More strategic, timely information needed in primary healthcare

One year after the publication of The Intelligent Practice, a recent survey carried out by Dr Foster Intelligence found that current primary care information provision is lacking in strategic vision.

Information provided by PCTs seems to be drawing mixed reviews. Asked to evaluate the overall quality, format and frequency, nearly half of respondents said that what they were receiving from their PCT was sufficient, although more than a quarter found the information insufficient.

Putting you in the picture

Putting you in the picture is the first edition of the North West Specialised Commissioning Team’s newsletter.

Intended primarily for colleagues in Primary Care Trusts (PCTs), this first edition outlines some of the team’s key achievements since their formation in April 2007.

Many of the projects they were involved in are ongoing, and they will update you on progress in future newsletters.

(Published February 2008, 8 pages)

Choice at referral

Best practice guidance and information for referrers, providers and commissioners on how the roll-out of free choice in elective care in 2008/9 will operate.

(March 2008)

Refocusing the care programme approach: Policy and positive practice guidance

Following the national consultation, Reviewing the Care programme Approach (CPA), and having considered the issues identified, this guidance updates policy and sets out positive practice guidance for trusts and commissioners to review local practice to refocus CPA within mental health services.

(Published March 2008, 64 pages)

National Primary Care Research & Development Centre: Practice Based Commissioning

This study has three main aims.

Establishing the rationale for the introduction of practice-based commissioning, will focus on the
programme theory for the policy.

Addressing how the scheme is being implemented.

Investigating the outcomes from practice-based commissioning on local health economies.

Other documents and conferences

New Horizons for Mental Health Commissioning - An opportunity to help shape the agenda. 7th May 2008

Report of a national review of NHS Health Library Services in England; Recommendation 33- The Commissioning process needs to be underpinned by knowledge

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PBC: Personalise your Improvement with the No Delays Achiever

The No Delays Achiever from the NHS Institute now offers (from 29 February 2008) Practice Based Commissioners the ability to select their PBC groups and examine their patients’ 18 week journeys. The No Delays Achiever is a web-based tool that creates Referral to Treatment pathways. Once you have registered on the No Delays Achiever site you can create a personalised Cluster view for your PBC network, selecting individual GP practices based either on PCT affiliates or from further afield. You can then analyse patient journeys from trust level all the way down to HRG and (anonymised) consultant level. You can learn more about how to use the tools in the No Delays Achiever from a commissioning perspective using the Commissioner’s Guide.

(You must first register with this site to use this tool)

No Delays: Commissioning

Dental Commissioning and Contract Monitoring - Tendering, Procurement & Contracting

Hints and tips procurement paper; This briefing note sets out some of the key lessons learned by a number of PCTs that have undertaken procurement exercises for NHS dental services. Competitive tendering exercises have been highly successful in several respects in primary care dentistry as they have: enabled PCTs to re-commission lost services; secured improved access in specific localities (or for specific types of population) in line with local oral health needs assessment; improved quality; tested the local market and securing improved VFM, as measured by the PCT’s average £/UDA before and after the exercise. PCTs felt they had achieved improved value for money without a reduction in quality.

(Published February 2008, 4 pages)

Evaluation of One-Stop Shop (Oss) Models of Sexual Health Provision

In 2001, the Government published the National Sexual Health and HIV Strategy and one of the recommendations is the provision of more comprehensive and integrated sexual health services. One of the commitments in the strategy was to undertake an evaluation of different models of One Stop Shops.

This report, which has just been published provides valuable findings and information for PCT commissioners and service providers considering an integrated approach as well as those already providing integrated services.

(Published February 2008, 250 pages)

Improving Access to Psychological Therapies implementation plan

This document provides SHAs, PCTs, training providers and service providers with an overview of what is needed to deliver the implementation of IAPT. The additional funding from the Comprehensive Spending Review 2007 will pay for the major training programme that provides the necessary number of suitably trained therapists and enables progressive expansion of NICE-compliant local Psychological Therapies services.

(Published February 2008, 32 pages)

National Infarct Angioplasty Project (NIAP) interim report

NIAP is a feasibility study looking at how far primary angioplasty can be rolled out as the main treatment for heart attack in place of clot-busting drugs. This interim report covers findings based on the first year of data from seven pilots and is being published for information.

(Published February 2008, 56 pages)

Practice-based commissioning : tips for preparing and pitching a proposal

Practice-based commissioning has been the focus of several recent pieces of guidance for pharmacists in England as well as the subject of an awareness week last year organised by national pharmacy bodies. The aim of a Dragons' Den style meeting, organised by Hampshire and Isle of Wight Local Pharmaceutical Committee [LPC] last week, was to gain some practical experience of preparing a business case and pitching for a service.

Pharmaceutical Journal 2008; 280 (7488): 153

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Strategic commissioning for older people

Whole system strategic commissioning for older people is undeveloped; however it is now rising up the agenda. This paper looks first at the development of a systematic approach to strategic commissioning. It then goes on to examine what is happening on the ground to develop a whole system approach to strategic change, particularly across social care, healthcare and housing, but also linked to a wider wellbeing approach. Finally, it examines the structures and processes that are being developed to support whole system strategic commissioning.

Journal of Care Services Management, January 2008, vol. 2, no. 2, p. 154-166

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Apply for Beacon Status

The Beacon Scheme, now entering its tenth successful year is looking to be the biggest and brightest round of all. Ministers have announced 12 themes that will be officially launched for application in early March 2008; including strategic commissioning.

Other documents and conferences

Department of Health Seminar on Mental Health Commissioning 7 May 2008

Conference: Transforming PCT Provider Services 30th April 2008

Book: More responsive public services? A guide to commissioning migrant and refugee community organizations

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Commissioning NHS primary care dental services: meeting the NHS operating framework objectives

High level guidance launched by Ann Keen, Parliamentary Under Secretary of State for Health Services, on 16 January 2008, sets out the Government's commitment to maintaining and expanding NHS dental services and the expectations on the NHS to deliver year on year increases in access, as set out in the NHS Operating Framework 2008/09 and to provide more detail on what this means for commissioners and providers in developing dental services locally, including managing the 2009 transition.

(Published January 2008, 5 pages)

The Future of Care Funding: Time for a change

Bringing together the findings from the Caring Choices events and website, this report looks at possible solutions to the problem of funding long-term care. Caring Choices, a coalition of 15 organisations from across the long-term care system, aimed to raise awareness and encourage debate, as well as generate and test out ideas among those with experience and understanding of the current system. Highlighting key areas of agreement and issues around the design of a new system, this report is an important step towards reform.

(Published January 2008, 36 pages)

Practice Based Commissioning GP practice survey

This is the second quarterly practice survey, covering a sample of practices from each primary care trust (PCT). The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC. The survey is part of a group of indicators that will be assessed together to give a picture of PBC implementation.

(Updated February 2008)

Best practice guidance for joint working between the NHS and the pharmaceutical industry

The purpose of this guidance is to; Encourage NHS organisations and staff to consider joint working as a realistic option for the delivery of high-quality healthcare; Inform and advise NHS staff of their main responsibilities when entering into joint working arrangements with the pharmaceutical industry.

(Published February 2008, 12 pages)

New release of NICE commissioning tools

In December 2007 NICE released an updated version (version 2) of the commissioning tools, offering enhanced functionality to end users, and updating the five commissioning tools published last year for activity, population and Payment by Results data.

This new version of the commissioning tools enables; commissioners within strategic health authorities to log in and view data at primary care trust level; general practices within a commissioning group to give other practices in their group permission to view their data, and to model commissioning intentions for the group; 3-year planning of commissioning intentions; the creation of user notes to accompany any commissioning model created; printing of selected tables, or all tables, within a commissioning tool together with any associated user notes.

Over December 2007 and January 2008 six new tools have been released.

Mental Health Act Commission's Biennial Report; Risks, Rights, Recovery

It is reported that patients deemed to be a threat to themselves or others are being denied hospital beds while commissioners squabble over money. The Mental Health Act Commission has found practitioners are being told to delay sectioning people with urgent mental health needs until primary care trusts ascertain who should pay for their treatment. The problem is being blamed on high bed occupancy levels and the need for PCTs to balance budgets. The Mental Health Act Commission claims that this has encouraged PCTs not to detain patients who have travelled from other areas until the home PCT has agreed to pay. The commission's biennial report Risks, Rights, Recovery criticises the practice as "improper".

(Published 2008, 290 pages)

Implementing practice based commissioning

In its recent report, the Audit Commission described the current state of implementation of practice based commissioning (Putting Commissioning in to Practice). The commission defined such commissioning as a way of managing financial risk as well as a means of improving services and use of resources. Under practice based commissioning, primary care trusts devolve indicative budgets to practices (practices do not receive the actual money, but operate within an agreed budget held and administered by the primary care trust) to give them financial incentives to manage referrals, and to commission and redesign services to make them more convenient, appropriate, and cost effective.

BMJ, 2007;335:1168

(Ask your local health librarian about access to this article - don't know who they are? Use HLISD to find them)

Learning from investigations

The Healthcare Commission has urged boards of all NHS trusts in England to heed the lessons from serious failings in healthcare services. It has highlighted the importance of good leadership, effective management and systematic use of information. The Learning from investigations report reviewed all investigations undertaken by the Commission under its statutory powers from August 2004 to April 2007. Investigations are undertaken where patient safety is seriously at risk. The report highlights clear common trends in the investigations the Commission has undertaken: poor leadership; ineffective management; inadequate teamwork with staff feeling unable to communicate problems; and a lack of clarity about who was responsible for what across the trust.

(Published 2008, 64 pages)

Working Across Boundaries for 18 weeks and beyond – registration now live

The NHS Institute is holding a learning and sharing event (registration link) for NHS organisations to work across professional boundaries to reduce delays. The day will showcase No Delays improvement work implemented by Ambassador Sites and Learning Networks and include sessions on a number of NHS Institute tools. A key focus of the day will be team development and facilitated action planning, so priority of attendance will be given to those coming in teams.

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Please Undertake This Survey to Help Us Improve The Commissioner

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Towards World Class Commissioning Competency

This paper is intended to assist the thinking of those currently seeking answers to questions, such as: What are health care commissioners required to do? What knowledge, skills, attitudes and behaviours are required to do it well? Who (either within or beyond the NHS) is most likely to possess these attributes at the moment? How should these capabilities be developed and distributed in future? The paper concludes that a one-size fits- all approach to defining and developing commissioning competency is unlikely to be optimal, and reiterates that competency depends not just on knowledge and skills, but on values, motivation, and agency. This is an important message for those involved in commissioning at all levels of the system.

(Published December 2007, 24 pages)

Practice based commissioning - budget setting refinements and clarification of health funding flexibilities, incentive schemes and governance

The direction of travel for practice based commissioning remains unchanged. This document follows up the commitment made in Practice based commissioning: practical implementation to refine the budget setting methodology, and responds to requests received through the Commissioning Framework for Health and Well-being consultation for clarification on the flexible use of NHS funds, governance arrangements and incentive schemes.

(Published December 2007, 16 pages)

King's Fund statement on NHS Operating Framework 2008/09

Commenting in response to the publication of the NHS Operating Framework for 2008/09, King’s Fund chief executive Niall Dickson said:

'It is right that the government should set national priorities and right too that they should maintain the assault on hospital infections and the drive to cut waiting time. These are areas that patients are justifiably concerned about and it is imperative the NHS makes progress in them.‘

Crucially, this document is an important step forward in getting to grips with what has long been the Achilles heel of the service – commissioning. The Department of Health is right to emphasise that better care and services will not be achieved through central directives and targets, but through better local commissioning led by primary care trusts (PCTs).

Practice and Provider Monitor (PPM) - a common information source for both providers and commissioners

Designed to build on the Practice Based Commissioning (PBC) and Hospital Activity Tracker (HAT) tools, PPM allows commissioners, GPs and service providers to share, discuss and monitor in-hospital activity on-line.

The new PPM tool includes: new, easy-to-use tool design; budgeting function with the ability to upload and cascade budgets down to practice level; an activity query facility, enabling the GPs, PCTs and acute trusts to highlight queries and resolutions with one another; new standard built-in reports; an HRG national tariff look-up table for easy reference.

Collaborative commissioning of National Screening Programmes

This best practice guidance sets out roles and responsibilities for the collaborative commissioning of national screening programmes, as recommended in Sir David Carter's Review of Commissioning Arrangements for Specialised Services.

(Published December 2007, 23 pages)

A funding model for health visiting

This is the second of two papers offering the information required to work out how to fund a health visiting service. The first paper gave the basic requirements, while this one identifies and explains the separate components of the service along with issues of scope and skill mix.

Community Practitioner, Dec 2007, vol. 80, no. 12, p. 24-31

A personal approach to public services

Across the political spectrum there is broad agreement around the direction of travel in public service reform, with the emphasis being on localism, citizen engagement, plurality of provision, personalisation, and choice. The ultimate prize is public services that are targeted at the greatest need, delivered in a coherent way, and responsive to users’ views and experiences. This is addressed by A Personal Approach to Public Services.

(Published 2007, 27 pages)

Evidence-based Commissioning Collaboration

The Evidence-based Commissioning Collaboration is currently made up of 2 commissioning consortia: North Derbyshire, South Yorkshire & Bassetlaw Commissioning Consortium (NORCOM), and part of The North East Yorkshire & North Lincolnshire Primary Care Organisation (NEYNL), which, on behalf of PCTs in their areas, are working with the School of Health and Related Research (ScHARR). ScHARR is based in the University of Sheffield and houses the northern arm of the Trent Research and Development Support Unit.

The objective of the Collaboration is to share research knowledge about the effectiveness and cost-effectiveness of service interventions to inform the commissioning process. These will usually be interventions which are not likely to be addressed by NICE in the near future. The choice of topics is determined collectively by the PCTs through their commissioning Consortia.

Other documents and conferences

Event: Working Across Boundaries for 18 Weeks and Beyond

Sustainable Pathway-Based Commissioning: An Interactive Workshop

National Stroke Strategy

Annual health check consultation: Commission sets out proposals for 2008/09 assessment of NHS trusts

How to change practice: understand, identify and overcome barriers to change

Liverpool - Joint commissioning & service delivery and Mental Health