Making commissioning effective in the reformed NHS in England

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)

Health Inequalities Intervention Tool

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:

• Life expectancy in Spearhead local authorities
• The gap in life expectancy between the Spearhead local authorities and England
• A breakdown of the causes of the life expectancy gap by disease type and age

(Published 05/01/07)

Commissioning toolkit for community based eye care

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)

GP reforms improve NHS referrals

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)

Primary Medical Services Contracts - A guide for potential contractors

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)

Health policy: a new look at NHS commissioning

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

Implementing PBC

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

The NHS Contracts for 2007/08

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)

National Partnership Agreement: commissioning of health services for prisoners

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)

Websites of interest

Practice Based Commissioning- NLH Health Management Specialist Library

PCTs as Commissioners- NLH Health Management Specialist Library

Inclusion or control? : commissioning and contracting services for people

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

NTA for Substance Misuse - commissioning

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

The only thing you can't predict is where it will go

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

PCTs to assess services

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

BMA principles for effective and successful commissioning

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)

10 high impact changes for genitourinary medicine

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)

Improving Stroke Services: A guide for Commissioners

This Department for Health guide provides advice to commissioners on good practice on improving stroke services and highlights key issues to consider and summarises supporting resources. The toolkit, ASSET, is to assist NHS commissioners modernise stroke services. It shows PCTs and GPs, by using their own statistics, how better care will save money in the long run, reduce hospital bed days, and save lives.

(Published 7/12/06, 50 pages)

Developing General Practice in Anytown PCT through a Balanced Scorecard approach. (Developed by Tower Hamlets PCT.)

PCTs are now being required to commission and performance-manage primary care. It is clear that a number of useful performance indicators, including, for example, QOF, access surveys, patient surveys and premises surveys now exist to support this function. Nowhere however, are these different performance indicators brought together to allow a more balanced assessment of primary care performance and development. The purpose of this paper is therefore to bring these indicators together, set out minimum acceptable standards, and the PCT’s approach to improving standards.

(Published December 2006, 44 pages)

Care and Resource Utilisation: Ensuring appropriateness of care

This Department for Health document sets out for commissioners using practice-based commissioning (PBC) and primary care trusts (PCTs) some techniques to help identify areas where services can be redesigned, thereby freeing up resources to focus on clinically needy patients. Care and resource utilisation (CRU) is all about giving the patient the right treatment in the right place at the right time.

(Published date 14/12/06 86 pages)