EALING
North West London
Cardiac & Stroke Network
Primary Care Trust
Commissioning High Quality
Stroke Services
Peter Kottlar
Joint Head of Older People Commissioning and
Lead for Stroke Services
Ealing PCT & NW London Cardiac and Stroke Network
20th March 2009
History of Commissioning in NHS
• 1991 introduction of ‘purchasing’
• Aim: separating the interest of those
receiving healthcare from those supplying
them
• 1990s: GP fund-holding move to Primary
Care Groups (PCGs)
• 2001: Primary Care Trusts (PCTs) created
What is Commissioning?
• Process of ensuring health and care
services provided most effectively meet
the needs of the population
• Roles of PCTs
– the advocate for patients; and
– the custodian of taxpayers’ money
Objectives of Commissioning
• Improve health and wellbeing and
reduce health inequalities
• Improve quality, effectiveness and
efficiency
• Increase choice and responsiveness
• Develop comprehensive services
• Achieving best value within
available resources
Seeking
patient
views
Commissioning Cycle
PATIENTS
and
PUBLIC
COMMISSIONING:
Strategic Planning Stage
NEEDS
ASSESSMENT
– Public Health data
– Other statistics/data
– identify unmet need?
REVIEW
SERVICES
– Service Mapping
– Gap analysis
– Identify service improvements
DECIDE
PRIORITIES
– Development of strategic plan
– Resources/Budgeting
– Involve users and carers
COMMISSIONING:
Service Procurement Stage
DESIGN
SERVICES
CAPACITY
PLANNING,
DEMAND
MANAGEMENT
SHAPING
STRUCTURE
OF SUPPLY
– Development of service model
– Involve service users and carers
–Development of strategies for care
and resource utilisation
– PCT develop service specification, PIs
– Support & encourage providers to develop
services
– Invite NHS/private/3rd sector providers
COMMISSIONING:
Monitoring & Evaluation Stage
MANAGING
PERFORMANCE
SEEKING
PATIENT/
PUBLIC VIEWS
–Ensure agreed targets are met
–Review patient set goals
–Develop improvement plans
–Patient outcomes & experiences
–Informs commissioning actions
Seeking
patient
views
Commissioning Cycle
PATIENTS
and
PUBLIC
World Class Commissioning
‘WCC will deliver a more strategic and
longer-term approach to commissioning
services, with a focus on improving health
outcomes’
Commissioning Assurance Handbook, 2008
World Class Commissioning
ASSURANCE
SYSTEM
VISION
WORLD CLASS
COMMISSIONIN
G
COMPETENCIES
DEVELOPMENT
FRAMEWORK
World Class Commissioning
VISION
‘Adding life to years and
years to life’
Better health and well-being for all,
better care for all,
and better value for all.
World Class Commissioning
COMPETENCIES
6
Stimulate the market
1
Locally lead the NHS
7
Promote improvement and
innovation
2
Engage with public/patients
8
Secure procurement skills
3
Collaborate with clinicians
9
Secure procurement skills
4
Manage knowledge /assess
needs
5
Prioritise investment
10
Manage the local health
system
11
Make sound financial
investments
World Class Commissioning
ASSURANCE SYSTEM
PURPOSE: to understand whether PCTs are improving as commissioners
of better health outcomes
PCT are assessed by NHS London across three elements:
OUTCOMES
Rate of improvement
COMPETENCIES
Level 1 - 4
GOVERNANCE
R
A
G
World Class Commissioning
DEVELOPMENT FRAMEWORK
BOARD DEVELOPMENT
FRAMEWORK FOR PROCURING
EXTERNAL SUPPORT FOR
COMMISSIONERS
World Class Commissioning
“The aim of world class commissioning,
and therefore the ultimate test of its success,
will be an improvement in health outcomes
and a reduction in health inequalities”
Commissioning Assurance Handbook, 2008
References
• Health Reform in England: Update on Commissioning Framework –
Department of Health, 2006
• World Class Commissioning, Department of Health, 2007
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worl
dclasscommissioning/index.htm
• Commissioning Specialised Services, Department of Health, 2007,
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Com
missioningspecialisedservices/index.htm
WORLD CLASS COMMISSIONING
COMPETENCIES
1
SKILLS
Locally lead the NHS
PROCESS AND KNOWEDGE
REQUIREMENTS
OUTPUTS
WORLD CLASS COMMISSIONING
COMPETENCIES
1
Locally lead the NHS
SKILLS (sub-components)
•Listens to partner NHS organisations and other providers
•Signals future priorities of the local NHS
•Has good presentation and influencing skills, e.g. in reputation management
•Has good organisational development skills
PROCESS AND KNOWEDGE REQUIREMENTS
•Able to articulate vision of NHS, fair personal, effective and safe
•Is skilled in engagement & involvement methods
•Understands own the strengths and weaknesses, and develops its competence
OUTPUTS
•Clear Communication policy on reports, findings, commissioning plan
•Strong interaction with other organisations
•Good understanding of reputation management
WORLD CLASS COMMISSIONING
COMPETENCIES
1
Locally lead the NHS
Level 4
Level 3
Level 2
Level 1
Does not meet
Level
2 requirements
• Key stakeholders
somewhat agree that
PCT is the local
leader of NHS
•PCT has an
understanding of its
current and intended
reputation, with
strategies in place to
address this
•Key stakeholders
agree that the PCT
is the local leader
of the NHS
•The PCT actively
participates in and
leads the local
health agenda
• The local
population
agree that the local
NHS is improving
services
• Key stakeholders
strongly agree that the
PCT is the local leader
of the NHS
• The PCT actively
participates in and
leads the local health
agenda, effectively
participating in
multi-agency and NHS
wide agendas
• The local population
strongly agree that the
local NHS is improving
services