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Right Care in action
Doncaster CCG – Commissioning for Value:
Successes, Challenges and Solutions
Dr Anna Kirkman & Martha Coulman
1 NHS | Presentation to [XXXX Company] | [Type Date]
Commissioning for Value: Successes,
Challenges and Solutions
Dr Anna Kirkman NHS Doncaster CCG
Martha Coulman NHS Doncaster CCG
• Background
• Successes and challenges
• Solutions
National context
Local context
• Reduction in running costs
(50%) taking account of
retained commissioning
• Flat cash plus impact of
capitation formula (8%
reduction in financial
• Bottom quartile for unplanned
admissions growth
Intelligence-driven approach to identify opportunities to
improve the value that our population gets for the money
invested in healthcare
Management and supporting resources focussed on the
priorities of the organisation
Consistent framework and underpinning processes to support
decision making
1. Identified variation
2. Commissioned deep dive
pack in respiratory; identified
specific elements of the
pathway where there is
3. Clinically led redesign
currently being implemented
Mental Health
1. Identified variation
2. Commissioned review of
mental health services; due to
complete November 2013
Successes and challenges
Key Successes:
Key Challenges:
Technically successful; the process
enabled a strategic focus on the clinical
areas that represented the greatest
opportunities for improvement
Debate about the “quality of strategic
priorities”; i.e. is the information “good
Positive mechanism to influence partners;
mental health is a HWBB priority
Deep dive approach supported the
development of structured delivery plans
Changing commissioning architecture of
NHS, we do not have commissioning
responsibility for critical elements of
pathways for example smoking cessation
Streamlined business processes in order
to align delivery and facilitate prompt
implementation of decisions
Improve the quality of system wide planning
Provider engagement; we rely on
our providers to translate our
plans into delivery
Co commissioners; we can’t use
our resource allocation to
commission elements of service
that are not our responsibility but
we can influence
Service user engagement; we
need to develop a local
understanding of the pressures
that the NHS is facing
We need to bring our partners along and
create energy for change in order to achieve
system transformation
1. Involving partners in planning process;
intelligence is sense checked, current
service transformation is considered,
partners plans are taken into account,
commissioning responsibilities are
understood and “elephants in the room”
are addressed at an early stage
2. Robust service user engagement; on-line
survey, social media, print media, face to
face consultation, develops a broader
understanding of the issues
3. Robust system wide plans that reflect
benchmarked intelligence and “soft”
Delivery: Turning plans into reality
Transformation teams “bought in
to the process”
Time taken from decision to
Understanding potential delays in
Managerial and clinical capacity
Engage transformation teams
from the outset
Stream line the decision making
process/ governance structure
Simplify business planning
processes; introduction of initial
viability assessments, sourcing
assessments etc.
Ensure that management and
clinical capacity is focussed on
priorities; development of delivery
plans and aligned objective
setting; (strategy, delivery plan,
team objectives, personal
System improvement
Clinical leadership, clinical engagement, provider
engagement, service user engagement, co commissioner
engagement, and effective business processes
Right Care for Populations
The NHS Right Care website offers resources
to support CCGs in adopting this approach:
• online videos and ‘how to’ guides
• casebooks with learning from previous
• tried and tested process templates to
support taking the approach forward
• advice on how to produce “deep dive”
packs locally to support later phases,
within the CCG or working with local
intelligence services
• access to a practitioner network
Find the full series at:
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