Covering Note for Commissioning Best Practice Specification
Document use:
The attached output specifications will form part of the
contract negotiations between the lead commissioner and
each Integrated Cancer System (ICS) and monitored at
ICS level from 2013.
The lead commissioning arrangements for London Cancer
Alliance (LCA) ICS are not yet finalised. As such, in 2012
they will sit in individual provider contracts alongside the
agreed quality metrics, CQUIN, and plan for the delivery of
the model of care.
Every commissioner will include it in every contract
including cancer services in the current contract
negotiations under Section C part 4 ‘Documents to be
relied on’. However, commissioning against these best
practice pathways will not be actively monitored until a
period of monitoring activity over 2012/13.
Contracting arrangements
2012-13:
The outcome specifications are intended to:
 Support the best practice pathways with a written
description of best practice – moving away from
detailed service specifications, towards a focus on key
outcomes.
 Provide closer alignment between pathway
descriptions, quality standards, outcome measures and
the way that services are monitored.
 Provide a common format across the two systems for
commissioning cancer pathways
Standard contracts will continue to be in place between
providers and cluster lead commissioners for 2012-13.
For Cancer, the quality metrics set out in the output
specification will be used to monitor the progress of each
ICS. Commissioners are currently working with London
Cancer Alliance (LCA) ICS to agree the number of metrics
to prioritise from April 1st 2012 and a pragmatic approach to
data collection.
The best practice pathways will not be performance
managed in 2012. However, the informatics requirements
as set out in the output specification will be collected so as
to inform proposals for an alternative payment
methodology.
Process for development:
The output specifications are based on initial work by
Cancer networks in London and have been discussed with
clinicians working in the relevant specialties including
surgeons and oncologists. They are consistent with the
Map of Medicine and NICE guidance.
Clinical contributors
[names]:
Colorectal output specification: Celia Ingham-Clark
(Medical Director, Whittington Health, Colorectal surgeon);
Other forums that have
considered this document:
John Bridgewater (Consultant in medical oncology, UCLP);
Muti Abulafi (Colorectal Surgeon, Croydon HS)
Breast cancer output specification: Arnie Purushotham
(Professor of breast cancer, Director of Integrated Care,
KHP)
Brain cancer output specification: Keyoumars Ashkan
(Consultant Neurosurgeon, Kings College Hospital);
Jeremy Rees (Consultant Neurologist, National Hospital for
Neurology and Neurosurgery Queen Square)
London Programmes Cancer Implementation board
Date of completion:
January 2012
Inclusions / exclusions:
The content describes commissioner expectations that will
be used to monitor ICS delivery of a best practice pathway
from 2013. Working with the ICSs, benchmarks will be
established against each component of the output
specification.
Inclusions / exclusions specific to a specific pathway are
set out under “scope” in the output specification.
Where document should sit
in Trust Contracts:
The output specification has been produced as part of the
implementation of best practice pathways and is a different
document from that included in a standard NHS contract
between providers and commissioners. It includes
information from all the sections of section B of the
standard contract.
The document could sit in Section C part 4 “Documents to
be relied on” so that the key commissioner expectations
based on outputs in a specific cancer pathway, are set out
in one place. As such it is desirable for this specification to
be shared with clinicians.
Reference to other
documents:
Model of care for cancer services – London Health
Programmes; Cancer co-dependencies framework –
London Health Programmes; National Institute of Health
and Clinical Excellence (NICE) Improving outcomes
guidance; NHS Map of Medicine.
Next steps:
The lead contractor for each ICS will:
 Articulate the roles, responsibilities, and interactions
between (a) the lead contractor and the ICS and (b)
the ICS and it’s provider organisations;
 Work with ICSs to agree deliverables in 2012/13
and any sanctions for non-delivery;
 Dovetail the content of the output specifications in
into Trust schedules and make explicit about what
is being monitored at an ICS level.
 Agree benchmarks for each of the commissioning
measures and prioritise which will be monitored
from April 1st 2012.
Roll out to other cancer
pathways:
Output specifications have been developed for brain
cancer, colorectal cancer, and breast cancer. Output
specifications will be developed for other pathways over
2012.
Review frequency:
Annual