The New Landscape Transforming Commissioning
Agenda
• The likely impact of the White Paper on the
commissioning landscape
• The NHS London Commissioning Development
programme
You may have seen...
NHS revamp to
‘push up standards’
NHS shake-up 'hands
funding powers to GPs’
“Biggest reorganisation in
the NHS since 1974”
NHS 'reorganisation' is
outlined
“radical
programme
for a radical
government”
Andrew Lansley has a clear vision...
• patients must be at the heart of
everything we do
• the NHS must be focused on
achieving continuously improving
outcomes for patients
• we must empower clinicians
• we must prioritise prevention and
create a public health service
• we must reform social care
alongside healthcare
Andrew Lansley: 'A shared ambition to improve outcomes'
This includes some concrete changes
Out with the old, in with the new
• Funding from DH > SHAs > PCTs > GPs and
Commissioned Providers
• 80% of funding to be held by GPs, who will
commission using an ‘Any Willing Provider’
model
• Public Health responsibilities held by PCTs
• Responsibility for Public Health to be held by
Local Authorities
• FT status for NHS Hospital Trusts optional
• All hospital trusts must become an FT, or part
of one
• Occasional financial bailouts
• Limited independent sector commissioning
support of NHS funded services
• No bailouts for commissioners and providers
• Commissioning support will become a new
‘market place’ for the NHS, with considerable
outsourcing
The end state will look very different
Parliament
Funding
Accountability
DH
NHS
Commissioning
Board
Monitor
(economic
regulator)
CQC
licensing
Local Authorities
Local
strategic
partnership
GP
Commissioning
Consortia
contract
Providers
Accountability for results
Local
HealthWatch
Patients and Public
The NHS Commissioning Board will
provide national leadership
• establishing consortia (assigning them if necessary)
Responsible
for:
• calculating practice-level budgets (based on weighted capitation) and allocating to
consortia
• ensuring the NHS in England is resilient and is mobilised in times of national emergency
• primary care & ‘family health services’ – dental, optometry and pharmacy
• national and regional specialised services
It will
commission:
• maternity care
• health services for those in prison or custody
• equality in health outcomes
• choice & personalisation, including personal health budgets
It will
promote:
• research and use of evidence
• productivity
& competition
It will promote:
GP Consortia will commission the majority of
services for their local populations
• commissioning the majority of healthcare services
• managing combined practices’ commissioning budgets
Responsible
for:
• deciding commissioning priorities to reflect local needs, supported by an outcomes
framework
• commission services using the Any Willing Provider model
• use a lead commissioner arrangement
Will be
empowered to:
• procure support for commissioning activities
• agree local priorities each year – carrying out patient and public involvement exercises
• take part in risk-pooling arrangements & appoint staff for statutory governance role
Will need to:
Will need to:
• ensure continuity of services and promote health equality
Plus many players in the current structure will
be given increased powers to support the new
world
• strengthen patient and public voice
HealthWatch • advise the NHS Commissioning
Board, Monitor and the Secretary of
State
“Nothing
about me,
without me”
• local health improvement
Local
Authorities
• local coordination of joint
commissioning
• fund and hold to account ‘local
HealthWatch’
Plus many players in the current structure will
be given increased powers to support the new
world
• license providers, alongside Monitor,
against safety & quality standards
“Greater
autonomy will
be matched
by increased
accountability
”
Care Quality • targeted and risk-based inspections,
Commission
• enforcement if standards not met
• economic regulator for providers to
the NHS and social care
Monitor
• promote and enforce competition &
choice
• powers to set efficient or maximum
prices
Plus many players in the current structure will
be given increased powers to support the new
world
“Improvement
in quality and
healthcare
outcomes is
the new
governing
principle”
National • independent, non-departmental public
Institute
body
for Health
• develop quality standards for key care
and
pathways
Clinical
Excellence • social care as well as health
Public
Health
Service
• will take over functions of existing
improvement & protection bodies
• set LAs national objectives for
improving population health
outcomes
• research and evaluation
The scope of NHS London’s contribution to
supporting the transition to GP-led
commissioning is currently being defined
Support development of GP consortia
Support development of commissioning support market
Establish NHS Commissioning Board
Realign clinical networks
Define and implement transition structures
Joint working and communications
Thank You
Rachel Bartlett
Assistant Director, Commissioning Development
E: rachel.bartlett@london.nhs.uk