntary organisations and national policymakers.
(Published July 2007, 76 pages)
This paper argues that effective joint commissioning between health and social care is a necessary component of the government's plans for adult services manifest in the policies of its 2006 white paper, 'Our health, our care, our say'.
Journal of Care Services Management 2007; 1 (3) p. 279-93
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Strategic Health Asset Planning and Evaluation toolkit (SHAPE) has been developed by the Department of Health for SHAs and PCTs. SHAPE is a web enabled, evidence based tool designed to support and inform strategic planning. It brings together existing national data sets of clinical activity, human geography and healthcare estate assets supported by Geographical Information Systems (GIS) technology.
This paper presents a conceptual framework that is expected to facilitate comprehensive, rigorous, and standardized evaluation of contracting-out at health system level.
Health Policy 2007; 82 (2) p. 200-11
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As the primary care landscape changes following recent proposals for expansion and greater services, astute individuals and teams are taking the opportunity to expand their horizons.
Management in Practice 2007; 8 p. 26-27
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The purpose of this Primary Care Service Framework is to equip commissioners, providers and practitioners with the necessary background knowledge, service and implementation details to safely commission and deliver a high quality, integrated service for the management of health for people with learning disabilities in primary care.
(Website)
South West Primary Care Leads Network Event: PBC & Pharmacy
New university-accredited programme: Advanced Commissioning
Delivering the 18 week pathway; Update
Practice based commissioning and 18 weeks: How to create win-wins
Improving services and support for people with dementia
Dental Commissioning and Contract Monitoring
How can funding of long-term care adapt for an ageing population?
This briefing bulletin will help directors of children’s services and senior managers with lead responsibility for strategic commissioning to improve outcome for children and young people by developing more robust commissioning arrangements. The briefing is informed by a study seminar sponsored by the Improvement and Development Agency (IDeA), the Department for Education and Skills (DfES) and Research in Practice (RiP). Discussion at the seminar was wide ranging; it provided a rich source of information and practical suggestions. The seminar confirmed that strategic commissioning is a complex process and that directors of children’s services need to play a lead role in championing new approaches. Commissioning must focus on outcomes – and this is a different and challenging way of designing and performance-managing services.
(Published July 2007, 20 pages)
This guidance provides assistance in influencing the commissioning process for nurses who manage and lead children’s and young people’s services. As children’s nurses, it is our professional duty to monitor the quality of services provided to children and their families and influence processes for service enhancements. Commissioning processes are continually evolving, and this document will provide information and support to help you influence the development of effective, efficient and appropriate high quality services for your area.
(Published May 2004, 20 pages)
The Laming Inquiry, followed by the publication of Every Child Matters, heralded the start of a debate that would bring about the most significant changes to the provision of Children’s Services for a generation. This document seeks to bring together core principles and challenges, as well as evidence of good practice. We hope it will help professionals in all sectors to share a common understanding of commissioning and the role of voluntary sector plays at the moment and has the potential to play in the future, as we progress our shared goal of improving children’s outcomes.
(Published 2004, 35 pages)
The framework aims to help local planners and commissioners to design a unified system in each local area which will create a clear picture of what children and young people need, will make the best use of resources, and will join up services so they provide better outcomes than they can on their own. The framework is designed for people working in all sectors of children, young people and maternity services including political leaders, senior management, planners, commissioners, providers, corporate procurement, finance, legal and other support staff, central and regional government officials.
(Published 2006, 36 pages)
This self-assessment tool is designed to assist PCTs and their partners in assessing their knowledge and capability to commission children's and young people's services. It reflects the importance of effective partnerships in commissioning the integrated services, which are fundamental to the improved outcomes of services for children and young people.
(Published April 2007)
This paper examines commissioning processes for drug services in the case of vulnerable young people. In the context of government's modernisation agenda it characterises drug service commissioning as an activity that should occur across professional boundaries in health, social care, local authority and crime agencies.
Drugs education prevention and policy, 2003, 10 (3) p. 251-262
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What will a shake-up of children's services mean for joint commissioning bodies? Amanda Reid provides an overview.
Care and Health Magazine, 2005 Suppl., (105) p. 17-18
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The Children and Young People's Plan (CYPP) is an important element of the Every Child Matters reform programme. It has been a powerful force in driving forward better local integration of children's services and the development of local partnership arrangements.
A series of 12 papers that presents the findings from NFER’s analysis of Children and Young People’s Plans (CYPPs) were produced. Number 3 Commissioning and Resourcing in Children and Young People’s Plans sets out how aspects of commissioning and resources feature in CYPP and includes illustrative examples.
This document provides best practice guidance for commissioners and providers on how the roll-out of free choice in elective care in 2007/8 will operate. It supplements existing guidance on choice at referral policy and implementation by setting out a framework to govern the further extension of choice in 2007/08.
(May 2007, 16 pages)
This document evaluates the NHS Institute’s Care Closer to Home Programme, which ran from November 2005 to March 2007. It identifies the factors that helped or hindered progress in shifting care outside hospital, and the lessons for the NHS from the experience of field test sites. The NHS Institute’s Care Closer to Home Programme
was established in 2005 to explore the scope for bringing about shifts in care within the NHS. Following an observation phase that ran from November 2005 to February 2006, the NHS Institute selected five healthcare communities to act as field test sites. In these five sites, 14 projects were identified to provide the focus for the programme.
This report summarises the main findings of the evaluation and the lessons for the NHS. It notes that almost all the 14 projects have started to test the scope for making shifts in care, with some getting underway more quickly than others.
(May 2007, 49 pages)
The Government has set out its vision for a Sure Start Children's Centre in early community. Children's centres offer significant opportunities for improving children's health and ensuring that families are able to access the information, support and services they need to help their child to thrive and achieve their full potential. The purpose of this document is to increase PCTs awareness of the childrens’ centres agenda and the opportunities it provides.
(June 2007, 30 pages)
This document aims to help Local Pharmaceutical Committees think through the action they should be taking to assist community pharmacy contractors understand and engage with Practice Based Commissioning (PBC). As well as providing background information on the place of PBC in current policy, it provides practical suggestions.
The NHS has undergone many reforms over the past decade. To test out where the reforms – and interactions between them – might lead the NHS, the King’s Fund formed a partnership with Loop2, Monitor and Nuffield Hospitals to produce Windmill 2007. This initiative included a two-day simulation of a fictional but realistic health economy from 2008 to 2011 and extensive discussions of the emerging findings from that event with clinicians, managers, policy-makers, regulators and analysts.
(June 2007, 80 pages)
This report sets out a rational way forward to secure the long-term future of the NHS in England. The main body is divided into two sections, on: a) where and why the reform programme is going wrong; b) the BMA’s rational way forward for health service reform in England.
(May 200, 82 pages)
A Practice Based Commissioning (PBC) Comparators website is launched nationally this month. The benchmarking service uses existing data sources from The Information Centre and NHS Connecting for Health Secondary Uses Service, standardises it for population and breaks it down by GP practice to show activity and referral patterns and outcomes for a number of key conditions.
This guidance provides advice on strategic commissioning of sedation services, together with advice on some transitional issues where PCTs have sought clarification of existing guidance. (June 2007, 14 pages)
A toolkit to enable PCT commissioners plan and commission high-quality TB services for their local population. (June 2007, 60 pages)
This paper sets out the tools and levers now available for practice based commissioners to provide more services in the community.
Journal of Care Services Management 2007; 1 (3): 245-251
Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD) which are costly to manage.
PBC has the potential to increase the quality and range of services available to patients, but PCTs must exercise caution to avoid conflicts of interest.
HSJ, 2007; 117 (6057): 14-15
Health Management Specialist Library: Demand Management, referral from primary to secondary care
NHS Costing Manual: 2006-07
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
Focus On Commissioning - End of Life Care: A Commissioning Perspective
Estimating health and productivity gains in England from selected interventions
Dental Commissioning and Contract Monitoring - General Commissioning
Practice Based Commissioning (PBC) Bulletin 5 – Pharmacy and PBC
Commissioning News
This briefing paper is intended for use by managers and professionals who are either involved in the direct management and delivery of integrated services in England, or the commissioning of these services. The paper provides an overview of the scope of public health practice, outlines some of the tools and techniques that might be used in designing and evaluating integrated services, and explains how they might be used as a lever for change and service improvement. The paper includes case studies showing how public health techniques can be applied, and links to further resources and material for those interested in developing a more detailed understanding of public health practice.
(Published May 2007, 52 pages)
Our health, our care, our say - a new direction for community services reinforced the importance of services provided by healthcare professionals working in community settings, and both Practitioners with Special Interests (PwSIs) and NHS specialist staff have a key role in the delivery of such services. This updated national guidance aims to provide practical support to commissioners for the provision of more specialised services closer to home with the emphasis on the role of PwSIs. It also includes new robust governance arrangements for GPs and Pharmacists with Special Interests to ensure the services in which they work are safe, of a high quality and better able to meet patients’ needs in the communities in which they are located.
(Published May 2007)
King’s Fund: Although practice-based commissioning (PBC) receives widespread support among the main political parties and NHS stakeholder groups, implementation of this policy has been slow. The NHS now boasts ’universal coverage’ of PBC but in practice this means it has created an environment in which PBC could flourish rather than one in which it is flourishing. This paper considers the current state of PBC implementation and how it might be driven forward within the NHS. Drawing on the results of a ‘straw poll’ of GPs and practice managers, the paper outlines a course of action that the NHS could adopt to move PBC from a good idea to effective practice.
(Published May 2007, 16 pages)
(Press Release)
The Department of Health document: Specification of the provision of psychological therapies by commissioner-led pilot sites. Organisations are invited to tender for participation in pathfinder sites based on the specification and demonstrate how and when they will meet the specifications contained within the document.
(Published May 2007)
Everyone in society has the right to make a difference within their local community, but some can be restricted by their mental health problems. This document, by CSIP Choice and Access Team, describes services that provide everyone with depression and anxiety disorders with access to the right treatment. It also sets out the learning so far from the demonstration sites. It is intended to be used to inform the development of a further 10 Pathfinder sites. Other commissioners who wish to review their current services and consider improvements to their services can also use it.
(Published May 2007, 32 pages)
Zosia Kmietowicz states GPs and practice managers in England are struggling to implement practice based commissioning, a survey shows, because of problems getting support and information from their primary care trusts.
BMJ 2007;334:1079
The introduction of practice-based commissioning [PbC] has meant a new set of challenges - and responsibilities - for the practice manager. The need to oversee clinical delivery demands a new relationship with the community and with local hospitals. Christine Ranson, a practice manager in the West Midlands, relates how PbC has impacted on both her surgery and her job.
Management in Practice 2007; 6 : 19-21
The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease. CONCLUSIONS: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.
Int J Technol Assess Health Care. 2007 Winter;23(1):71-9.
The national director for diabetes sets out how services are changing to meet the needs of patients, and how they need to change in the future. Clinicians in primary and secondary care need to work together and work in partnership with patients to improve care for people with diabetes.
(Published May 2007, 16 pages)
The Department is publishing information that it collects from SHAs to monitor progress towards universal coverage and practice take-up of incentive payments. This information is collected on a monthly basis and will be published once figures have been verified. Latest data from 31st March 2007 shows all PCTs had achieved universal coverage by December 2006, practice uptake is at 96%.
February. (Published April 2007)
PCC has published four Primary Care Service Frameworks: Long Term Conditions, Support for Self Care, Sexual Health and Obesity. Each Primary Care Service Framework is a generic, comprehensive and enhanced service specification for PCT commissioners and Practice Based Commissioners for 2007/08. Each Primary Care Service Framework has been developed in the context of the Commissioning Framework, White Paper implementation, key national priorities and targets, and delivery mechanisms of Practice Based Commissioning.
The purpose of this guidance is to help local healthcare commissioners throughout the UK to handle requests from the public to go to certain other European countries for treatment which in the UK is provided in hospitals. It reminds commissioners of the arrangements that already exist for handling such requests and explains the implications of recent rulings by the European Court of Justice (ECJ) in the Watts and other related cases. It advises commissioners that they must have systems in place for handling requests to go abroad for treatment.
(April 2007)
The NLH Health Management Specialist Library have produced this page to support demand management. The NHS Operating Framework 2006/7 includes an expectation for PCTs to have plans in place for the management of demand in three key areas: practice-based commissioning, provisions in contracts and monitoring arrangements.
This self-assessment tool is designed to assist PCTs and their partners in assessing their knowledge and capability to commission children's and young people's services. It reflects the importance of effective partnerships in commissioning the integrated services, which are fundamental to the improved outcomes of services for children and young people. (Published April 2007, 16 pages)
The National Institute for Health and Clinical Excellence (NICE) is producing a series of web-based Commissioning Guides to help the NHS in England effectively commission the best care for patients. NICE believes it important to involve patients and the public in the development of these guides, and is seeking applications from organisations representing the interests of patients, carers and the wider public for the Commissioning Programme’s Steering Group.
The National Audit Office is planning to undertake a study on the new contracts for GPs. This is the second in a series of studies on Pay Modernisation in the NHS. The study aims to address the question: 'Do the current contracts for GPs' services offer good value for money?'.
Wynn Jones and Lakasing discuss how responding to PBC, enhanced service bids and alternative provider medical services (APMS) is proving difficult for practices.
British Journal of General Practice, 2007, vol. 57 (537) p. 328-9
This Consultation highlights issues of the Commissioning framework for health and well-being that are of particular relevance to primary care trusts (PCTs) and invites the comments of NHS Confederation members on the key issues raised in the document.
The Department of Health has developed a simple toolkit that can be used to determine weighted capitation indicative budgets at practice level. The data files for use in the toolkit have now been updated to include 2006 data. The weighted capitation formulae are benchmark Supporting practice based commissioning in 2007/08 by determining weighted capitation shares at practice level.Welcoming social enterprise into health and social care guide to determine 'fair resource shares' and not an automatic means to set indicative budgets. As detailed in 'Practice based commissioning: Practical Implementation', practice indicative budgets in 2007/08 should be calculated on the basis of actual activity (at 2007/08 prices), current formulae for prescribing plus uplift and weighted capitation where no historic data is available.
(Published 2006, Updated March 2007)
A Department of Health resource pack which signposts people / organisations to support and guidance on setting up a social enterprise in the health and social care sector. This pack offers both those wanting to start and those already operating a social enterprise a useful gateway to important information needed to set up or expand service in the health and social care arena. This pack is also useful to commissioners who want to contract with social enterprises. The information in this pack is designed to support the development of social enterprise in England.
(Published March 2007, 37 pages.)
The one-year ‘towards practice based commissioning’ directed enhanced service (TPBC DES) will end on 31 March 2007. Arrangements for the DES are set in legislation in the Statement of Financial Entitlements (SFE) (Amendment) (No. 3) Directions 2006. Payment of component 2 (C2) of the DES will depend on achievement against the objectives/targets set locally in practices’ DES plans.
(March 2007)
Maternity Matters: choice, access and continuity of care in a safe service is published by the DH for commissioners, service providers and other organisations involved in the provision of maternity services. It builds on the maternity services commitment outlined in Our Health, Our Care, Our Say and is an important step towards meeting the maternity standard set out in the Children’s NSF.
(Published April 2007)
The Information Access Toolkit is designed to help commissioners and providers of health and social care services to meet the information needs of people with long-term neurological conditions. The toolkit was developed over two years by the Information Access Project at the Brain and Spine Foundation, and was launched during Brain Awareness Week (12-18 March 2007) at Spinal Injury Association House in Milton Keynes.
(Published March 2007)
As the NHS works towards achieving financial balance and meeting targets for service improvement, increasing attention is being given to ways of improving efficiency. The focus on efficiency is likely to sharpen in the period up to and after 2008 when the growth in expenditure is likely to slow following the outcome of the comprehensive spending review.
(Published February 2007)
This NTA document has been developed for service managers and practitioners delivering specialist substance misuse services to young people under the age of 18. It describes a framework for specialist substance misuse assessment, how specialist substance misuse assessment dovetails with the Common Assessment Framework (CAF) for children and young people (DfES, 2006a) and outlines the context of undertaking an assessment of young people and care planning arrangements.
(Published February 2007, 28 pages)
In this article the authors express their views on how the commissioning process can be held to account through patient and public involvement. Ten areas essential to effective scrutiny are outlined.
Health Service Journal, 22 March 2007, vol. 117, no. 6048, p. 18-19.
This document focuses on the role of third sector organisations as providers within health and adult social care.
(March 2007, 28 pages)
Commissioning Toolkit for Long Term Conditions
Department for Health: Detailed questions and answers on Practice based commissioning: practical implementations
National Event: Implementing Care Closer to Home - Providing Convenient Quality Care for Patients
Practice-based Commissioning; Implementation examples by location
Practice-based Commissioning; Implementation examples by topic
For the first time, the information requirements for commissioning GPs have been identified. The Intelligent Practice, the fourth report in the independent Intelligent Board series, proposes a basic set of criteria as the information necessary to the running of a successful practice. The report's steering group, all practising GPs, unanimously agreed that practice-based commissioning is the key to the modernisation of the NHS. Effective commissioning depends on effective information. GP commissioners are not receiving the information they need to ensure that their local populations receive the best quality health services. This report is a practical guide for GPs and PCTs. It sets out two frameworks of minimum information requirements: one for every GP and another more detailed one for lead commissioners.
(Published February 2007, 18 pages)
Commissioning for health and well-being means involving the local community to provide services that meet their needs, beyond just treating them when they are ill, but also keeping them healthy and independent. This framework builds on the White Paper Our health, our care, our say, which promised to help people stay healthy and independent, to give people choice in their care services, to deliver services closer to home and to tackle inequalities. This framework is about action, with a particular focus on partnership. It is for everyone who can contribute to promoting physical and mental health and well-being, including the business community, government regional offices and the third sector.
(Published March 2007, 100 pages)
Over the last ten years, there has been increasing concern at the rising numbers of preventable drug related deaths. Many drug-related deaths can be prevented by commissioning and providing a baseline of quality services that are evidence-based and responsive to local need. The aim is to provide treatment through integrated care pathways across all four treatment tiers that are as seamless as possible, as indicated in Models of care (NTA 2002). The establishment of effective interfaces between services across all tiers of service provision requires communication and collaboration between services. Central to this are joint commissioning of services, common assessment /referral protocols that are appropriate to each tier and the establishment of robust service level agreements.
(Published February 2007, 12 pages)
This King’s Fund Briefing discusses the Department of Health second ‘operating framework’, The NHS in England: The operating framework for 2007/08 (Department of Health 2006), which provides a set of rules and guidance for NHS organisations in England for the year ahead. Aimed primarily at managers and clinical staff, the operating framework for 2007/8 is the latest in a series of explanatory documents that aim to explain the purpose of NHS reforms and add detail on how those reforms should be carried out.
DH Operating Framework
This guidance provides advice on strategic commissioning of sedation services, together with advice on some transitional issues where PCTs have sought clarification of existing guidance. Previous guidance on sedation services has focused on transitional issues associated with the new contractual arrangements from 1 April 2006. This guidance addresses strategic commissioning issues that have previously been covered only by more general guidance on specialist dental services.
(Published February 2007, 13 pages)
Commissioners will not have to pay for any type of hospital treatment they have not authorised, or for activity which exceeds agreed limits, under the new model contract. The final contract, published on Friday, makes no concessions to foundation trusts' fears that it threatens their survival. Primary care leaders have welcomed it as a 'necessary rebalancing' between commissioners and providers.
Access to the Health service journal requires self registration
PCTs can now commission primary medical care services from a range of different providers. Yet a recent study by the Kings Fund reveals that the volume of alternative types of provider in primary care remains small and the use of APMS contracts limited.
British Journal of Health Care Management, 2007, vol. 13, no. 2 p. 43-46 (Available via your local NHS Library)
This article outlines the government's changes to the way that primary and community health services will be commissioned and provided. It also discusses the opportunities that exist for nurses to lead and develop services for the benefit of patients in the implementation of changes.
Nursing Standard, 2007, vol. 21, no. 23, p. 43-48 (available via your local NHS Library)
In December HSJ ran the PCT Futures conference in London, bringing together a wide range of speakers from government, primary care, and the independent sector. In this special report we examine some of the main themes to emerge, from the complex arguments around splitting commissioning and provision, to the role of independent providers and writing a new chapter in the troubled history of public engagement.
HSJ, 2007, vol. 117, no. 6040, p. 29-33 (available via your local NHS Library)
The objective of this study was to evaluate the cost-effectiveness of a nurse-led, home-based, case-management intervention (NHI) after hospital discharge in addition to usual care. In conclusion the authors do not recommend the implementation of this intervention in populations that do not consist of severely vulnerable and complex patients.
Journal of psychosomatic research, 2007, vol. 62, no. 3, p. 363-70 (available via your local NHS Library)
This Guide to Commissioning Mental Health Services is the second in a series of guides developed by the National Primary and Care Trust Development Programme (NatPaCT) to assist Primary Care Trusts (PCTs) and Local Authorities in the vital role leading ‘Whole System Commissioning’ of health and social care. The structure and content has also been informed by a wealth of input from the National Institute for Mental Health in England (NIMHE) whose aim is to improve the quality of life for people of all ages who experience mental distress. This Guide has been designed to support PCTs and Local Authorities in understanding how to use their commissioning activities as a key part of improving the mental health of the communities they serve.
(Published January 2005, 162 pages)
This guidance is designed to assist commissioners of mental health services in the refocusing of day services for working-age adults with mental health problems into community resources that promote social inclusion and promote the role of work and gaining skills in line with current policy and legislation. This is good practice guidance for commissioners and it progresses the implementation of the developmental standards as set out in 'National Standards: Local Action'; published by the Department of Health in 2004.
(Published February 2006, 28 pages)
This paper looks at the implications of GP practices commissioning mental health services, and the risks and benefits to the patients who use the services.
(Published November 2004, 8 pages)
This document provides best practice guidance to help PCTs plan for, design, commission and monitor services that will deliver improved physical health and well-being for people with severe mental illness. It describes appropriate leadership for a physical healthcare programme, roles and responsibilities of those involved and provides case studies.
(Published August 2006, 38 pages)
Parsonage argues that payment by results represents both an opportunity and a threat for mental health commissioners. On the positive side, it offers PCTs the chance to exert more leverage in the system, for example in the planning and design of services and, where supply conditions permit, in promoting choice and contestability. On the downside, it requires them to manage more risks, particularly financial risks.
Primary Care Mental Health, 2005, vol. 3, no. 4, p. 271-273 (available via your local NHS Library)
Increasingly there is greater emphasis on user/carer involvement in the delivery of mental health care. There are five levels of participation from none at all to partnership and optimal involvement. A two-year pilot steering group was established by a health authority in December 2000 and criteria for independent evaluation agreed. These included the context, data collection, analysis and report, and recommendations based on the findings to increase user/carer involvement in all aspects of mental health service delivery.
Mental Health Review, 2006, vol. 11, no. 1, p. 16-2 (available via your local NHS Library)
The 10 high impact changes were first launched in 2004. Now, building on the success of the original work, this guide sets 10 High Impact Changes for use across mental health services. The scope is wider but our aim of improving quality and efficiency of care for each and every service user remains the same and will continue to guide our service improvement activity through 2006 and beyond. The 10 high impact changes aim to improve quality of care but they are also about improving the efficiency of services – making the best use of resources to benefit service users. In this sense the drive to increase efficiency provides a more streamlined and effective service tailored to individual service user needs.
(Published June 2006, 57 pages)
Successive Department of Health (DH) initiatives have sought to achieve widespread, sustained service reconfiguration in the NHS, aiming to deliver patient-centred services closer to where people live and work. This has proven to be extremely challenging, and the DH has concluded that fundamental reforms to NHS commissioning are necessary to drive change. Effective commissioning will assure service users and tax payers that those who configure and contract health services on their behalf are doing so in a manner that achieves the best possible health outcomes and provides value for money. But what is effective commissioning: what does it look like? This is the question the Health Policy Forum recently asked the Health Services Management Centre and the King’s Fund to investigate. The resulting report 'Making commissioning effective in the reformed NHS in England' will enable commissioners to benchmark and help Strategic Health Authorities and others to performance manage commissioners. We believe it constitutes a useful contribution to the ongoing debate on NHS reform.
(Published December 06, 54 pages)
The Health Inequalities Intervention Tool is designed to support Spearhead Primary Care Trusts with their Local Delivery Planning and commissioning. It is designed to help achieve the Department of Health (DH) Public Service Agreement (PSA) target for life expectancy.
The DH PSA target on life expectancy aims to 'by 2010 reduce by at least 10% the gap between the Spearhead areas and the population as a whole'. This tool provides information on the following:
This DH document provides PCTs and practice based commissioners with practical advice on commissioning community based eye care services. It draws on evidence that has emerged from the evaluated pilot pathways (glaucoma; age-related macular degeneration (AMD); low vision) that were set up following the work of the Eye Care Services Steering Group. It also fits within the wider commissioning framework.
(Published 17/01/07 2007, 60 pages)
Early examples suggest commissioning changes could cut 2.5 million pointless GP referrals - NHS meets target for rolling out reforms. GPs are sending fewer patients to hospital for unnecessary appointments following Government reforms giving practices a greater say in how the NHS provides and buys services for patients. Reports from the NHS, published for the first time today, show that GP practices in some parts of the country are cutting the number of patients they refer to consultants by a quarter by taking direct control of commissioning decisions.
(Published 26/01/07)
One of the key objectives set out in the White Paper Our health, our care, our say is to secure better access to general practice. In some places this will mean encouraging or allowing new providers, including social enterprises or commercial companies, to offer services to registered patients alongside traditional general practice. This guide is aimed at these new providers, or potential primary medical services contractors.
(Published November 2006, 37 pages)
Joan Higgins argues that the way in which commissioning is being developed in the NHS raises serious questions. The current approach is unlikely to activate real change. Geographical restrictions on commissioning should be reconsidered.
BMJ, 2007, vol. 334, no. 7583, p. 22-24
The health department has finally released further guidance on practice based commissioning; the document outlines the role that PCTs should be taking with regard to commissioning.
Practice Management 2007, vol. 17, no.1, p. 10-11
These documents support the NHS operating framework for 2007-08.
The NHS contract for acute hospital services will cover agreements between PCTs and providers for the delivery of acute hospital based care.
(Published December 2006, 73 pages)
The National Partnership Agreement is an over-arching agreement between the Secretary of State for Health and the Home Secretary for and on behalf of Her Majesty’s Prison Service. It is intended to underpin and complement the local partnership arrangements between NHS Primary Care Trusts and public sector prisons within the Prison Service. This is an updated version of the National Partnership Agreement issued in 2003. This document is intended to cover accountability and commissioning for health services for prisoners from April 2006, when transfer of commissioning responsibility for services from HMPS to NHS. Primary Care Trusts will be complete. It is intended that this document will be regularly reviewed and revised as appropriate.
(Published 15/01/07, 18 pages)
This paper seeks to critically assess the impact made by the introduction of commissioning and contracting as a new culture of social care in learning disability services. It offers an evaluation of the growth in importance of the user as consumer. Does the commissioning and the contract process give users with learning disabilities a greater influence over their services and ultimately their lives? It is suggested that far from empowering people with learning disabilities to have a say in the services they want, the emerging culture of business contracts and new public management transfers power firmly back into the hands of professionals making the decisions. Social work practice is changing in response to major shifts in social trends and at the behest of market values. Traditional models are being rejected and the challenge for social work is to adapt itself to operate within a competency based paradigm.
British Journal of Learning Disabilities, Concannon, Liam December 2006, vol. 34, no. 4, p. 200-205
Commissioning plays a major role in ensuring that a range of appropriate drug treatment services are available to meet the needs of the local population. The needs of the community for drug treatment must be understood and the system of service put in place to address these needs has to be well planned, coordinated and monitored in order to achieve this task.
NTA Commissioning Page
Cliff Prior, the new CEO of Un Ltd, the Foundation for Social Entrepreneurs which heads up a group of not-for-profit organisations, discusses in an interview social enterprises and their potential for providing community services in the NHS.
Health Service Journal, December 2006, Vol. 116, no. 6035, p. 18-19
All PCTs will have to conduct service reviews next year to examine the services they commission. They will also have to do a “local end of life service baseline review” in 2007-08, plus a strategy for choice in maternity.
Health Service Journal, December 2006, Vol. 116, no. 6036, p. 6
The BMA views the commissioning of patient care as a key function of a National Health Service seeking to balance the clinical needs of patients with the finite resources that society is prepared to make available via general taxation. Most importantly, effective commissioning has the potential to improve the range and quality of health services available to patients.
This document outlines a series of principles which the BMA would wish to see upheld as the role of commissioning develops.
(Published, November 2006)
The National Support Team for Sexual Health is tasked with assisting PCTs and sexual health services achieve 48-hour access to GUM services. This guide provides Ten High Impact Changes which will help commissioners and services to implement sustainable solutions that will improve access and reduce STIs in their area.
(Published 11/12/06, 68 pages)
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