World Class Commissioning and the Place of Practice Based Commissioning

1
World Class Commissioning and the Place of
Practice Based Commissioning

• Sir Ian Carruthers OBE
• Chief Executive
• Wednesday 13 February 2008

2
The rationale for World Class Commissioning

• Previous commissioning organisations did not
  always deliver improved outcomes for their
  populations, for a variety of reasons scale,
  complexity, competence, focus
• The national World Class Commissioning programme
  is a conscious attempt to refocus the work of the
  NHS on commissioning for health and well-being

3
Methodology

• Designed in partnership with Primary Care Trusts
  and other key stakeholders
• Building on previous diagnostic work and
  assessment regimes such as the Fitness for
  Purpose programme
• Fundamentally about raising the bar on
  commissioning to deliver improved outcomes for
  patients and public

4
World Class Commissioning

• Vision
• Competencies
• Assurance
• Development

5
Vision

• Better health and well-being for all
• People stay healthier for longer
• People live longer and health inequalities are
  dramatically reduced
• Better care for all
• Services are of best clinical quality which is
  evidence based
• People exercise choice and control over the
  services that they access so they become more
  personalised
• Better value for all
• Informed investment decisions
• Primary Care Trusts work across organisational
  boundaries to maximise effective care

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Competencies

• 1. Locally lead the NHS
• 2. Work with community partners
• 3. Engage with public and patients
• 4. Collaborate with clinicians
• 5. Manage knowledge and assess needs
• 6. Prioritise investment
• 7. Stimulate the market
• 8. Promote improvement and innovation
• 9. Secure procurement skills
• 10. Manage the local health system
• 11. Make sound financial investments

7
Assurance framework

• Three elements
• Health outcomes and quality (linked to Vital
  Signs)
• Competencies (with identified metrics)
• Governance
• Self-assessment, peer review and external
  moderation
• National system, led locally by Strategic Health
  Authorities to drive and support performance and
  improvement

8
Governance

• The assurance framework will need to test both
• governance structures and processes
• and
• the will of the Primary Care Trusts to have the
  courageous conversations necessary to drive
  improvement

9
Development Programme

• The what of getting Primary Care Trusts to
  excellence is non-negotiable
• The how is for local determination, assured by
  the Strategic Health Authority

10
Development Programme

• 5 themes in national programme
• Leading world class organisations
• Developing the strategy for world class
  performance
• Demonstrating world class performance
• Developing world class competence
• Sharing world class expertise
• Development needs will be identified in assurance
  process
• Build/buy/share model

11
World Class Commissioning - Progress

• Vision shared and agreed with NHS
• Competencies shared and agreed with NHS
• Assurance being tested
• Development in design phase nationally

12
The Place of Practice Based Commissioning

• Practice Based Commissioning has relevant
  activities at each stage of the commissioning
  cycle
• Assuring and developing the competencies of
  Practice Based Commissioners will be a crucial
  element of the World Class Commissioning
  programme

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Practice Based Commissioning is

• The principal route for Primary Care Trusts to
  secure clinical leadership (not just engagement)
  from primary care clinicians
• The principal route for primary care clinicians
  to influence the strategic direction of services
  through Primary Care Trusts

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Mechanics are necessary

• Budgets
• Information
• Management support
• Incentive schemes

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but not sufficient

• Relationships are critical with Primary Care
  Trust, between practices and consortia, Local
  Medical Committees, clinicians and managers
• Attitudes
• focus on patients, improved health and health
  care
• willingness to innovate and take risks
• agree key priorities for change

16
Issues that need to be managed

• Conflict of interest general practitioners
  acting as commissioners and providers
• Practice focus on small-scale local service
  development rather than broader strategic changes
• Tensions with role of Primary Care Trusts as
  commissioners of primary care

17
Next Steps to Strengthen Practice Based
Commissioning

• Review of implementation of Practice Based
  Commissioning in NHS South West, to
• review progress
• identify critical success factors
• recommend way forward linked to work on World
  Class Commissioning