Intelligent Practice: understanding the information needs of GP commissioners

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 framework for health and well-being

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)

CRC Commissioning services to reduce drug related deaths

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)

Operating framework 2007/8- King’s Fund Briefing

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

Commissioning conscious sedation services in primary dental care

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)

New model contract threatens survival, foundations warn

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.

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So where are the alternative providers in primary care?

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)

Developing service provision for patients in primary care.

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)

PCT futures : faster, stronger, better.

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)

Cost-effectiveness of a nurse-led case management

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)

The Commissioning Friend for Mental Health Services

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)

From segregation to inclusion: Commissioning guidance on day services for people with mental health problems

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)

Practice-based Commissioning in the NHS: The implications for mental health

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)

Choosing health: supporting the physical health needs of people with severe mental illness (commissioning framework)

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)

Payment by results: opportunity or threat for mental health commissioners?

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)

Improving user/carer involvement in commissioning and reviewing mental health services.

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)

10 High Impact Changes for Mental Heath Services

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)

Other Documents or Websites of Interest

Commissioning framework for health and well-being

Kings Fund Hot Topics - Mental Health

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)