The PCT Procurement Guide supports NHS commissioners in deciding whether and how to procure health services through formal tendering and market-testing exercises. The Guide sets out the policy and regulatory context for procurement, and issues to consider when developing a procurement strategy. The Guide should be read in conjunction with the Principles and rules for Cooperation and Competition, published as Annex D of the 2008/9 Operating Framework, and the Framework for Managing Choice Cooperation and Competition

The Framework for Managing Choice Cooperation and Competition supports SHAs and PCTs in understanding the roles, responsibilities, values and behaviours required for the effective management of choice and competition within the NHS. The Framework is the outcome of a series of workshops and seminars with senior SHA and PCT leaders. The Framework should be read in conjunction with the
Principles and rules for Cooperation and Competition (Annex D of the 2008/9 Operating Framework) and the PCT Procurement Guide (published 16 May 2008). Additionally, the Framework signals a further series of tools and guidance for system managers to be released throughout the year.

• Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit
• CSIP Better Commissioning programme
• New NICE Commissioning guides: Cognitive behavioural therapy and Faecal continence service
• West Kent PCT: World Class Commissioning strategy and delivering a commissioning model
• National Cancer Intelligence Network
• Commissioning Specialist Library: Have you say
• A resource to help primary care pharmacists in England involved in PBC
• Revised guidance: primary care dental contracts Advice on managing end of year issues
• Other documents, websites and conferences

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This is the third quarterly practice survey (National summary of results), covering a sample of practices from each primary care trust (PCT). The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC.  The survey is part of a group of indicators that will be assessed together to give a picture of PBC implementation.

Key findings:

• There has been a rise in the number of practices commissioning new services through PBC (+8 percentage points since Wave 1 and +5 percentage points since Wave 2). 41 percent have commissioned new services through PBC.
• The percentage of practices who have agreed a commissioning plan with their PCT has continued to increase (+11 points since Wave 1 and +3 points since Wave 2). 57 per cent of practices have now agreed a commissioning plan.
• 62 percent of practices support the policy of PBC (a rise of 5 percentage points since Wave 1, and 3 percentage points since Wave 2).
• The percentage of practices agreeing that PBC has improved patient care has marginally increased from 12 percent in Wave 2 to 16 percent in Wave 3. The proportion who disagree that PBC has improved patient care is in line with that of the previous two waves (31% in Wave 3, 30% in Wave 2, and 31% in Wave 1).
• 71 percent of practices claim to have a good relationship with their PCT, a decline of 3 percentage points on Wave 2.
• The proportion of practices who have received a financial incentive scheme has marginally declined since Wave 2 to the levels recorded in Wave 1 (down 4 percentage points since Wave 2 - now 62 percent).
• There has been a rise in the proportion of practices who engage with their local population from 61 per cent in wave 2 to 70 per cent in Wave 3 (an increase of nine percentage points).
• Around 4 in ten practices continue to rate their PCT’s managerial support for PBC as good (40 per cent in Wave 3, 42 per cent in Wave 2 and 37 per cent in Wave 1), however, half continue to rate managerial support for PBC as poor (49 per cent in Wave 3).
• As in previous waves, around a third of practices continue to rate the quality, format and frequency of information provided by their PCT as being good

The Secretary of State has made two sets of Directions, both in respect of Local Involvement Networks (LINks). The first set of directions are to LINks themselves, setting out their duties when it comes to providing annual reports to the Secretary of State. The second set are to commissioners of health and social care services (primary care trusts, NHS trusts in England, strategic health authorities, and local authorities). These set out the requirements they need to include in their future contracts with independent providers. A briefing has been produced by the DH for providers of independent services about this second set of Directions.

The Commissioner Volume 3 Issue 3 from the North West Primary Care Librarian’s Group was published today with its podcast ( Standard Podcasts [6:22m]) contents are:

• PBC: Personalise your Improvement with the No Delays Achiever

• Dental Commissioning and Contract Monitoring - Tendering, Procurement & Contracting

• Evaluation of One-Stop Shop (Oss) Models of Sexual Health Provision

• Improving Access to Psychological Therapies implementation plan

• National Infarct Angioplasty Project (NIAP) interim report

• Practice-based commissioning : tips for preparing and pitching a proposal

• Strategic commissioning for older people

• Apply for Beacon Status

• Other documents and conferences

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The Diabetes NSF and transformation of care services is crucial to addressing the escalating Diabetes epidemic thought to be affecting the lives of 2 million people in the UK and imposing a £3.5 billion a year cost on the health service, equivalent to 5% of the NHS budget

Dr Sue Roberts, National Clinical Director for Diabetes, reviews the key factors and changes required to manage the scale of the epidemic and to deliver better outcomes for people with diabetes. It considers:

• Impact of the transition from Acute to Primary Care setting for diabetes services
• Building capacity to screen and treat 750,000 hidden sufferers
• Revolutionising commissioning
• Scaling up patient education programmes to support self-care

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David Stout, Director of PCT Network at the NHS Confederation, shares his vision for World Class Commissioning and its potential to transform health services and drive improvements in health outcomes.

He advises on how Trusts can step-up their current approaches in World Class ways - for example, planning for the longer term needs of the population through more effective public engagement and techniques such as risk stratification.

In particular, Mr Stout defines the role of the NHS Confederation and how they are supporting PCTs in their transition.

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The World Class Commissioning initiative provides a major opportunity for Trusts to transform care services and develop new ways of maximising the value of limited healthcare budgets.

While Trusts wait for the WCC Assurance Framework, there are many ways to start planning the transition to World Class Commissioning. Evidence-based analysis of population requirements, how money has been spent and how other organisations are approaching commissioning is a key starting point.

In this interview, Andrew Beale, Executive Director of Matrix Knowledge Group consultancy, discusses how evidence-based analysis can help Trusts to better understand their current position, population healthcare patterns and to maximise the benefit of their investments within the available resources.

Genitourinary Medicine 48-hour Access: Getting to target and staying there  is a good practice guide for primary care trusts to help support clinics to reach the Genitourinary Medicine (GUM) 48-hour access target by March 2008.  It builds on the 10 High Impact Changes for Genitourinary Medicine 48-hour Access (HIC).

High impact changes detailed are:

1. Measure demand and capacity across the local health economy
2. Begin a process improvement project to inform service redesign
3. Analyse and improve utilisation of the multidisciplinary teams in GUM
4. Develop a separate pathway to manage screening of patients at low risk for STIs
5. Review current access system and make it easier for patients to access the service
6. Reorganise clinic opening hours to improve access
7. Reorganise the physical environment to maximise the space available for seeing patients
8. Reduce unnecessary clinical activity to increase capacity for new patients
9. Assess the state of readiness of STI service providers outside GUM, and prioritise developments that will help meet and sustain the GUM access target
10. Make costs of GUM services transparent and develop commissioning consortia which reflect patient flows

The Right Result? Payment by Results 2003-07 details how Payment by Results (PbR), has been embedded across the NHS and has helped hospitals to be more business-like.  It should start to deliver the significant increases in productivity and efficiency across the NHS that the policy was designed to achieve.The PbR policy was introduced by the government four years ago and is a system of paying hospitals nationally set prices for the number of patients and types of conditions they treat. It is designed to encourage hospitals to treat more patients, more efficiently without compromising quality of care.

This Audit Commission report finds that under PbR most hospitals have improved their financial management and now have a better understanding of how much it costs them to treat patients. The impact on the NHS in terms of efficiency and activity has been smaller than expected, however, and PbR seems to have contributed to positive trends rather than driven them.

The report sets out a number of priorities for future development of the policy that need to be addressed if PbR is to deliver further improvements:

For Primary Care Trusts

• Further develop commercial, legal and contracting skills, identifying gaps in line with the developing World Class Commissioning competencies, to improve their ability to operate in the PbR environment.

• Ensure that 2008/09 contracts contain appropriate incentives and penalties to support appropriate, high quality care, for example, readmissions targets, and that information requirements are clearly specified and enforceable. Progress against these targets should be reported regularly.

• Adopt a robust yet proportionate approach to monitoring and challenging provider activity and costs under contract, prioritising investment in practice level information systems so that practices can engage in the planning and monitoring of hospital activity.

• Actively monitor provider actions in response to the Audit Commission’s PbR data assurance audits, and use the findings from these audits to supplement existing information on potential data quality issues.

For Acute NHS Trusts

• Ensure that robust information and reporting systems are in place that meet all internal and external requirements within the minimum reporting deadline of 30 days following the end of the month, and that local information systems are in place to complement SUS as necessary.

• Embed and promote service-line management and reporting, paying particular attention to the use of surpluses and how this will be managed within the organisation.

• Understand the costing data they require to manage the business, and invest in improving internal costing systems, considering the business case for introducing patient level costing systems where appropriate.

• Prioritise the implementation of the OPCS-4.4 classification system for procedures, to improve coding internally and to support the introduction of HRG4.

• Engage in discussions with commissioners about changing patient pathways, demand management and use of local flexibilities, such as unbundling the tariff into its component parts.

For the Department of Health

• Identify and explicitly prioritise the changes that will be most effective in achieving policy objectives, and ensure that the development programme for addressing these priorities is realistic, properly resourced and communicated to stakeholders.

• Ensure that timely guidance, support and direction continues to be provided to both commissioners and providers in a balanced way, including more effective mechanisms for receiving and providing feedback, particularly in relation to contract and information issues.

• Review and address the perceived limitations of SUS in supporting PbR, ensuring there is a clear vision for NHS data and organisations’ responsibilities that is shared by NHS Connecting for Health and the Information Centre for Health and Social Care, and that the expectations of the NHS are consistent with this vision. Additional steps should be taken to ensure that guidance from these bodies is consistent.

• Invest in information systems to capture and report on community services and support the development of an appropriate payment mechanism.

• Monitor usage of the new standard contract and reinforce the move toward a consistent approach to contracting across the NHS, providing guidance as appropriate to ensure that balanced, fair contracts, that support nationally agreed principles, are negotiated.

• Use the tariff as a policy lever to drive desired behaviours, rather than purely as a reflection of average costs, signalling likely changes to the NHS well in advance.

• Explore the use of separate payment streams in addition to the tariff, for example to reward quality or to fund capital costs, where this is necessary to provide the right incentives to NHS bodies.

• Carefully monitor the implementation of HRG4 to ensure that the additional complexity of the payment classification is warranted and is not undermining policy objectives.

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World Class Commissioning is set to transform Primary Care and promises to drive unprecedented improvements in patient outcomes. But what should World Class look like, how is it different from current commissioning approaches and what must PCTs do to make the transition?

In this interview from HealthExec TV, Gary Belfield, Director of Commissioning at the Department of Health, outlines the vision for World Class Commissioning, the skills and capabilities PCTs will need to get there, as well as examples of how PCTs might transform their existing ways of working to reach World Class status.

Also reviews:

• how Trusts can assess their readiness for World Class Commissioning
• Bridging skill gaps through sharing best practice and procuring external support
• the Assurance Framework as a tool to drive performance and development
• the DH Development Framework to support Trusts in their transition

The new edition of The Commissioner is out today.  Now with new added podcast!

• Commissioning NHS primary care dental services: meeting the NHS operating framework objectives
• The Future of Care Funding: Time for a change
• Practice Based Commissioning GP practice survey
• Best practice guidance for joint working between the NHS and the pharmaceutical industry
• New release of NICE commissioning tools
• Mental Health Act Commission’s Biennial Report; Risks, Rights, Recovery
• Implementing practice based commissioning
• Learning from investigations
• Working Across Boundaries for 18 weeks and beyond – registration now live

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Mental Health Act Commission Twelfth Biennial Report - Risk, Rights, Recovery finds that there are severe funding issues faced by providers of mental health services in that:

• Patients deemed to be a threat to themselves or others are being denied hospital beds while commissioners disagree with regard to funding.

• The Mental Health Act Commission has found practitioners are being told to delay sectioning people with urgent mental health needs until primary care trusts ascertain who should pay for their treatment.

• The problem is caused by high bed occupancy levels and the need for PCTs to balance budgets.

• This has encouraged PCTs not to detain patients who have travelled from other areas until the home PCT has agreed to pay.

Thse practices are unsuprisingly condemned in this report.

Practice based commissioning: GP practice survey Wave 2 (September 2007), covers a sample of practices from each primary care trust. The aims of the survey are to get feedback from practices on their perception of the support offered by their primary care trust and on the clinical and financial engagement of practices with practice based commissioning. It finds that:

• A slight increase in support for PBC: Fifty-nine percent of GP practices say they are supportive of PBC as a policy (57 percent, Wave 1). Seventeen percent still oppose it, but this is a fall from the 20 percent opposing it in Wave 1.

• The percentage of practices saying that it is too early to tell whether PBC has improved patient care has increase from 37 percent to 46 percent. Thirty percent (31 percent, Wave 1) say that PBC has not improved care and 12 percent (13 percent, Wave 1) say that it has.

• Thirty-six percent (33 percent, Wave 1) of practices have commissioned one or more new services through PBC.

• A ten percentage points increase in the percentage of practices that received an indicative budget for 2007-08, from 56 percent in Wave 1 to 66 percent in Wave 2. However, 76 percent (74 percent, Wave 1) still feel that it has yet to make a difference to the way the GP practice operates.

• An increase in the percentage of practices that have agreed a commissioning plan with their PCT, from 46 percent in Wave 1 to 54 percent in Wave 2.

• Forty-two percent of practices (37 percent, Wave 1) rate the quality of managerial support provided by their PCT as good, the percentage rating it as poor is now 49 percent (51 percent, Wave 1).

• Around a third of practices rate the quality, format and frequency of information provided by their PCT as being good, a figure that has not significantly changed from Wave 1.

• 74 percent of practices (72 percent, Wave 1) say they have a good relationship with their PCT.

• A rise in the number of practices responding to the survey compared to Wave 1, from 59 percent (1,198) to 70 percent (1,398) in Wave 2.

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.

• Introduction
• Briefing 1: Working with lesbian, gay, bisexual and trans (LGBT) people
• Briefing 2: Improving access to health and social care for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 3: Young lesbian, gay and bisexual (LGB) people
• Briefing 4: Older lesbian, gay and bisexual (LGB) people
• Briefing 5: Lesbian health
• Briefing 6: Gay men’s health
• Briefing 7: Bisexual people’s health
• Briefing 8: Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 9: Mental health issues within lesbian, gay and bisexual (LGB) communities
• Briefing 10: Sexual health
• Briefing 11: Trans people’s health
• Briefing 12: Lesbian, gay and bisexual (LGB) people from Black and minority ethnic communities
• Briefing 13: Disabled lesbian, gay and bisexual (LGB) people

A brief shout out to Sue over at Lancashire Care who noticed this.

Volume 3 Issue 1 of the Commissioner is now available with the following content.

• Towards World Class Commissioning Competency
• Practice based commissioning - budget setting refinements and clarification of health funding flexibilities, incentive schemes and governance
• Commenting in response to the publication of the NHS Operating Framework for 2008/09
• Practice and Provider Monitor (PPM) - a common information source for both providers and commissioners
• Collaborative commissioning of National Screening Programmes
• A funding model for health visiting
• A personal approach to public services
• Evidence-based Commissioning Collaboration
• Other documents and conferences

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Turning Point and Dr Foster Intelligence have produced ‘A Personal Approach to Public Services’, a new report which states world class public services can be provided without structural reform or significant additional resources or costs, the holy grail of the public sector! Key to achieving this are:

• Intelligent customer insight - improving effective and consistent use of data to know understand and profile the diversity of the communities served
• Service design - must involve stakeholder participation including local people, particularly those in most need, to design services around need
• Personalisation - create individual budgets and provide multiple needs through one integrated service
• Prevention - make prevention a mainstream activity at the heart of the commissioning process
• Partnerships - make partnership work for users rather than creating talking shops and further bureaucracy.

The NHS in England: operating framework for 2008-09 (includes Annexes A, B and C) gives an overview of the priorities for the NHS next year. The annexes provide more detail on the priorities, how they are measured and how the new arrangements for managing the system will work. The framework also details PCT allocations for 2008/09.

Principles and rules for Cooperation and Competition are the subject of Annex D and recognise that competition and choice are powerful levers to drive up service quality, deliver better value and reduce inequalities but require enforceable rules guiding and governing behaviour within the healthcare system.  These rules ensure fair and transparent competition where this is needed to make the best use of resources and enable innovation, and provide essential safeguards for the interests of patients, taxpayers, and the reputation of the NHS.

There is also a new Standard NHS contract for acute services in Annex E.

In summary the 2008-09 Operating Framework sets out:

1. NHS priorities for the year ahead: freeing up the front line by moving towards local stretch targets, whilst delivering on national priorities. 2008/09 is the start of the next three-year planning round. In this context, the Operating framework sets out the priorities and planning framework for the NHS for the 2008/09 financial year, within the context of the 3 year CSR period 2008/09 – 2010/11;
2. Reform levers and enabling strategies: reform with a purpose – to improve services. The focus will be on developing world class commissioning as the key agent for change on behalf of patients and the public, using the full range of levers and incentives to transform services and improve outcomes;
3. Financial regime: setting out a framework that fully supports reform goals and incentivises transformational improvements in services within available resources. Key to this will be the need to sustain the surpluses the NHS is on track to deliver;
4. The business processes: ensuring a business-like and transparent approach to planning that supports locally led decisions whilst providing accountability. There is a strong emphasis on genuine partnership working at a local level with local government and other partners to ensure that local health and wellbeing needs are better understood and addressed in partnership.