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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)
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)
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).
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.
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)
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
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)
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.
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
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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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