Salford Primary Care Trust
August 2009
Summary of Transforming Community Services Commissioning Strategy
1
Introduction
1.1
This document sets out the PCT’s commissioning intentions to transform community
services in Salford. It forms part of a response to the Department of Health’s
Transforming Community Services (TCS) Programme which was launched in
January 2009, and sets a clear vision to make quality the organising principle for the
NHS. In short it is about moving away from an overdue emphasis on the production
of services and meeting targets, towards an emphasis on quality, patient experience
and the outcomes of our services.
1.2
Community services have been given their widest possible definition, embracing the
Independent Sector, the Third Sector and Voluntary Sectors as well as the Provider
arm of the PCT. Our strategy sets out our aspiration to be transformational in our
approach to developing services that will be outcome based, with providers leading
the way to develop innovative and cost effective solutions to improved service
delivery in an ever demanding market. We will strive to become an even more
customer focused organisation, listening to our key stakeholders and prioritising their
needs. The strategy for Community Services is clearly embedded within Salford’s
five-year Strategic Commissioning Plan 2009-2014. It embraces the Strategic Plan’s
overarching goals, pledges and commitments to be a Public Health led PCT
concentrating on Health and Well-being as well as treating the sick.
1.3
In the past seven years the NHS has seen unprecedented growth in service
investment and provision, which have resulted in improved services and reductions in
waiting lists for healthcare. Times are changing and more challenges are facing
healthcare organisations both as commissioners and providers of services. PCTs
will have to look for new opportunities to continue the development and improvement
of services. There will be in real terms reductions in resource allocation from 2011
onwards and this will lead by necessity to establish more robust commissioning and
performance systems in place that will demonstrate effective and efficient delivery of
service provision, whilst demonstrating value for money and continuous service
improvement.
1.4
The 5 year strategy demonstrates how NHS Salford will continue to develop as
effective and efficient commissioners of community services using a range of
commissioning tools and competencies to deliver high quality services from highly
productive and efficient providers.

1
We will continue to develop a better understanding of our current provider
landscape to enable us to ‘shape’ our future landscape. We intend to stimulate
the market for community services ensuring greater plurality of provision and
choice of services for patients. To do this we work with a range of providers
across all the sectors to ensure that all interested providers with vision and
innovation have the same opportunities to complete to deliver services.
Salford Primary Care Trust
August 2009

We will describe the services we wish to commission clearly and identify the
objectives we wish to achieve.

We will develop services with a keen eye on quality, innovation, productivity and
prevention and we will use recognised quality metrics such as Commissioning for
Quality
and
Innovation
(CQUIN)
to
reward
high
achievement.

We will take a whole pathway approach to commissioning to ensure seamless
services for our patients and carers and in so doing we will develop local prices
and explore new governance arrangements to reflect new ways of working in a
more integrated way.
In commissioning high quality community services, we will demonstrate our World Class
Commissioning competencies.
1.5
The TCS Commissioning Strategy has been stratified into seven clinical pathways,
which mirror those identified in Lord Darzi’s Review:







Health and Well-being
Children & Families
Long Term Conditions
Acute Care in the Community
Rehabilitation (including Neurological rehabilitation)
Mental Health
End of Life Care
1.6
A health market analysis has been undertaken of the current provider landscape.
This together with the Joint Strategic Needs Assessment has helped to identify the
priority areas for review and re-design and these are reflected in the accompanying
Action Plan. Patients and carers as well as Practice Based Commissioners have
been pivotal to this process.
1.7
Whilst this strategy signals our high level commissioning strategy intentions for the
future direction of travel for community services to both current and prospective
providers, we include in the strategy four showcase pathways as exemplars of our
future intentions. Each demonstrates our systematic approach to the recognised
commissioning cycle and our implementation of World Class Commissioning
competencies in effecting transformational change. The exemplar pathway redesigns which will become blueprints for our approach to commissioning other
community services are:




Stop smoking services
Improved access and quality to young people’s Sexual Health Services
Diabetes integrated care service
Expansion of intermediate Care and development of the ‘Step Up’ ‘Step Down’
pathways
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Improved Access and Quality of Young People’s Sexual Health Services
2.1
This is an example of how young people themselves were involved in the initiative
from start to finish. The views of 1400 young people were sought at the start to
shape future services, Young people were involved not only in designing the
specification but also in the evaluation and selection of the preferred provider; an
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Salford Primary Care Trust
August 2009
outcome focussed specification was developed which invited innovative Providers to
demonstrate new ways of reaching out to this client group in a more extensive way
than has been the case hitherto.
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Diabetes Integrated Care Services
3.1
The majority of patients with diabetes should be managed within primary and
community care. We will develop and evaluate a model which will have the patient at
the centre as an expert party in their own care programme. Primary care will be
supported by a specialist integrated team which could provide an in-reach service
into the hospital. We will look at different, more meaningful was of counting patient
activity and assessing outcomes via a personalised care plan. Different funding
mechanisms will be explored to disincentivise admission to hospital and we will look
at a new governance arrangement for this model of care. Subject to this model being
successfully evaluated, it is likely to become the blueprint for the management of
other long term conditions.
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Stop Smoking Service
4.1
The overarching strategic commissioning plan for all services has health and wellbeing as one of its core themes. We propose to radically re-design Stop Smoking
services by changing the emphasis from the number of quitters to a systematic
reduction in prevalence. Social marketing expertise has been used to target specific
socio-economic groups (C2DE) to maximise their engagement and achievement.
The model being pursued is a 4 tier approach focussing on smoke free environments
(0), brief interventions (1), enhancing existing primary care services (2) and specific
targeted support for individuals and groups delivered by specialist advisers. This
approach will be evaluated and is a potential blueprint for other services in
development such as alcohol and obesity.
5
Extension of Intermediate Care to Develop Step up/Step down Services
5.1
Alternative strategies to hospital admission and opportunities for early, safe
discharge are key areas which NHS Salford will pursue with vigour over the coming
years. This project has demonstrated the importance of partnership working
particularly with the local authority. New ways of working have been developed
across agencies and disciplines with a switch from generic working to multidisciplinary teams. Extensive stakeholder involvement took place (80 events and
2,000 contributors) to identify gaps and shape the new services. The new services
will be easier to access via a single entry point and rapid response teams. Care will
be available closer to where people live.
6
Conclusions
6.1
In order to ensure a level playing field for all interested Providers that may wish to
respond to these commissioning intentions as pathways are developed, we will
refresh the procurement strategy to reflect the requirements of the Transforming
Community Services Programme. One of our guiding principles is to work toward a
modern, fit for purpose estate within our community which will optimise service
delivery for staff, patients and carers. To this end a Commissioning and Asset
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Salford Primary Care Trust
August 2009
Management Strategy for Community Services will be developed to complement our
commissioning intentions.
6.2
Our strategy will be accompanied by a Procurement and contestability Policy and a
Community Estates Strategy.
6.3
This strategy signals a high level direction of travel for community services. It sets
out our aspirations and given examples of how we will approach the redesign of
pathways which will change the historic emphasis from hospital to community, in
response to what our staff, patients, carers and the public have told us. The strategy
covers a five year time frame and the Action Plan identifies the areas to be prioritised
over that time span. The detailed work of each of these pathways will be presented
to the Overview and Scrutiny Committee as they are developed. Comments and
views are welcomed from the Committee to inform the final document.
4