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

• 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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• Updated Child Health Promotion Programme
• Towards World Class Commissioning Competency
• Education Commissioning Briefing
• National Dementia Strategy
• More strategic, timely information needed in primary healthcare
• Putting you in the picture
• Choice at referral
• Refocusing the care programme approach: Policy and positive practice guidance
• National Primary Care Research & Development Centre: Practice Based Commissioning
• Other documents 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

Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit aims to support the corresponding programme and has one principal aim - to help PCTs implement NICE Guidelines for people suffering from depression and anxiety disorders. The Government is committed to improving access to psychological therapies and announced additional funding to increase services over the next three years. This Commissioning Toolkit is designed to help PCTs improve or establish stepped care psychological therapies following NICE guidelines. The toolkit is structured around the commissioning cycle and is specifically linked to the World Class Commissioning competencies.

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 Report of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity identifies that the collection and use of outcomes measures in the NHS is both practical and essential.   In order to do so effectively the report makes the following recommendations:

• Measurement of patient outcomes and use of that information to drive better commissioning of services should be made an explicit element of the Government’s vision of “world class commissioning”.

• Mortality and survival data should be collated and published for all condition/treatment areas at the same time as collection of other outcomes data is initiated. Data on casemix must be collected, so that the crude mortality/survival data can be adjusted for the casemix treated. Confidence intervals should be estimated and reported to permit comparisons to be made over time and between providers.

• For elective surgery, condition-specific measures should be collected beforeand after surgery simultaneously with the generic EQ-5D for all NHS patients undergoing common procedures.

• Measurement of mental health outcomes in secondary care should be reinvigorated with collection of HoNOS data being incentivised in addition to mental health providers being reminded of its mandatory nature as part of the Mental Health Minimum Data Set. Routine collection at annual intervals of the CORE-OM measure for all patients receiving community based mental health services be piloted in a range of NHS Trusts at the earliest practical opportunity in 2008/09.

• Research is required to identify a generic measure of health related quality of life that is suitable for application to mental health patients as well as recipients of other kinds of health care.

• The practicality and value of collecting and using measures of outcomes for COPD patients should be piloted by a range of commissioners and their secondary and primary care providers, commencing in 2008/09. The preferred disease specific measure is either the Chronic Respiratory Disease Questionnaire (CRDQ) or the St George’s Respiratory Questionnaire (SGRQ).

• For colorectal cancer patients, mortality data (1 year and 5 years after diagnosis) should continue to be monitored and assessed as an important but partial measure of health service productivity in this disease area given its relatively high rate of mortality. But at the same time instigation in 2008/09 of pilot programmes of routine use of the EORTC QLQ-CR38 instrument to measure outcomes in colorectal cancer patients simultaneously with the EQ-5D or an SF- series generic measure should be undertaken.

• Collection of data about the wider benefits from health services by addition of questions on patients’ experience of care to the patient questionnaires used to measure health outcomes. Aspects covered should include: access, care co-ordination, autonomy, choice, communication, confidentiality, dignity, quality of amenities and support for carers.Further research is needed into the relative values of the wider benefits referred to in recommendation 8 and by compassion with health outcomes.This should be commissioned during the course of 2008/9.

• Information on wider benefits is already collected in national patient surveys. Building on its ‘customer experience information’ project, the Department of Health should work with its counterparts in Northern Ireland, Scotland and Wales on a UK-wide stock-take of patient surveys in process and planned, and then use this as the basis for discussion with all the interested parties how to co-ordinate those surveys in future.

• After a short period of research to identify the most practical way of collecting such data, including working days lost, measurement of productivity effects should be commenced for patients being treated for mental health problems, diseases of the nervous system and diseases of the musculo-skeletal system should be identified.

• Modification of existing national surveys of a sample of the general population should be investigated as one way of collecting at a general level data relevant to the wider societal impacts of health care interventions, including impacts on carers.

• Health care professional bodies, including the Royal Colleges, should explicitly and actively support the collection and use by their members of patient outcome measures, including the provision of training in their collection and use for both existing and new clinicians.

• Training in understanding and using outcome measures should be provided to NHS commissioner and provider managers.

• Investment should be made in IT and appropriately trained staff to enable user-friendly information collection, collation and analysis of outcome measures.

• The NHS should, commencing as early as possible in 2008/09, pilot, monitor and evaluate explicit incentives to collect, collate, analyse, feedback and use patient outcome measures. Initially at least this would not be extended to rewarding providers for the measured levels of outcomes achieved, although that could be considered once experience with use of outcomes measures has accumulated.

• There should be an expectation that within 5 years (i.e. by the end of 2012/13) routine measures of patient outcomes comprising the impact of an NHS intervention in terms of patient survival, quality of life, and experience of care, are collected for the majority of NHS activity. Within 10 years it should be the exception rather than the rule to find an area of NHS activity that is not assessed and actively managed according to the outcomes achieved.

• The NHS should work with the ONS Centre for the Measurement of Government Activity to ensure that the health outcomes data used by the NHS can also used by ONS in its periodic assessments of NHS productivity and, subsequently, in the National Accounts.

Extensively discussed in the mass media Choice at referral: guidance framework for 2008/9  provides best practice guidance and information for referrers, providers and commissioners on how the roll-out of free choice in elective care in 2008/9 will operate.  It is supplemented by the Impact of Free Choice policy in Choose and Book R4.0.

Public and patient involvement in the NHS from the BMA looks at the concept of public and patient involvement. It has a focus on the new mechanisms that are designed to ensure local communities more say in commissioning services.

It concludes there is a real risk of the having the opposite effect. To increase the involvement of ordinary people in their health service, more effective fora for expressing their views are required. Suggestions on how this may be achieved are developed in this report.

Local Pharmaceutical Services (LPS) - guidance notes provides information on aspects of LPS permanence which allows PCTs to enter into LPS contracts without requiring prior approval of the Secretary of State for Health and provides PCTs with flexibility to make LPS arrangements in response to local needs within timetables of their own choosing. The guidance also details the commissioning process and may be of use to those PCTs that wish to use LPS

To access this video you will be required to give some details about yourself to HealthExecTV.

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

More responsive public services? A guide to commissioning migrant and refugee community organisations is a practical guide from the Joseph Rowntree Foundation to commissioning migrant and refugee community organisations (MRCOs) to deliver public services.

The government is promoting the role of the ‘third sector’ in delivering public services, and wants to ensure that services meet the needs of all potential users. Many migrant or refugee-led community organisations are already delivering services in culturally-sensitive ways, and it is possible that more of these organisations could become formal public service providers.

This guide reviews the commissioning process, why it should include bodies like MRCOs, what MRCOs are and what they can offer to commissioners of public services. It demonstrates how MRCOs can engage with the commissioning process, asks whether it is the right step for them to take, and suggests what changes in their organisations and capacities might be required. It explores potential commissioning opportunities for MRCOs in eight service areas, including accommodation, Supporting People services, health care and legal advice, and includes over 30 practical examples of service provision.

In 2001, the Government published the National Sexual Health and HIV Strategy and one of the recommendations is the provision of more comprehensive and integrated sexual health services. One of the commitments in the strategy was to undertake an evaluation of different models of One Stop Shops. 

Evaluation of One-Stop Shop Models of Sexual Health Provision, which has just been published provides valuable findings and information for PCT commissioners and service providers considering an integrated approach as well as those already providing integrated services. 

It finds:

‘Better Care: Better Lives: Improving outcomes and experiences for children, young people and their families living with life-limiting and life-threatening conditions’ aims to improve the care and support given to children in England with life-limiting or life-threatening condition and their families. The strategy calls on commissioners, service providers, voluntary sector partners – to improve the experiences of young people and their families by:

• improving data sources

• building stronger joint working arrangements

• developing better needs assessments and support regimes

• tackling inequalities

• encouraging the delivery of care in the most appropriate setting.

To access this video you will be required to give some details about yourself to HealthExecTV.

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.

To access this video you will be required to give some details about yourself to HealthExecTV.

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

To access this video you will be required to give some details about yourself to HealthExecTV.

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.