World Class Commissioning Driving high standards of service through commissioning

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World Class Commissioning Driving high standards
of service through commissioning

• Adrian Reedman
• Director of Strategy and Redesign
• Birmingham East and North PCT

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Delayed transfers of care
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In other words
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Same primary outcome

• What needs fixing?
• What people do we need doing what to who, when
  and with what ?
• What bits do we get from who ?
• How do we plug them together ?

• What are we trying to achieve?
• What is the total journey?
• Outcomes not activity ?
• Build involvement, empowerment and responsibility
  in ?
• Commission the entire service and decommission
  un-integrated bolt-ons ?

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Driving quality through commissioning not
contracting

• What outcomes are we trying to achieve?
• How do we achieve a cost effective Retinal
  Screening service?
• Central screening factory
• Economies of scale
• Provider convenience
• Quality through uniform provision
• How do we halt preventable blindness in diverse
  communities with diabetes?
• Service close to community
• Economies of utility
• User convenience
• Quality through sensitive provision

At the heart of a high quality service is a
commissioner that has asked the right
question AND A provider that has developed the
specification and met it consistently
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Outcomes at the start, middle and end of service
design

• What are your design principals ?
• Value, feel,
• Reach/access
• Clinical outcomes, service outcomes
• Planned evaluation
• Approval
• How does your design effect these principals ?
• What are the possible unintended consequences ?
• Measure, evaluate, report, learn, change

When we fail to measure as we intended to, who
are we cheating ?
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What tools are at our disposal ?

• Asking the right question
• Starting with the end in mind
• The Commissioning cycle, Gateways and
  disinvestment strategies
• The OSCAR framework for Outcomes
• Organisational outcomes for providers and
  commissioners
• What should we learn as an organisation new
  consent routes, patient activations, systems of
  care, care closer to home
• Satisfaction outcomes for all involved
• Patients, Carers, Practitioners, providers,
  commissioners, partners
• Clinical outcomes
• Activity
• Volume, location, quality
• Resources
• Return on Investment, Programme Budgeting

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What is commissioning?

• Commissioning is a cycle of activity that
  involves
• Assessment (or reassessment) of need
• Identifying resources
• Planning how to use the resources
• Arranging service delivery through a procurement
  process
• Monitoring and reviewing service delivery

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World Class Commissioning
Partnering Community Pharmacy
Physicians Information sharing Monitoring
effectiveness
Engagement strategies Raising aspirations
PBC agenda Care Pathway development Quality
improvement
Predictive modelling, needs variance analysis
Potential of community services and increasing
social capital Innovative prescribing
(Sheffield)
Activity Performance Collect, Publish, Assess and
regulate Benchmarking, Performance
Management Support provider innovation Provider
motivation, shared responsibility
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Commissioning plans and Pharmacy

• Strategic Plan
• Commissioning intentions that effect Rx ?
• Transforming Community Services
• Are there pathways that you can influence that
• Improve outcomes for patients
• Lower pathway cost
• Improve the experience
• If healthcare closer to home doesnt involve
  innovative pharmaceutical delivery

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Some opportunities in Birmingham

• COPD Management and exacerbation avoidance
• Are there better ways, to deliver better
  molecules, at
• more tightly defined at-risk groups, at more
  appropriate
• times that will deliver improved outcomes
• OSCAR
• Most commissioners would rather spend 2000
  avoiding an admission than paying for the
  admission.
• WHY ?
• End of Life
• Gold standard framework increases Rx of EoL
  drugs
• Are you tracking use, because good symptom
  control leads to reduced utilisation
• Are you talking to your EoL commissioners ?

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