The future of commissioning

NHS Providers has launched a new publication series “Provider Voices” which promotes the views of leaders from a range of trusts and other parts of the service on some of the key issues facing the NHS.

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The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.

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NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library

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How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.

General practitioners’ views of clinically led commissioning

Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years | BMJ Open

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Objectives: The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement.

Results: While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do.

Conclusion: CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership.

Full reference: Moran, V. et al. (2017) General practitioners’ views of clinically led commissioning: cross-sectional survey in England. BMJ Open. 7:e015464

Hull CCG pools entire budget with council in £600m fund

A Yorkshire clinical commissioning group is aligning its entire budget with a local authority to create a strategic commissioning fund of £600m | HSJ

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  • Hull CCG to align entire £400m budget with local authority
  • CCG chief officer joins Hull City Council’s corporate management team
  • Committee in common will approve decisions by new integrated commissioning board

Read the full article here

Early benefits of delegated commissioning

NHS England have produced a series of Delegated commissioning case studies to show how CCGs are using delegated commissioning to improve care for local people. 

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CCGs have reported that delegated commissioning is leading to:

  • The development of clearer, more joined up visions for primary care, aligned to wider CCG and STP plans for improving health services;
  • Improved access to primary care;
  • Improved quality of care being delivered to patients;
  • Improved CCG relationships with member practices, including greater local ownership of the development of primary care services;
  • Increased clinical leadership in primary care commissioning, enabling more local decision making;
  • Greater involvement of patients in shaping services;
  • A more sustainable primary care system for the future.

NHS England have produced a series of case studies to show how CCGs are using delegated commissioning to improve care for local people:

Bite-size guides on patient insight

NHS England has launched two further bite-size guides to patient insight to help CCGs and providers make better use of national surveys and feedback data and to plan their own local insight work to inform service reviews and redesigns | NHS England

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We want to help providers and commissioners to understand the use of patient insight better and to use it effectively in delivering local services.  Publications on this page are designed to help build understanding and skills in this area and we will add new topics over time.

View the guide to ‘how and when to commission new insight and feedback’ here

View guide to ‘what’s already available’ here

View the guide to ‘Patient Reported Outcome Measures (PROMS)’ here

Shaping healthy cities and economies: The role of clinical commissioning

New report shows how clinical commissioning can help realise full potential of local economies | NHSCC

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NHS Clinical Commissioners have today launched a new report showing the positive contribution that clinical commissioners are making to their local economies. With the recent Autumn Statement making it clear that neither health nor social care will receive additional funding to alleviate pressure on their increasingly overstretched services, the question of how the NHS can drive prosperity in local areas is an increasingly important one.

Read the full overview here

Read the full report here